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Signs of Benzodiazepine Misuse and Addiction

Benzodiazepines (sometimes referred to as “benzos”) are a class of prescription medications that fall under the larger category of central nervous system (CNS) depressants.5 Benzos are prescribed to treat specific anxiety disorders, seizure disorders, and sleep disorders.1 Commonly prescribed benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (Librium®), diazepam (Valium®), lorazepam (Ativan®), clonazepam (Klonopin®), and triazolam (Halicon®).4, 5

The U.S. Drug Enforcement Administration classifies benzodiazepines as a Schedule IV substance as they are medications with a known potential for misuse and dependence.6 Because of the potential for misuse and the risk of developing tolerance, dependence, or a benzodiazepine use disorder, these drugs are generally prescribed for short-term rather than long-term use.7

Results from the 2020 National Survey on Drug Use and Health showed that approximately 4.8 million people aged 12 and older misused benzodiazepines in the past year.10 This may include taking a higher dose than prescribed, taking another person’s medication, or taking benzos to get high.11

Using benzodiazepines for a prolonged period, an individual may become dependent on benzodiazepines meaning that if they cut back or stop using them altogether, they can go into serious withdrawals.1 Benzodiazepine misuse can be dangerous. Given the potential for misuse, it is important to know the signs of benzodiazepine abuse and addiction and the available treatment options if you or someone you care about are struggling.

Identifying Benzodiazepine Addiction

If you or a loved one is misusing benzodiazepines, it may be helpful to speak with a medical professional. In clinical settings, a medical professional can evaluate your history and assess signs and behaviors to determine the presence of benzodiazepine misuse. Medical professionals can also discuss what treatment options may be best based on various factors, including your age, patterns and history of substance use, and whether you have other medical or mental health conditions. Benzodiazepine misuse can potentially lead to benzodiazepine addiction, also known as a substance use disorder.

Addiction refers to the compulsive, uncontrollable use of a substance despite the harm that it causes. Addiction may entail not only physiological changes (such as tolerance and dependence) but several harmful behavioral changes adversely impacting every aspect of an individual’s life. Addiction development is accompanied by functional changes within the brain that can impact an individual’s drive, motivation, thought processes, and behaviors so much that drug use becomes prioritized over all else. The development of addiction is influenced not only by repeated substance use itself, but also by genetic, psychosocial, and environmental factors. Benzodiazepine addiction symptoms and signs of benzo addiction may vary by individual, but they may be various and visible.

The following 11 criteria are outlined in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and are used to diagnose a benzodiazepine use disorder:12

  • Benzodiazepines are taken in larger quantities or over a longer period than intended.
  • There have been unsuccessful efforts to reduce or quit using benzodiazepines.
  • A lot of time is spent obtaining, using, or recovering from benzodiazepines.
  • Experiencing cravings or strong desire to use benzodiazepines.
  • Benzodiazepine use results in failure to fulfill major role obligations, such as responsibilities at work, school, or home.
  • There is recurrent use of benzodiazepines despite experiencing social or interpersonal problems caused or made worse by taking benzodiazepines.
  • Important social, work-related, and recreational activities are given up or reduced because of benzodiazepine use.
  • Benzodiazepines are used in physically hazardous situations, such as operating a vehicle or other heavy machinery.
  • There is continued use of benzodiazepines despite psychological and/or physical health problems that may have been caused or made worse by benzodiazepine use.
  • There are signs that tolerance, or the need for more to achieve the desired effect or a diminished effect at previous doses, has developed.
  • Withdrawal symptoms occur when benzodiazepine use is discontinued, or another similar substance is used to avoid experiencing those withdrawal symptoms.

Signs of Benzo Misuse to Look for

It is not always easy to tell when someone is misusing or addicted to benzos. Some people try to hide their misuse, some are in denial, and everyone is different. It can be difficult to recognize the diagnostic criteria. However, there are other warning signs of benzo misuse. There can be changes in the way someone acts, in their behavior. You may also notice that an individual may be experiencing withdrawal symptoms, which may help you identify benzo misuse. Signs of misuse may range from subtle to obvious. Though it may be difficult, individuals want to be able to recognize these signs so you can get someone help before problems arise

Some potential signs of benzo abuse to look for in your loved one may include:

  • Doctor shopping
  • Lying or covering up use
  • Mood swings
  • Social withdrawal
  • Asking friends or loved ones for their prescription medication
  • Risk-taking behaviors
  • Combining benzos with other drugs

Withdrawal and Overdose

Additional signs of benzo misuse and addiction may include withdrawal symptoms or overdose. Dependence is a physiological adaptation of the body to a substance, wherein the body becomes so used to the drug being present in the system that when the individual cuts back on their use or quits, withdrawal symptoms emerge. With significant levels of physiological dependence, a person may continue to compulsively drink or use drugs to avoid unwanted withdrawal symptoms.

Withdrawal symptoms can vary in intensity based on the dosage and duration of benzodiazepine use.1 Benzodiazepine withdrawal symptoms may include:8

  • Headache
  • Palpitations
  • Sweating
  • Muscle aches
  • Confusion
  • Dizziness
  • Paranoia
  • Irritability
  • Depressed mood
  • Seizures

Because life-threatening complications (e.g., seizures) can occur, discontinuing benzodiazepines should be done under the supervision of a medical provider who can help gradually lower the dose and monitor withdrawal symptoms.8, 9

When someone misuses benzodiazepines, they may be at an increased risk for overdose. This risk of fatal overdose increases significantly when benzos are mixed with other medications, such as opioids or other CNS depressants.13 Many people who take benzodiazepines may also use other substances such as alcohol and opioids. In 2019–2020, there were increases in both fatal and nonfatal overdoses involving benzodiazepine and opioids.13

Given the potential for overdose, it is important to be able to identify signs of benzodiazepine overdose, which may include:4,14

  • Extreme drowsiness
  • Confusion
  • Impaired coordination
  • Decreased reflexes
  • Respiratory depression
  • Coma
  • Possible death

What to Do If Someone Is Showing Signs of Benzodiazepine Misuse or Addiction

If you or someone you care about may be struggling with benzodiazepine misuse, there are different steps you can take. Some things you may consider doing include:15, 16

  • Learning more about addiction. This may include gathering information from reputable resources and/or talking with a physician or other medical professionals who specialize in addiction.
  • Having an honest conversation with them. It is important to show compassion and offer support.
  • Encouraging them to speak with their doctor. This does not mean they have to commit to treatment, but it may help them learn more about benzodiazepine misuse and addiction and what treatment options are available to them.
  • Suggesting they attend a peer support group. It can be helpful to talk with others who are also experiencing addiction.

The good news is that addiction is treatable and can be successfully managed.15 Treatment can help people feel more in control of their lives by changing their attitudes and behaviors toward benzodiazepine use and by identifying triggers to prevent relapse.

How to Get Help

Because discontinuing benzodiazepines can be dangerous, a person may benefit from medical detox, which can help them more comfortably and safely withdraw from substances and facilitate the transition into ongoing addiction treatment.9 Following detox, ongoing addiction treatment (e.g., inpatient or outpatient rehab) can help a person identify and modify damaging behavioral patterns.17 For people who are struggling with other substances (e.g., alcohol, opioids) and/or a mental health disorder (e.g., anxiety), co-occurring treatment can lead to better outcomes and higher quality of care.18

It may feel overwhelming searching for benzodiazepine addiction treatment. The good news is you don’t have to do it alone. If you are interested in finding help for benzodiazepine misuse, you can use the Substance Abuse and Mental Health Services Administration’s locator tool. You can also contact American Addiction Centers (AAC) by calling . AAC is a leading addiction treatment provider and offers resources to assist you or a loved one in getting help. Our admissions navigators are available 24/7 to help you learn about treatment options, verify your insurance, and more.