Benzodiazepine Addiction Treatment and Rehab Options
Benzodiazepines such as Valium and Xanax are some of the most commonly prescribed drugs in the United States and are widely used to treat anxiety, seizures, and panic attacks. Even when used as prescribed, this type of drug can be highly addictive. Long-term benzodiazepine use can lead to significant physical dependence requiring professional addiction treatment.
Many who use benzodiazepines (either with a legitimate prescription or recreationally) mix the drugs with alcohol or other substances, increasing the risk of health complications or fatal overdose. Severe withdrawal symptoms can accompany benzodiazepine detox, so regular users who wish to quit should seek the supervision of a qualified treatment facility.
What Are Benzodiazepines?
Benzodiazepines (also called “benzos” for short) are prescription drugs that slow down activity in the central nervous system
to produce sensations of relaxation, sedation, and relief from anxiety. The 5 most commonly prescribed benzos are:1
- Alprazolam (brand name Xanax)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Temazepam (Restoril)
The different benzodiazepines have many specific medical uses. In a clinical setting, benzodiazepines are used as a sedative/anesthetic prior to surgery or other medical procedures. Others are more commonly prescribed to treat general anxiety, panic attacks, seizures, and muscle spasms. Certain benzos have proven indispensable in managing the acute alcohol withdrawal syndrome frequently encountered during the detox phase of recovery. 1
Benzodiazepine use is widespread in the U.S.
Many benzodiazepines are used in pill or tablet form, but are sometimes given intravenously prior to surgery or in cases such as acute seizures, where oral dosing would not be possible.1 Some begin to work rapidly but are short lasting. Others take longer to produce effects, but last longer.
Rapid onset drugs are used recreationally by people seeking their euphoric effects. People can obtain benzos either by seeing multiple doctors to obtain prescriptions, forging prescriptions, or buying them illegally.1
Benzodiazepine use is widespread in the U.S. Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67%.2 In 2011, there were almost 50 million prescriptions for alprazolam dispensed, more than 27 million for lorazepam, almost 27 million for clonazepam, and 15 million for diazepam.1
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Side Effects of Benzodiazepine
Side effects of benzodiazepine use vary depending on the person, specific drug, dosage amount, and length of time the drug was taken.
Short-term side effects of moderate benzodiazepine use can include:3
- Poor coordination.
- Drowsiness and fatigue.
- Slurred speech.
- Confusion and difficulty thinking.
- Nausea, vomiting, and diarrhea.
- Dry mouth.
- Slowed or difficult breathing.
In higher doses, such as in recreational use, side effects can include:3
- Extreme drowsiness and slow reflexes.
- Mood swings
- Erratic behavior.
Benzodiazepines can build up in the body with regular use over time, leading to long-term side effects that may include:3
- Severe disorientation.
- Muscle weakness and lack of coordination.
- Markedly impaired judgment.
- Chronic memory deficits.
- Significantly slowed/altered speech patterns (dysarthria).
Studies suggest that long-term users show signs of cognitive impairment and can’t think as clearly or as well as they used to. This decline can affect the person’s ability to succeed at work or school, and sometimes does not improve until months after benzo use has stopped.4 One recent medical study found an association between long-term benzodiazepine use and Alzheimer’s disease, concluding that unnecessary use of the drugs should be considered a public health concern.5
In 2015, there were nearly 9,000 overdose deaths involving benzodiazepines, more than 4 times as many as in 2002.6 Although most of these deaths were attributed to a combination of benzos and other substances (particularly opioids), the possibility of overdosing on benzos alone remains a very real threat.
Signs of benzodiazepine overdose include:7
- Nausea and vomiting.
- Muscle weakness or pain.
- Complete loss of coordination.
- Extreme drowsiness.
- Severely altered mental status.
- Altered level of consciousness, or full loss of consciousness.
- Difficulty breathing, or breathing stopped completely.
- Pale skin and bluish lips and fingernails.
If you recognize any of these symptoms of overdose in yourself or someone else, call 911 immediately.
The only effective way to reduce your risk of overdose is to take benzodiazepines only as prescribed by a doctor you trust. If you have prescriptions for both a benzodiazepine sedative and an opioid pain reliever, make sure you talk to your doctor about the risks associated with taking both medications. Your doctor may adjust your dosage of one or both medications to reduce the risk of dangerous complications.
It’s important to make sure the people in your life know which drugs you take so that they can tell paramedics or hospital staff in the event of an emergency. A drug called flumazenil (brand name Romazicon) may be used to reverse the effects of a benzodiazepine overdose, though it may trigger severe withdrawal symptoms in patients who are benzo-dependent.8
A Deadly Combination
The risk of fatal overdose increases significantly when benzodiazepines are mixed with other substances, especially alcohol, opioids, or other sedatives. In 2015, the number of overdoses resulting from a combination of opioids and benzodiazepines was nearly 6 times higher than the number of overdoses from benzos alone.6
The rate of benzodiazepine use and overdose is intertwined with the rise of opioid abuse and addiction, as these drugs are frequently used in combination with each other. In fact, 30% of opioid overdose deaths in 2010 involved some type of benzodiazepine.9
Mixing benzodiazepines and opioids increases the intensity of the high the person experiences. Similarly, mixing benzodiazepines and alcohol increases the sedative effect of each, promoting a more intense state of relaxation. People on methadone maintenance programs have been known abuse benzos because they find it creates a sense of euphoria that methadone alone does not produce.10
Respiratory depression is the primary cause of death in opioid overdoses, meaning that the person’s breathing slows or stops completely due to the sedative properties of the drug. When opioids are used with benzos, the combined sedative effect of the two drugs is even more likely to stop the person’s breathing and is therefore especially deadly.11
Dependence and Addiction
Medical researchers widely recognize the risk for benzodiazepine use to develop into substance dependence and addiction. People who take the drugs regularly for 6 months or longer are likely to develop tolerance, meaning they must take increasingly larger doses to feel the desired effect of the drug.3 Seeking larger doses and larger quantities of the drug may drive people to visit multiple doctors for prescriptions, or purchase benzos from the illicit street market.
The uncomfortable nature of benzodiazepine withdrawal makes it extremely difficult for people to quit using the drugs on their own.
Benzodiazepine users can also become dependent, meaning the body needs the drugs in order to function normally. Dependence is marked by the experience of withdrawal symptoms when the person stops taking the drugs—which for benzo users can happen in as little as one month after the first dose.4
The particularly protracted and uncomfortable nature of benzodiazepine withdrawal makes it extremely difficult for people to quit using the drugs on their own. Intense cravings and a desire to avoid withdrawal can lead people to compulsive, drug-seeking behaviors and a continued drive to use the drugs despite negative consequences—key indicators of an addiction requiring professional diagnosis and treatment.12
Withdrawal of Benzodiazepines
Benzodiazepine withdrawal can be extremely uncomfortable and may even lead to fatal seizures when not managed properly. Clinicians advise against attempting to detox on your own. A professional detox and rehabilitation facility can help manage symptoms and ensure your safety during the detox process.
Benzodiazepine withdrawal symptoms can vary from person to person, and the severity of symptoms depends on the specific drug and amount of time it was abused. Older adults are at an increased risk of withdrawal complications and risk for falls, heart attack, and delirium.13
Withdrawal symptoms can include:14,15
- Muscle tension and aches.
- Nausea and vomiting.
- Agitation and irritability.
- Anxiety and panic attacks.
- Poor concentration and memory.
- Delusions and paranoia.
- Confusion and delirium (particularly in older people).
Benzodiazepine withdrawal closely resembles alcohol withdrawal, including seizures and delirium. Grand mal seizures are a serious possible complication that can be life threatening. People who have been abusing benzos for more than a few months should never try to quit without the help of medical professionals because seizures can occur without warning even when no other withdrawal symptoms are present.13
The withdrawal timeframe will depend on the benzodiazepine type, dosage, and length of use. For short-acting benzos like alprazolam (Xanax), withdrawal usually begins 1–2 days after the last dose and lasts for 2–4 weeks.15 With longer-acting benzos like diazepam (Valium), withdrawal typically begins 2–7 days after the last dose and lasts for 2–8 weeks or longer.15
Symptoms may fluctuate in severity throughout the withdrawal period, but feeling better doesn’t mean the risk of complications has passed. Grand mal seizures are possible anytime between 1 and 12 days after the last dose.14
Detox is a difficult process regardless of the substance of abuse, but many people struggling with benzodiazepine addiction were initially prescribed the drug to manage an anxiety disorder or other mental health problem, which makes detox an especially challenging time.
As a patient detoxes from benzos, it is likely that symptoms of any prior mental health conditions will return, in addition to any panic attacks, hallucinations, or physical discomfort that accompany withdrawal syndrome. This makes it especially important to complete detox in a safe, professional treatment setting.
Substance abuse treatment professionals recommend a slow taper as the best method for beating benzodiazepine addiction.13 Tapering a drug means taking increasingly smaller doses over several weeks or months before stopping completely.
Tapering off benzodiazepines is the best way to manage uncomfortable withdrawal symptoms and dangerous complications. You can work with your doctor to determine the best tapering schedule for you depending on the type of benzodiazepine you’ve been taking and your usual dose.15 Medical supervision is an important component of the taper process, as doctors and clinicians will monitor your reaction to the decreasing dosages and adjust your taper schedule accordingly to best suit your body’s needs.15
If you are addicted to another substance like opioids or alcohol in addition to benzodiazepines, rehab specialists may help you taper off benzos while medically supporting your detox from other substances. This could mean, for example, taking methadone or Suboxone to treat opioid addiction while tapering off benzos.
Therapy is an essential component of addiction treatment, so detox from any substance should be accompanied by a comprehensive treatment plan.
Addiction treatment involves professional therapy and counseling for both physical and mental health. There are many different therapeutic approaches, and no single treatment program works best for everyone. The three basic components of addiction treatment are:
- Detox and medical stabilization.
- Substance abuse rehabilitation.
- Aftercare and relapse prevention.
Detox is seldom a sufficient intervention on its own to achieve lasting recovery; it is only the first step in the treatment process. At the start of recovery, each person will have differing treatment needs and, in many cases, varying degrees of risk for experiencing complicated withdrawal. As such, there are several distinct detox settings available to accommodate these situations, including hospitals, residential/inpatient, and outpatient programs.
Detox is seldom a sufficient intervention on its own to achieve lasting recovery; it is only the first step in the treatment process.
After successful completion of detox, people are encouraged to continue with their rehabilitation efforts. As part of this second component of addiction treatment, addiction counselors use a variety of therapeutic approaches. The most common is cognitive behavioral therapy (CBT), which focuses on identifying negative thought patterns and triggers that led to the patient’s drug abuse. Other methods include contingency management, motivational interviewing, and group therapy with a 12-step or other recovery-based support group.
As the rehabilitation stage nears completion, aftercare planning will begin. After discharge from rehab, patients will follow their individualized aftercare plans, which can include 12-step meetings, continued individual counseling, and group therapy. A strong aftercare plan strengthens the patient’s relapse prevention efforts and bolsters their chance for successful recovery.
Treatment Settings and Program Characteristics
Though the treatment details and design of rehab programs will vary considerably, there are several general treatment settings commonly utilized by those seeking to recover from benzodiazepine addiction. These include:
- A hospital: High-risk patients should detox in a fully functional hospital environment where they can be constantly monitored for medical complications. People with pre-existing conditions or a history of withdrawal complications might be safest in the ICU.
- Inpatient detox center: These are dedicated detox and withdrawal facilities that have extensive experience with addiction treatment. Patients live at the facilities during the duration of their treatment and are monitored by medical professionals. These programs typically run medically supervised detox protocols.
- Inpatient addiction treatment: These are comprehensive programs that last longer than detox, usually 30–90 days. They involve medical support and intensive therapy, but many incorporate a structured and supervised detox period at the start of the longer rehabilitation program. As treatment progresses beyond the detox stage, these programs offer individual counseling, group therapy, support groups, and family therapy.
- Outpatient detox program: These are dedicated addiction treatment programs that offer more flexible treatment schedules than inpatient programs. Depending on your needs, you might go in daily or weekly for treatment support. These programs can help monitor your health while you taper off benzos and provide methadone maintenance for opioid addiction.
- Intensive outpatient programs (IOPs): These are comprehensive addiction treatment programs that resemble inpatient programs, but they allow you to go home at night. Patients attend for a specified number of hours per day or week to participate in therapy and addiction treatment. They offer individual counseling, group therapy, support groups, and family therapy.
- Doctor’s office: If your doctor has low clinical suspicion for your chances of experiencing a complicated withdrawal, a tapering schedule may be prescribed and your progress monitored through regularly scheduled check-ins at the doctor’s office. Any ongoing outpatient addiction therapy or counseling might take place in an office setting for those who require less intensive services.
Each type of program has its own strengths and weaknesses. Your choice will ultimately depend on several factors, including personal preference and ability to take time away from work, school, or obligations at home.
Other factors you may want to consider when choosing a rehab and recovery facility include:
- Location: Are you looking for a rehab facility nearby or do you want to be farther away from home? Some people want to stay near a supportive home environment while tackling addiction recovery, while others seek to remove themselves from the day-to-day stressors that contributed to their addictive behaviors.
- Patient population: Do you want to be in a program with only women, men, veterans, LGBTQ+ people, or teens? There are numerous addiction programs that serve these special populations.
- Amenities: Some luxury rehab programs offer upscale amenities like private hotel-style rooms, swimming pools, saunas, yoga, and massage. Other treatment centers may have a focus on outdoor activities or artistic expression as part of the therapy provided.
- Insurance: Does your insurance cover addiction treatment? Many insurance providers will cover the cost up to a certain amount but have restrictions based on the individual plan.
- Cost and payment: Addiction treatment can be expensive. Consider what you are willing and able to pay, how much your health insurance will cover, and, if needed, research programs that offer payment plans or other flexible options.
Recovering from Addiction
Staying sober is just as difficult as getting sober. Those triggers that caused you to use drugs in the first place may come back when you return home. That is why it is important to have a plan for how to deal with triggers and the stresses of daily life.
Many people find that a weekly or biweekly meeting with a counselor or therapist in private practice is enough to prevent relapse. Others prefer to keep in touch with a sober community through support groups like Narcotics Anonymous (NA) and Alcoholics Anonymous (AA). These meetings are a good long-term strategy because they are free and convenient. There are even online and phone meetings that you can access whenever you have the time.
Recovery is a life-long process. The risk of relapse is high in the weeks and months following rehab, so it helps to have a strong aftercare plan in place. An aftercare plan is something you can work on with your counselors during addiction treatment and maintain through a lifetime of sobriety.
- Drug Enforcement Administration. (2013). Benzodiazepines.
- Bachhuber M., Hennessy S., Cunningham C., et al. (2016). Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013. American Journal of Public Health. 106(4):686–688.
- University of Maryland Center for Substance Abuse Research. (2013). Benzodiazepines.
- Johnson B., Streltzer, J. (2013). Risks Associated with Long-Term Benzodiazepine Use. American Family Physician. 88(4):225–226.
- de Gage S., Moride Y., Ducruet T., et al. (2014). Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 349:g5205.
- National Institute on Drug Abuse. (2017). Overdose Death Rates.
- U.S. National Library of Medicine. (2015). Diazepam overdose.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment: Treatment Improvement Protocol (TIP) Series, No. 45, 66-75.
- Jones C., Mack K., Paulozzi L. (2013). Pharmaceutical overdose deaths, United States, 2010. JAMA. 309(7):657–659.
- Jones J., Mogali S., Comer S. (2012). Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug and Alcohol Dependence. 125(1), 8–18.
- Gudin J., Mogali S., Jones J., & Comer S. (2013). Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. Postgraduate Medicine. 125(4): 115–130.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. Arlington, VA: American Psychiatric Publishing.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment: Treatment Improvement Protocol (TIP) Series, No. 45, 66-75..
- Brett J., Murnion B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber. 38(5):152–155.
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization: Geneva.