Benzodiazepines, more popularly known as “benzos” for short, are prescription medications that help treat anxiety disorders, panic disorders, insomnia, seizures, and severe alcohol withdrawal.
At therapeutic levels, benzodiazepines are effective, but when they are misused and abused, the effects can be deadly. Even though these medications are in the same classification, the duration of their effects is not the same. The three categories that describe how long their effects last are ultra-short acting, short-acting, and long-acting.
These medications are designed to be used during the short-term because they are highly addictive and ending dependence on them is difficult for many people. It is even possible to develop an addiction to a benzodiazepine without realizing it. People who are prescribed these medications are at risk of developing a physical or psychological dependence on it as well as those who use the drugs illicitly.
If there are noticeable changes in the way one feels, thinks, or behaves as a result of stopping or reducing benzodiazepine use, withdrawal likely has set in. This period is characterized by a number of symptoms that are uncomfortable or painful. People who have substance use disorder are at higher risk of developing an addiction to benzodiazepines and should tell their doctor before they start to take these medications.
How Benzodiazepines Affect the Brain
Benzodiazepines work by attaching themselves to the brain’s Gamma-aminobutyric acid (GABA) receptors, which are responsible for inducing calm or relaxed feelings. They also act as anti-anxiety, anticonvulsant, and muscle relaxer medications. These effects are appealing to some users so they abuse the medications to achieve them. Addiction to benzodiazepines include:
- Taking benzodiazepines without a prescription
- Using them to get high
- Using them in stronger doses or higher doses than prescribed
- Using them in ways that they were not designed to be used
- Mixing them with other substances, such as alcohol and opioids, for stronger effects
- Crushing up the medications or dissolving them so they can inject into the body
When benzodiazepines begin to work on the individual, they actually alter the brain chemistry. The neurotransmitter, or brain chemical, GABA, has its actions enhanced. GABA is primarily responsible for slowing an individual down or calming them down. With the presence of benzodiazepines in the system, the individual has a flood of GABA to the brain.
Over time with continued use/abuse, the brain begins to produce less GABA naturally. Relying on the assistance from the benzodiazepine to make up for the lack of GABA, the brain’s natural balance begins to shift and change. This causes the individual to become physically dependent on the benzodiazepine and develop a benzodiazepine addiction. Without taking the medication, the internal homeostasis of the brain is thrown completely off.
Once the initial dependence is formed, next comes the tolerance to the drug. Tolerance refers to the natural action of the body building up a resistance, or tolerance, to the drug and therefore requiring more for the same interaction and experience from the medication. Eventually, the individual will require heavy doses of the benzodiazepine in question, and be in full blown benzodiazepine addiction.
Because the actual brain chemistry is changed as a result of benzodiazepine addiction, the benzodiazepine withdrawal symptoms can be very intense, even life threatening. The brain must acclimate to operating without the presence of the drug, which can result in a shock to the system when benzodiazepine withdrawal sets in. This is a challenging and physically dangerous time for anyone with a benzodiazepine addiction, and the onset of withdrawals can be uncomfortable.
Common Benzodiazepines
Below is a list of some of the more common benzodiazepines that people may encounter. While all of them are equally addictive and potentially detrimental to the lives of those who fall into a benzodiazepine addiction, it’s important to be able to understand and identify the different medications that fall into this category of drug.
What You Can Expect from Benzodiazepine Withdrawal
Benzodiazepine withdrawal is a nasty experience that impacts an individual with an addiction to the medication to experience a variety of physical and mental symptoms. These benzodiazepine withdrawal symptoms can range from mild in severity to severe, resulting in excruciating and unbearable symptoms.
Worse still, benzodiazepine withdrawal is one of the only withdrawal processes that can prove to be fatal to the individual experiencing the benzodiazepine withdrawal symptoms. This is what makes the overall process precarious to say the least, and these symptoms can persist for up to weeks on end.
Some of the benzodiazepine withdrawal symptoms you may encounter are:
- Tremors
- Depression
- Suicidal Ideations
- Insomnia
- Anxiety
- Dysphoria
- Loss of appetite
- Muscle twitching
- Memory problems
- Motor impairment
- Nausea
- Vomiting
- Muscle pain
- Dizziness
- Lightheadedness
- Headaches
- Hallucinations
- Sensitivity to sound, light, and touch
- Numbness
- Restless Leg Syndrome
- Seizures
Benzodiazepine Withdrawal Timeline
There are a number of factors that impact the timeline associated with benzodiazepine withdrawal. Depending on the type of benzodiazepine used, length of time used, and the amount used, the benzodiazepine withdrawal symptoms may last longer. An individual who used more for a longer period of time will have a longer, more intense withdrawal process than an individual who only used a small amount for a short amount of time.
However, overall, the general benzodiazepine withdrawal timeline looks something like this:
6-12 Hours
Approximately 6 to 12 hours following the final dose, an individual struggling with benzodiazepine addiction may begin to feel the onset of withdrawal symptoms. These symptoms will usually be minor at the beginning, with the user feeling some anxiety, depression, restlessness, and some muscle pains.
Days 1-4
The benzodiazepine withdrawal symptoms will begin to fully manifest and more intense physical withdrawal symptoms may begin. Sweating, nausea, muscle pains, and other of the aforementioned symptoms will begin to show and the individual may be at increased risk for more dangerous withdrawal symptoms like seizures or suicidal ideations.
1-2 Weeks
Benzodiazepine have a notoriously long withdrawal process that typically peaks within 1 to 2 weeks following the final dose. The symptoms will continue to increase in frequency and severity. By week 2, the symptoms will have peaked completely and will begin to slowly fade and subside.
3 Weeks
The worst part about benzodiazepine withdrawals is that the lingering benzodiazepine withdrawal symptoms can last up to several months years following the final dose! The severity and frequency of occurrence may be minor, but some addicts have experienced persistent symptoms for up to two years!
Benzodiazepine withdrawal is a long process with several uncomfortable and potentially dangerous symptoms. Benzodiazepine withdrawals require medical intervention and should be addressed in a medical detox facility designed to successfully and safely detox patients off of benzos. This will not only increase the likelihood of long-lasting recovery from benzos, but also help circumvent any potentially risky withdrawal symptoms such as seizures.
What are the Benzodiazepine Withdrawal Treatment Steps?
As stated above, if you’re struggling with a benzodiazepine addiction, it’s best to seek professional help for your withdrawal symptoms. Benzos are a difficult habit to break thanks to the length and intensity of the withdrawal process. By undergoing professional addiction treatment and experiencing the full continuum of care (every level of addiction treatment from start to finish), you can receive the medical and clinical support you’ll need to break the cycle of addiction for good!
Detox
The first step in benzodiazepine addiction treatment is medical detox. Upon admission to a medical detox facility, you’ll undergo a medical assessment. The assessment will take into account the severity of your addiction and your overall physical health and any underlying health issues that may be exacerbated during the stress of benzodiazepine withdrawal.
During the detox stage, you’ll receive 24/7 medical supervision by a fully staffed medical and clinical team. An individualized detox plan will be formulated to fit your specific needs and you’ll be prescribed medication designed to ease the withdrawal process and have your progress monitored around the clock.
In addition to the full medical support, you’ll also have access to clinical support. The clinical team specializes in treating the mental health aspect of addiction, as all withdrawal symptoms are not physical. You’ll have access to therapists, case managers, and support staff who will be there to provide emotional support and guidance during the difficult transition from active benzodiazepine addiction to sobriety.
Although the primary purpose of detox is to provide medical stabilization, there will be some therapeutic measures in practice as well. Some introductory addiction education therapy groups and other therapeutic sessions will be provided so that you may begin to start working through the underlying causes of addiction as well as any other mental health issues you may be struggling with.
Inpatient
After completing a successful detox, it’s important to carry on with the next step in the full continuum of care, which is inpatient treatment. After the benzodiazepine withdrawal is over, it’s time to focus more completely on the therapeutic portion of addiction treatment.
Since addiction is a chronic mental health disorder, it’s important to get to the core reasons of your benzodiazepine addiction and work through all emotional issues you may be struggling with. These are the issues that may pop up later on down the road, and by working them out in a strong, structured therapeutic environment, you’ll safeguard yourself against relapse.
At an inpatient facility, you’ll live onsite at the center. There are different amenities that vary from facility to facility, and it’s important to take these into consideration whenever decided which facility is right for you. There are also differences in therapies and treatment techniques offered, so these must also be included in your decision making process.
Throughout your time living at the facility, you’ll undertake full time therapy on a structured schedule designed to help keep the focus on recovery and internal growth.
You’ll not only receive vital clinical support, but also educational courses and learn how to use different coping skills and life skills.
This is an extremely important and beneficial portion of the full continuum of care, and gives you time away to focus on working through your benzodiazepine addiction in a safe environment.
Intensive Outpatient
The next stage in the full continuum of care is the intensive outpatient stage, or IOP. In this portion of the treatment process, you’ll no longer be under 24/7 care and instead attend therapy sessions on a part time basis, living in alternative housing. Many recovering people choose to live in sober living facilities or halfway houses during this time to help still surround themselves with a recovery-oriented environment.
The point is that by this stage of your addiction treatment, you’ll be solid enough in your foundation of recovery to handle some more personal freedoms and responsibilities without succumbing to relapse.
During your participation in this aspect of treatment, you’ll still have access to intensive therapy sessions and clinical support, as well as be subjected to drug testing in order to keep you accountable to your program and recovery. This helps slowly acclimate you back into the community at large without overwhelming you with too many personal freedoms and limited therapeutic support.
Outpatient
The last part of the full continuum of care is the outpatient stage. Much like IOP, outpatient requires patients to seek alternative housing and provides only part time clinical hours, but on an even less frequent basis than IOP. In fact, most outpatient programs allow call for about one hour per week of therapy!
The idea is to just provide limited clinical support and intervention at this stage. It is hoped that you can remain more self-sufficient and dependable in your recovery and only need minor support and therapeutic assistance. You’ll still be required to submit drug tests, so the outpatient stage is effective in helping keep recovering addicts on track and accountable, even with limited clinical hours.
