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Overview of Benzodiazepines
Benzodiazepines are some of the most consumed drugs in the United States. Their consumption spiked in the last decade with their prescriptions rose by 67% between 1996 and 2013. In 2008 alone, approximately 75 million benzodiazepines prescriptions were written in the United States. Such a huge uptake has brought with it serious repercussions including thousands of addiction and overdose deaths.
The drugs have played a huge part in accelerating the United States’ substance abuse crisis . From 1998 to 2008, benzodiazepines abuse treatment programs nearly tripled. Close to 2.3% to 18% of Americans have abused these drugs in their lifetime.
A key part of tackling benzodiazepines abuse is understanding them properly. What are they and what is their medicinal benefit? Why are they so addictive? Is there hope for an individual with a Benzodiazepines abuse condition? This article outlines the facts you have to know.
What are Benzodiazepines?
Benzodiazepines are a class of drugs commonly identified as central nervous system depressants. These drugs, also known as tranquilizers, induce enhanced activity at receptors for Gamma-Aminobutyric Acid (GABA) neurotransmitter. GABA inhibits the activity of neurons, causing the brain and nervous system to slow down. The nerves in the brain become less sensitive to stimulation, leading to a calming effect.
The calming effect that benzodiazepines induce causes them to be effective for a wide variety of medical conditions. This includes in the treatment for anxiety and panic, seizures, as well as insomnia. They are also helpful with alcohol withdrawal and drug-caused agitation, depression, panic attacks, muscle relaxation, and sedation prior to surgery or other diagnostic undertakings.
Benzos For Anxiety & Depression
The most common benzodiazepines today include Xanax and Valium. Valium is one of the earliest benzodiazepines introduced in the early 1960s. At the time, medical specialists relied on drugs like barbiturates, meprobamate, and glutethimide to treat anxiety and insomnia. Benzodiazepines were safer and highly effective as compared to the older drugs. This spiked their uptake.
During the mid-1980s newer alternatives for the treatment of anxiety and insomnia entered the market. They had a sedating effect just like the one produced by benzodiazepines. However, those alternatives failed to replace benzodiazepines, whose popularity had already soared. So immense was their popularity that they became identified as one of the most prescribed medications.
Currently, more than 2,000 benzodiazepines have been produced. However, only a little more than a dozen are FDA-approved for medicinal use in the United States. They are mainly classified in terms of the period that their effects last for. The predominant classifications include:
- Ultra-short acting. Such as Midalozam (Versed) and Triazolam (Halcion). They normally have ultra-fast to fast acting potential after uptake. Some are active within 30-60 minutes after one has taken them.
- Short-acting. Such as Alprazolam (Xanax) and Lorazepam (Ativan). They have an intermediate to short-acting potential. Some take 3-8 hours while others may take 11-20 hours to start producing the desired effects.
- Long-acting – such as Chlordiazepoxide (Librium ) and Diazepam (Valium). They take more than a day to start being manifested in an individual’s system. Some can take up to three days to produce the desired effects in the body.
Common Side Effects of Benzodiazepines
Although benzodiazepines have a superb tranquilizing potential, they also tend to induce several side effects. The side effects differ widely depending on the benzodiazepine consumed, dosage, and the individual. When taken in low to moderate doses, these drugs cause the following side effects:
- Impaired motor functioning
- Vertigo
- Respiratory depression
- Drowsiness, lethargy, and fatigue
- Confusion
- Slurred speech and or stuttering
- Depression
- Impaired thinking and memory
- Tremors
- Altered vision
- Nausea, constipation, abdominal discomfort, dry mouth, vomiting, loss of appetite, and diarrhea
When taken in high dosages, benzodiazepines cause the following side effects:
- Mood swings
- Slowed reflexes
- Euphoria
- Hostile plus erratic behavior
Some benzodiazepines take a very long time to leave the body. As such, their ingestion in multiple dosages over a prolonged period can cause their accumulation inside body fat. This causes long-term effects which are also known as results of over-sedation. The symptoms might take several days to appear after over-sedation. The most common long-term effects include:
- Extreme drowsiness
- Disorientation
- Impaired thinking, judgment, and memory lapses
- Slurred speech
- Confusion
- Weak muscles and impaired coordination
Common Precautions for Benzodiazepine Use
There are certain conditions under which benzodiazepines consumption is prohibited.
This includes the following:
- Respiratory Disorders - Benzodiazepines may impair breathing causing fatal effects for individuals with respiratory conditions. This can include people with bronchitis, chronic obstructive pulmonary disorder (COPD), myasthenia gravis and sleep apnea.
- Pregnancy - Benzodiazepines form part of category D drugs which implies that they can induce harm to an unborn baby. They are contraindicated mostly during pregnancy.
- Breastfeeding - Benzodiazepines normally infiltrate breast milk implying that they can be ingested by the breastfeeding baby. They should, as such, be avoided until the baby reaches an age when they do not need breast milk anymore.
- Depression and/or Post-Traumatic-Stress-Disorder (PTSD) - Individuals with PTSD or severe depression are highly vulnerable to self-harm or suicide after taking benzodiazepines. They also may get drastic mood changes after using these drugs which is why they should avoid them.
- Elderly - These drugs have a high risk of causing dependence when taken by individuals above 65 years. Those individuals are also highly vulnerable to side-effects like memory loss, cognitive impairment, and loss of coordination.
Interactions
Benzodiazepines tend to interact in varied manners with other substances. Alcohol and opioids are some of the substances that can induce fatal effects when used alongside benzodiazepines. Since they all act as depressants on the central nervous system, they have magnified effects when used jointly. This includes slowed respiratory and heart functions to appoint where the systems may shut down.
Doctors normally weigh the benefits and risks of combining benzodiazepines with other substances. When the benefits are greater, they may prescribe one to consume the drugs alongside opioids or alcohol. However, one should get such a recommendation to avoid the life-threatening effects caused by multiple interactions.
It is also essential for one to exercise caution when taking benzodiazepines alongside vitamins or supplements. The following are the medicines, foods, and herbal products which might have severe interactions with benzodiazepines:
- Certain antifungals
- Antidepressants
- Antihistamines
- Certain antibiotics
- Certain blockers of the calcium channel
- Anticonvulsants
- Grapefruit
- Cough medicine
- St John’s wort
Benzodiazepines Abuse
Benzodiazepines widespread use has caused significant abuse and addition, especially over the last decade. This drug is now believed to have an estimated prevalence rate of 4% to 5% on the general population. In 2010 alone, the estimated new benzodiazepines users were 186,000. However, doctors only prescribe them in lower dosages because they have high addictive potential.
The most common cases of benzodiazepines abuse are noticed on individuals who use the drugs for pleasure. The drugs were initially developed to assist individuals with severe and real mental or physical health challenges. However, those who abuse them are driven by an ulterior motive of getting high.
In other instances, some people abuse their benzodiazepines prescriptions and ignore their doctors’ orders. This can include those who take the larger doses or have very short periods in between their dosages. They might take the drugs when they do not need them. Others even keep some pills hidden for a “bad day”. This is due to the addictive potential that these drugs have.
What Makes Benzodiazepines So Addictive?
Extensive research has shown that these drugs weaken the dopamine inhibitory neurons in the brain. As a result, the hormones that produce dopamine in the brain are unregulated. Dopamine causes individuals to seek pleasurable experiences. As such, individuals tend to change their behavior to pursue the stimulating experiences.
PolySubstance Abuse Issue
When individuals pursue pleasurable experiences, they normally use other drugs alongside benzodiazepines. This is typically referred to as polysubstance abuse. The severe cases of benzodiazepines abuse are mostly associated with polysubstance abuse. They are used as secondary drugs alongside mainly opioids and alcohol.
Benzodiazepines reduce the unwanted side effects of other drugs. This can include insomnia due to stimulant use or alcohol abuse withdrawal. However, polysubstance abuse is extremely dangerous and significantly heightens the risk of overdose. Most drug-related overdose deaths are brought about by a combination of both opioids and benzodiazepines.
How Benzodiazepines Abuse & Addiction Manifests
Benzodiazepines addiction occurs slowly without one noticing. Eventually, one gets hooked and they find themselves in a state of dependence. When one develops physical dependence, they have to take the drugs to feel normal.
Someone suffering from benzodiazepines addiction builds tolerance after some time. This implies that they continually require higher doses of the drug to get the same effects. They will skip other previously pleasurable activities just to use the drugs and may have some erratic behaviors. These include the following patterns of behavior which are typical benzodiazepines addiction signs:
- Swiping another individual’s pills for one’s personal use
- Doctor shopping” where one visits multiple doctors to get multiple prescriptions
- Seeking the drugs using fake prescriptions
- Stealing or borrowing someone else’s prescription
- Purchasing the drugs from illegal distribution channels, such as a street vendor
- Taking more benzodiazepines doses than previously intended or more than the prescribed amount
- Spending a lot of time seeking, using and recovering from benzodiazepines use
- Experiencing lots of cravings for the drugs or symptoms of withdrawal
- Requiring more benzodiazepines or higher dosages to achieve the previous same effects
- Prevalence of inhibited performance at home, school, or workplace
Benzodiazepines addiction is highly prevalent amongst individuals with a history of drug abuse. Valium and Xanax are the most abused drugs of this type mainly due to their swift action. Other than the long-term effects that these drugs induce, one may also get dementia. This is when one suffers gradual memory loss and experiences difficulties in memory and motor coordination.
Prolonged use places one at great risk of overdose even when they consume little amounts at a time. This is largely due to the fact that some of the drugs are stored in the body’s fatty tissues. The reserves can then cause an overdose which can be fatal. Some of the common signs and symptoms of benzodiazepines overdose include:
- Dilated pupils
- Clammy skin
- Rapid and weak pulse
- Shallow breathing
- Coma
- Death
Withdrawal & Detoxification
The brain’s chemical system tends to rewire once one gets used to using benzodiazepines. As such, an individual with an addiction problem will most likely have difficulties quitting the drugs. The physical and psychological withdrawal symptoms vary with duration and dosages of benzodiazepines use.
The drug users who go “cold turkey” and instantly stop using benzodiazepines may experience intense side effects. This is because the body has to adjust promptly to functioning without the drugs. The users who gradually stop using the drugs, on the other hand, may have fewer withdrawal symptoms.
The safest way to quit benzodiazepines abuse is to begin with supervised medical detoxification. This entails a procedure where the medical professionals offer drugs that help to mitigate the withdrawal symptoms. The doctors also offer a schedule that helps one to gradually lower their dosage without suffering any withdrawal symptoms.
Common Benzodiazepines Withdrawal Symptoms:
- Anxiety
- Sleeping difficulties
- Muscle tension
- Irritability
- Restlessness
- Hallucinations
- Ringing in the ears
- Coma
- Seizures
- Delusions
- Cramps
- Suicidal thoughts
Benzodiazepines Treatment and Rehab
Detoxification is only the first stage of quitting benzodiazepines. One needs to undergo treatment to ensure that they have fewer chances of experiencing a relapse. A relapse is when one goes back to using the drugs when they had previously stopped. There are numerous forms of treatment and rehabilitation and the most common is the inpatient kind.
Inpatient treatment involves a system where drug users get monitored throughout the recovery period. The withdrawal symptoms can as such be addressed and dealt with as soon as they develop. This ensures a full recovery. The other advantages of inpatient treatment include:
- Trained and qualified staff available to deal with the problems associated with drug abuse and withdrawal
- Drug education on effects of long-term abuse and addiction so that users know the risks
- A recovery-enhanced environment where individuals feel motivated to stop their drug abuse behavior
- Handling of issues that induce addiction so that individuals are empowered to recognize drug abuse patterns
- Support from dedicated specialists who work to ensure that drug users turn their lives around
Individuals recovering from benzodiazepines abuse can stay for varied periods inside the inpatient treatment centers. The average stay is normally 30 days long but some programs stretch for up to 60 or 90 days. Some of the factors which influence how long an individual may stay in the program include:
- Presence of co-occurring disorders like mental health conditions
- The severity of an individual’s addiction
- The number of times the individual has been to rehab beforehand
Treatment normally involves a series of therapy or counseling sessions. It includes Cognitive Behavioral Therapy (CBT). This involves drug users being taught about their behaviors and how such contribute to their addiction. Most addiction cases develop as a result of behavior and a change in behavior results in less dependence.
One of the ways in how CBT is used in the treatment of benzodiazepines treatment is to address insomnia. Most individuals experience a lowered rate of insomnia when they change their sleeping habits and thoughts about sleep. This can include going to bed early and avoiding food before one goes to bed. Individuals are also taught to avoid unrealistic ideas like the need for pills to induce sleep.
CBT is also applied for anxiety treatment and other mental health challenges. Patients who undergo such therapy have higher chances of experiencing long-term recovery. This is because they will rarely get triggered to use the drugs as was the norm prior to rehab.
Treatment centers also offer family counseling for those recovering from benzodiazepines use. This involves incorporation of the family members in therapy sessions. Individuals who are supported by their family members feel loved and challenged to change their lives. They also form better and stronger links with their family members that continue even after recovery.
Ongoing Care
Recovering patients still need care after they have come out of rehab. The most common on-going care program is the 12-step recovery program. This involves a series of 12 recovery actions that continue even long after rehab. It requires individuals to attend meetings with other people who are in various stages of recovery. The ones who have advanced in the program mentor those who have just joined.
Conclusion
Benzodiazepines are some of the most used drugs in the United States. The numerous prescriptions offered by medical professionals make the drug to have the potential to be abused. The individuals who abuse these drugs develop gradually tolerance and eventually slip into addiction.
Most individuals who abuse these drugs tend to use it as a secondary drug. They combine the drug with mostly alcohol or opioids to lower unwanted effects or get an intense stimulation. This is very dangerous because the chances of overdose are higher during polysubstance abuse. Abusing multiple substances has the potential of inducing fatal overdose deaths.
Addiction is difficult to overcome individually. Luckily, individuals struggling with benzodiazepines abuse can get help to reclaim their lives. The most important step during recovery is detoxification. This should be done under a medically-supervised setup for unwanted effects to be monitored and rectified.
The next step after detoxification is a comprehensive treatment which mostly succeeds under an inpatient setup. The individuals who undergo inpatient treatment get all-round care and hence rarely relapse after the program ends. Some of the common treatment approaches include cognitive behavioral therapy and family counseling.
Are you facing a benzodiazepines abuse problem or have someone undergoing the same? Do not despair as recovery is possible. Get in touch with Addiction Helpline America to find a qualified treatment center near you.