Benzodiazepine Addiction

A drug addiction is a substance use disorder. It is a disease that affects a person’s brain and behavior. From illegal drugs, prescription drugs to over the counter drugs, drug addiction comes in various forms. The addiction leads to an uncontrollable use of these drugs. Generally, people prefer using drugs that provoke their mental abilities such as psychoactive drugs which includes marijuana.

Drug addiction is one of the prominent problems that any society has to deal. It is detrimental to the society because it deprives the economy of productive labor and imposes high costs for drug treatment. Unfortunately, most of the deaths from overdoses are attributed to an overdose on prescription drugs rather than the expected illegal drugs.

With this mindset, it is necessary to be aware of what drugs are being abused in order to develop suitable strategies to curb drug addiction.

Benzodiazepine

It is initialized as BZD or sometimes referred to as benzos. Benzodiazepine belongs to the class of drugs called psychoactive drugs.

What is a psychoactive drug?

A psychoactive drug is a chemical substance. It alters brain function. A psychoactive drug causes changes in perceptions, moods, consciousness, cognition and behavior. Examples of psychoactive drugs are cocaine, methylphenidate and benzodiazepine. There are various uses of psychoactive drugs which include: recreational, medicinal, spiritual or research purposes. Sometimes, psychoactive drugs are used purposefully to either improve performances or alter consciousness. Psychoactive drugs are admitted orally (tablets, capsules), through an injection, intravenous route or inhalation. The administration of every drug is different depending on which method is more efficient.

Some psychoactive drugs have therapeutic values. They are prescribed by physicians or any other healthcare practitioners. Such drugs include: anesthetics, analgesics, anticonvulsants and antiparkinsonian drugs. Furthermore, these drugs may be used to treat neuropsychiatric disorders such as antidepressants, antipsychotics and stimulant medications. Therefore, we can deduce that most psychoactive drugs are used in the detoxification process for rehabilitation of people addicted to other psychoactive drugs.

Psychoactive drugs are commonly abused because they have a euphoric feeling thus the user finds them pleasant. Moreover, they are reinforcing drugs inducing a state of addiction despite their negative consequences. The treatment of psychoactive drug addiction involves a combination of psychotherapy, support groups and other psychoactive substances. Some psychoactive drugs can be very unpleasant that a person is unable to use them again.

Uses of psychoactive drugs

There are uses that are relevant for all psychoactive drugs including:

• Anesthesia to block physical pain
• Pain management
• Treating mental disorders (antidepressants, stimulants, antipsychotics, mood stabilizers, anxiolytics, hypnotic depressants)
• Recreational purposes for their abilities to alter moods and perceptions (hallucinogens, stimulants, hypnotics, analgesics, inhalants)
• They are used as non-lethal weapons in the military

Benzodiazepine as a psychoactive drug

The core chemical structure of BZD is the fusion of a benzene and diazepine ring. The first discovery of this kind of drug was accidental in 1955 known as chlordiazepoxide or Librium. In 1963, it began being marketed as benzodiazepine diazepam or valium. In the 70s, BZDs were the most prescribed medications in the world.

As a psychoactive drug, benzodiazepine affects the brain neurotransmitter, GABA, enhancing its activity. This effectively slows down nerve impulses throughout the body. Moreover, it increases the chances of channel opening events which inhibit action potential by increasing conductance of chloride ions. Concurrently, the likelihood of seizures is greatly decreased. There are two benzodiazepine receptors in the nervous system of the body. One receptor cause the anti-anxiety effect while the other receptor elicits the sedative effect.

BZDs were widely prescribed because they act as minor tranquilizers or as an anxiolytic. An anxiolytic is a medication that inhibits anxiety. However, these minor tranquillizers have an anxiogenic effect if used over long periods of time. This means that instead of inhibiting the anxiety, the anxiolytics can cause the anxiety when used of a long time.

Effects of Benzodiazepines

Benzodiazepines enhance the effect of the neurotransmitter gamma-amino butyric acid (GABA) which are brain chemicals performing communication between brain cells. This results in sedative, hypnotic, anxiolytic, anticonvulsant and muscle relaxant properties.

1.) Sedative properties

A sedative is a substance that reduces irritability and excitement. They are central nervous depressants. They interact with brain activity causing it to decelerate. BZD behaves in the same way, causing a sedation effect.

2.) Hypnotic properties

The purpose of hypnotic drugs is to induce sleep. Such drugs are mostly used in the treatment of insomnia or surgical anesthesia. As a hypnotic drug, benzos initiates, sustains and lengthens sleep.

3.) Anxiolytic properties

As mentioned earlier, an anxiolytic is a drug that reduces anxiety. This is one of the reasons why BZDs are commonly prescribed for therapeutic reasons. They have the ability to inhibit anxiety.

4.) Anticonvulsant properties

Anticonvulsants are drugs that are used to treat seizures and bipolar disorder. They act as mood stabilizers and treatment of neuropathic pain. As an anticonvulsant, BZD suppresses the excessive rapid firing of neurons in the brain during seizures.

5.) Muscle relaxant properties

A muscle relaxant is a muscle relaxing drug. It affects the skeletal muscle function while decreasing muscle tone. It can be used to alleviate symptoms such as muscle spasms, pain and hyperreflexia. BZDs have this property as well.

Uses of BZDs

From the properties mentioned above, BZDs are useful in treating:

• Anxiety (anxiolytic)
• Insomnia (hypnotic)
• Agitation (anxiolytic)
• Seizures (anticonvulsant)
• Muscle spasms (muscle relaxant)
• Alcohol withdrawal treatment to treat severe withdrawal symptoms
• Premedication for dental or medical procedures.

Categories of BZDs

1.) Short-acting BZDs are preferred for the treatment of insomnia. There are few to no side effects associated with these benzos.

2.) Intermediate-acting BZDs are similar to short-acting BZDs because they are also preferred for treating insomnia.

3.) Longer-acting BZDs are preferred for treatment of anxiety. Unfortunately, long term benzodiazepines lead to addiction and have intense side effects.

Adverse Effects of BZDs

• BZDs are deemed to be safe and effective for short-term use. However, cognitive impairment and paradoxical effects can occur. These paradoxical effects are such as aggression or behavior disinhibition (lack of restraint portrayed by disregard of social conventions and poor risk assessment)
• BZDs have been shown to increase the rates of suicide. Furthermore, their long term use is associated with adverse psychological and physical effects. These drugs decrease effectiveness, cause physical dependence and withdrawal. Due to these effects, a withdrawal from BZDs improves physical and mental health.
• An interaction between benzodiazepines and alcohol is very dangerous. Unfortunately, most benzo addicts take the drug while still abusing alcohol. Furthermore, a combination of other drugs such as opiates and antidepressants and BZD is fatal. These combinations result in depression of the central nervous system.
• Cardiac and respiratory arrest is associated with intravenous benzodiazepines. IV administration is also accompanied with apnea, nausea, vomiting, skin rash and reactions at the injection sight.
• The use of benzos while pregnant or breastfeeding increases the risk of congenital malformations.
• Benzodiazepines can cause anterograde amnesia when used in high doses over a short period of time. Anterograde amnesia is the lost ability to create memories after the event that caused the amnesia. It leads to partial or complete inability to recall the recent past. However, long-term memories before the event remain. BZDs also have an effect of dissociation. This refers to mild or severe detachment form physical and emotional experiences. Simply put, it is the detachment from reality.

Examples of BZDs

Benzodiazepines include: Niravam, Ativan, Xanax, Librium, Klonopin, Valium, Halcion, Restoril, Tranxene and Alprazolam.

The most commonly abused benzodiazepine drugs are: alprazolam used in treating anxiety and insomnia and diazepam used to treat insomnia, panic attacks and seizures. Others include Klonopin, Ativan and Halcion.

Benzodiazepine (Benzo) Addictions

A benzo addiction, is when a person develops drug tolerance, withdrawal symptoms and drug seeking behavior despite its harmful effects. Benzodiazepines are prescription drugs. This makes them ripe for abuse. BZDs have been abused orally and intravenously. The common way to ingest benzo is orally through a tablet or a capsule. However, people may have legitimate medical reasons to use them but may develop an addiction in the end. This is especially common in patients who do not follow doctor’s orders.

Despite the fact that BZDs have calming effects, they are highly addictive. The drug is open to more abuse if there is a greater intoxicating effect that results from a rapid increase in the plasma level following ingestion. Many people continue to use the drug because of the unpleasant withdrawal symptoms rather than the pleasurable effects of the drug. The majority of people addicted to BZDs are individuals who have a therapeutic dose dependence. These individuals do not need to escalate their doses to higher levels or abuse their medication.

Since 2002, there has been a 79% increase in the use of benzodiazepines. This has led many medical practitioners to refrain from prescribing the drug. In the short term, benzo is effective in treating acute anxiety and insomnia

It is possible to tell a person addicted to BZD by checking for the following symptoms:

• Physical weakness
• Blurred vision
• Drowsiness
• Poor judgment or thinking
• Doctor shopping
• Asking for benzodiazepine pills
• Mood changes
• Inability to cut the use of the drug
• Risk-taking behavior
• Combination of BZD with other drugs
• Slurred speech
• Dizziness
• Lack of motor coordination

Over time, a person builds a natural tolerance to BZDs. This means that they will require a higher volume of the drug in order to reach the familiar high.

Benzodiazepine addiction is defined as a sedative disorder in the mental health community. For such a diagnosis, one must show the any two of the following symptoms within the same 12 month period:

1.) If a person takes the sedative for a longer period or higher volume than first intended

2.) More time is spent in getting and using the drug and recovering from its effects.

3.) The person experiences withdrawals if the drug is not in their system. The withdrawals can be due to characteristic withdrawal syndrome for the substance. It can also be due to using the substance to relieve or avoid withdrawal symptoms.

4.) More of the drug is needed to achieve the familiar high over a long period of time

5.) Impaired performance at home or work for an individual who uses the drug.

6.) A constant use of the drug even after suffering persistent social and interpersonal problems

7.) A person tends to give up their social, recreational and occupational activities because of substance use

8.) Despite physically hazardous situations, the substance is used recurrently.

9.) Continuous use of the substance despite knowledge of a physical or psychological condition that is likely to be exacerbated by the substance

10.) Cravings for the substance

11.) Tolerance indicated by an increase in substance intake or a diminished effect without continued use of the same amount of substance.

When a person exhibits any of these symptoms, then they are deemed to have a sedative addiction. Furthermore, a benzodiazepine dependence diagnosis is made if a patient shows any three of the set criteria.

Chronic abusers of benzodiazepines exhibit the following symptoms: anorexia, insomnia, anxiety, tremors, headaches, and memory problems.

Alarming facts about benzo addiction

• It is very easy to become addicted to BZDs. Taking benzo causes a surge in dopamine levels in your brain which leads to a sudden wave of pleasure, irresistible at times.
• Quitting benzo addiction can be quite difficult. Benzo is highly addictive and quitting can cause severe withdrawal symptoms such as: sweating, nausea, headaches, muscular pain, stiffness, difficulty in concentrating, perceptual changes, sleep disturbance, irritability, increased anxiety, panic attacks, heart palpitations and muscle tremor. Those on high benzo doses can suffer from seizures or psychosis once they withdraw from usage.
• The use of benzos often creates cognitive impairment. Most individuals who use BZDs tend to become forgetful of things they previously knew or how to perform task they once knew. Moreover, the older the addict the higher the risk of developing memory lapses. Research shows that benzo is one of the commonly abused drugs among the elderly.
• It is likely to develop Alzheimer’s disease from a long term use of benzodiazepines.
• Early death is a very likely possibility. Aside from the fact that benzodiazepines cause cognitive malfunctions, have severe withdrawal symptoms and increase the risk of developing Alzheimer’s disease, BZDs easily cause death.

Research shows that most deaths associated with prescription drugs are a result of abuse of benzodiazepines.

What causes a benzodiazepine addiction?

A tolerance to the muscle-relaxant, anticonvulsant and sleep-inducing effects of these drugs causes an addiction. Furthermore, withdrawal effects develop upon cessation. As a result, people end up taking them for a longer time than intended just to handle the withdrawal effects. This tolerance occurs within a few weeks after beginning the dosage in most patients.

Generally, a tolerance to the useful medical properties of benzodiazepine leads to an addiction rather than healing.

Risk Factors

There are factors that contribute towards acquiring a benzo addiction:

• Long term use beyond four weeks
• The use of high doses
• Use of potent and short-acting benzodiazepines
• Dependent personalities
• Proclivity for drug abuse

Withdrawal

Long-term benzodiazepine users have many physical and mental health issues and are always advised to discontinue its use. Since many patients use benzo to avoid the severe withdrawal symptoms, different withdrawal rates are customized for each patient. The time needed for withdrawal is influenced by factors which include length of use, dosage taken, lifestyle health and social and environmental stress factors.

Withdrawing from the use of benzodiazepines should not be done abruptly. It will lead to extensive withdrawal symptoms.

Benzodiazepines affect the neurotransmitters, therefore a patient may still exhibit protracted withdrawal symptoms despite slow titration of dosage. This is attributed to the fact that there are persistent neuroadaptations.

Prevention

Users of benzo have a high risk of developing tolerance dependence and adverse health effects. Therefore, the health committees in the UK and US recommend the scraping off benzodiazepines as a treatment for anxiety or insomnia. The committees determined, that BZDs are not suitable treatments for depression or psychosis. After 3-14 days of use, benzos lose their sleep-promoting properties.

From these conclusions, the deduction is that benzo addiction can be prevented by avoiding the use of the drug altogether or by a gradual withdrawal of its use.

Alternative methods of treating conditions like insomnia have been proven to be more effective than benzodiazepines. One effective method is cognitive behavioral therapy.

Treatment

Patients who are physically and psychologically dependent on benzodiazepine are the ones who need treatment. Benzodiazepine is highly addictive, with an addiction developing within a few weeks after use. Patients are advised to withdraw small increments over a period of months.

Treating a benzo addiction follows the principle of treating other drug addictions. The only difference is that outpatient rehab is not recommended due to the adverse withdrawal symptoms. Besides that, benzodiazepine treatment follows the steps below:

1.) Detoxification

This process can be intense physically and psychologically. Psychological and medical support is paramount in this stage. Addressing any rebound anxiety is necessary

2.) Behavioral therapy

Behavioral therapy is important to treat any underlying trauma which may be a contributing factor to a patient’s addiction. This therapy is essential in treating the behavioral side effects of benzodiazepine addiction which are aggression, irritability, hyperactivity and agitation. Aside from the patient’s therapy, family therapy is important as well. Family support goes a long way in helping an addict recover.

3.) Addressing co-occurring conditions

Statistical reports show that 45.7% of people in treatment for benzodiazepine addiction are also diagnosed with a co-occurring health disorder. Mental health issues can make the journey to recovery of a benzo addict very frustrating. The withdrawal symptoms exacerbate the situation. A benzodiazepine addiction is intertwined with issues such as depression and anxiety making it impossible to extricate one from the other and treat it successfully.

4.) Safeguard against relapse

Safeguarding from relapses can be done by joining peer groups and prevention groups to help handle any triggers that can cause one to turn to the drug one more time.

5.) Aftercare programs

Aftercare and support after treatment are the core things. Without these programs, it is very easy to slip back into an addiction. Furthermore, these programs are essential to help an individual transition into life after recovery.

Influence of Benzodiazepine Addiction on Society

Benzo addictions are associated with many deviant behaviors. This includes drug related crimes. Legal and illegal users of BZDs were found to be more likely to live on the streets. Moreover, they are unlikely to have a full-time job and are more likely to be previous users of heroin or methamphetamines.

It has also been shown that benzo addicts are more likely to receive illegal incomes or to have been arrested and imprisoned.

Benzo has also been used to facilitate sexual assaults and robberies because of their muscle relaxant and disinhibiting factors. They are very effective in sedating victims to immobilize them and rob them.

The highly addictive nature of benzodiazepines and their adverse effects have pushed governments to set more stringent regulations on the use and prescribing of the drugs. Clearly, these concerns are justified.

Many people are unaware that they may be addicted to benzodiazepine because it seems to be quite useful. However, this is only for a short time. A long term use of the drug can be very detrimental to both a patient’s mental and physical health. It is one of those dangerous drugs that need to be avoided at all costs. Patients with conditions that presumably are treated by benzodiazepine such as anxiety should seek other alternative forms of treatment.

The issue of benzodiazepines addiction should not be allowed to spiral out of control. More precautions should be taken. People should be enlightened. Governments should do more to help those who are already addicted and prevent the percentage of addicts from spiraling. The cost of treating addicts is way cheaper than the expense of having a proliferation of benzo addicts. Indeed, it is better to be safe than sorry. This is the way to ensure that we safeguard our society and heal families from the painful effects of Benzodiazepine addiction.