How Do Benzodiazepines Work?

Unless you’re in the medical field, it’s unlikely that you refer to the familiar drug names of Xanax and Valium by their generic, scientific terms, alprazolam and diazepam, which are benzodiazepines. What are they and exactly how do benzodiazepines work? It has to do with their chemical structure and how it affects the central nervous system. All drugs that fall into the benzodiazepines category increase receptor activity for the gamma-aminobutyric acid (GABA) neurotransmitter.

The GABA neurotransmitter hinders neuron activity, slowing down the nervous system and results in a sedated state of mind. The calming and relaxing effect helps to promote sleep and ease stress and anxiety. Benzodiazepines differ mainly in how quickly they are absorbed, how long their effects last, and how long they take to leave the body referred to as the half-life. In general, people turn to benzos due to their quick-acting release. 

For instance, Xanax, a medication prescribed to treat anxiety, is an intermediate-acting benzo that has a half-life between 12 and 14 hours. Many people will begin to experience its effects of sedation within the first 10 minutes and its peak impact arrives within one to two hours after taking it. Lingering effects can last up to four hours. It then stays in the body for up to 14 hours. 

Although most benzos are used to treat similar ailments, here are a few of the most known types and what they’re used to manage:

  • Alprazolam (Xanax) – Used to treat panic disorders and anxiety
  • Clonazepam (Klonopin) – Used to treat panic disorders
  • Lorazepam (Ativan) – Used as an anticonvulsant and works well as a treatment of acute agitation and mania
  • Diazepam (Valium) – Used to treat anxiety and seizures

When used conservatively, benzos are considered an effective treatment, but remain highly addictive and require medical guidance to prescribe the right dosage and to prepare a plan to discontinue use safely. For those who overmedicate or who use benzos recreationally, these parameters don’t exist. Therefore, the risk of experiencing extreme side effects and/or overdosing increases significantly. 

Commonly Prescribed Benzo Uses

How do benzos work for other conditions and symptoms besides anxiety? They are often also prescribed to help people who suffer from panic attacks, insomnia, manic behavior, and phobias. They’re used to treat symptoms associated with these types of conditions, such as:

  • Increasing need for sleep
  • Racing thoughts
  • Agitation
  • Muscle spasms
  • Tremors
  • Seizures

Benzos are prescribed for temporary, short-term use to alleviate or minimize these symptoms. It’s not recommended that prescriptions go beyond a two-week period, since they are highly addictive and start to lose their effectiveness after this time. Due to the sense of calm and euphoria benzos provides, physical dependence can quickly set in if there aren’t alternative remedies in place that don’t require the use of drugs.

People who exceed the prescribed amount or use benzos beyond the regulated period of time create an accumulation in the system that lowers tolerance levels and requires more to feel the same positive effects. Regardless of how much and how often a person takes benzos, there are side effects that occur, ranging in frequency and intensity. 

Side Effects Associated with Benzo Use

Like all other medications, benzos comes with their own set of side effects. Not every person will react in the same way. Because this category of drugs has a chemical makeup in common, it depends on how this intermingles with an individual’s nervous system. It is further dependent on how much a person takes, how often, and if any other substances are involved like alcohol or opioid use. 

Generally speaking, how benzos work is they slow down the brain to a relaxed state. As a result, the following side effects that may be experienced:

  • Drowsiness
  • Lethargy
  • Fatigue
  • Inability to concentrate
  • Blurry vision
  • Forgetfulness 

When taken in higher dosages, benzos can cause: vertigo, impaired motor coordination, mood swings, and slurred speech. Those who frequently depend on benzo use may demonstrate hostile or aggressive behavior in certain instances. Since most benzos have an intermediate to long half-life, it takes several hours and sometimes days before the drug is completely eliminated from the system. 

As a result, accumulation of benzos develops in the fatty tissues due to repeated doses over an extended period of time. As buildup occurs, the body experiences an increased tolerance to the drug. This can cause people to overmedicate either accidentally or with intention. Either way, the increased tolerance levels eventually results in benzo dependency and addiction. 

How Benzos Cause Addiction

When benzos are present in the body, the GABA receptors adapt to them to activate the slowdown of the brain and nervous system. When the drug is eliminated, it becomes less active and may cause withdrawal symptoms to occur as a result of its dependency. Based on the type of benzos used, this withdrawal reaction can occur as quickly as 24 hours after the last use for short-acting benzos and possibly a month with longer-acting ones. 

Withdrawing from benzo use abruptly can disrupt the system to the point of a person experiencing seizures or hallucinations. The practical way to handle benzo withdrawal is to reduce the dosage gradually, with timelines depending on how long someone has been taking benzos. Withdrawal symptoms are painful, uncomfortable, and intense. They often involve:

  • Restlessness
  • Irritability
  • Aches and pains
  • Heart palpitations
  • Insomnia
  • Nausea
  • Vomiting

Due to the severe nature of benzo withdrawal, many people experience relapse and continue with use. This cycle of addiction raises the risk of benzodiazepine overdose. 

As of the most recent data provided by the Centers for Disease Control and Prevention, there were 70,237 reported drug overdose deaths in the U.S. in 2017. Although a majority of these were due to opioid overdose, a rising number of these cases also involve benzodiazepines. According to statistics published in the American Journal of Public Health, benzos were involved in an estimated 31 percent of fatal overdoses.

The rising levels of anxiety reported today compared with the rising misuse of anti-anxiety medication has linked this behavioral trend of addiction to the similar levels of the opioid epidemic affecting the country. Per the American Psychiatric Association, more than one in eight adults used benzos in 2017, an increase over previous years. Of this total, over 17 percent accounted for misuse (using the drug without a prescription or using the drug longer or more often than prescribed) of benzos. 

This misuse was found to be the highest among people ages 18 to 25, primarily to alleviate tension or relax. Due to how often the drug is prescribed and how easily addiction can occur, benzo use affects millions of people every year, starting at a young age. It has a direct impact on those who turn to these medications in hopes of alleviating anxiety or curing insomnia, but it also affects the friends and family members that bear witness as addiction takes over.

Why It’s Important to Seek Help for Benzodiazepine Addiction

Addiction changes the physical makeup of the brain to a point where discontinuing use without the help of a treatment facility is not the safest or most successful route of care. Withdrawal side effects can result in unpredictable reactions. Going through the process in a well-structured environment is important to preserve a person’s physical and mental wellness. 

When undergoing treatment in the care of Northbound, a support team made up of certified and trained therapists and psychiatrists monitor your progress and help to minimize discomfort as much as possible. Additionally, they’re available to step in as needed to prevent withdrawal side effects from causing further harm. It’s also best to receive care for addiction in a medically-managed facility versus experiencing it alone to prevent relapse. The pain of withdrawal symptoms coupled with the power of addiction makes it difficult to go through the detox process without others to help you through.

Without addiction treatment, drug abuse causes further damage to the body. Not only does it have physical effects, but emotional and psychological ones as well. Addiction can lead to problems at work, in personal relationships, and setbacks when working toward long-term goals. Part of the recovery process involves addressing how addiction has negatively influenced all aspects of your health and incorporating ways to get your life back on track.

Recovery from benzodiazepine addiction takes time and consistent care. With the help of others in a secure, welcoming space, it’s possible to overcome the stronghold it’s had and begin healing. Each phase of treatment is specifically designed to create a holistic healing plan. The detox process is always the first step in order to start with a clean slate. This is followed by residential treatment and intensive outpatient care. 

Parts of these programs involve providing solutions to the causes of addiction and any related conditions that may be at the root of the problem. Together, with a dedicated team, you’ll implement a personalized plan and timeline that makes sense for your individual needs and goals. Step by step, you’ll be on a healthier path toward achieving and maintaining sobriety for the sake of your future happiness and well-being. 

Sources:

https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816010/;

https://www.cdc.gov/drugoverdose/data/statedeaths.html;

https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids;

https://www.psychiatry.org/newsroom/news-releases/study-finds-increasing-use-and-misuse-of-benzodiazepines;

Article Reviewed by Paul Alexander

Paul AlexanderPaul Alexander is the founder and CEO of Northbound Treatment. He received his Certified Addiction Treatment Specialist training at Saddleback College in Mission Viejo, CA, and was awarded Outstanding Alumni Service Award in 2002. Paul holds a Bachelor of Arts degree in Criminology, Law and Society, Summa Cum Laude, from University of California, Irvine, and a Juris Doctorate degree from Loyola Law School of Los Angeles. He believes wholeheartedly in transformational leadership, organizational health and effective, fully integrated substance use disorder treatment.

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