Psychiatric Times notes that while the United States is gripped by an opioid crisis, there’s another category of drugs that are over prescribed, abused, and have resulted in more and more people being hospitalized for overdoses. That category is benzodiazepines, the name behind some of the most popular and prescribed medications today, but a cause for alarm in a culture where potent prescription drugs are passed around and consumed without a second thought. Benzodiazepine abuse is a legitimate health concern, but treatment options exist to help repair lives that have been damaged by the addiction.
A Considerable Increase in Prescriptions and Overdoses
In March 2016, the Centers for Disease Control published the reports of a study that ran from 1999 to 2013, analyzing trends in the rate of overdoses of prescription drugs. Thirty percent of the 22,767 fatalities involved people abusing benzodiazepines; the final year of the study saw 6,973 such deaths.
The point was echoed by the American Journal of Public Health, which wrote that the amount of benzodiazepine prescriptions and overdoses have “increased considerably.” Psychiatry Today writes of a 89 percent increase in hospitalizations for recreational use of benzodiazepines, from 143,500 in 2004 to 271,700 in 2008. Benzodiazepines accounted for 29 percent of fatalities as a result of overdosing on pharmaceuticals.
The statistics are grim, but understanding what benzodiazepines are, how they work, and what makes them so powerfully effective goes a long way in addressing the reasons behind their abuse and how the abuse can be treated.
Benzodiazepines boost the effect of the GABA neurotransmitter in the central nervous system. The GABA neurotransmitter is responsible for controlling the amount of nervous transmission to the brain, calming nervous activity and thereby regulating mood, emotions, and behavior. Some people have certain medical or mental health conditions that result in the GABA neurotransmitters not working as they should, rendering them unable to control how they feel about a situation and unable to control how they respond to those feelings.
When a person takes a benzodiazepine, the drug boosts the synthesis of the GABA neurotransmitter, helping that person better manage their moods and behavior. Where a person may once have felt powerless to stop their stress or anxiety, taking the benzodiazepine induces feelings of calm, relaxation, and even happiness.
The way benzodiazepines increase the production and effect of the GABA neurotransmitters opens the door to a number of medical and mental health-based applications:
- Anxiety disorders
- Alcohol withdrawal symptoms
- Panic attacks
The Benzodiazepine Tree
There are many different drugs that are created from the benzodiazepine chemical structure. These drugs are often distinguished by the length of their effects, ranging from ultra-short acting to long-acting. Everyday Health lists some common benzodiazepines and their brand names:
The Center for Substance Abuse Research writes that some of the most prescribed medications in the United States are benzodiazepines.
Most of the drive behind the demand from benzodiazepines is because of their effectiveness, but nonmedical consumption accounts for a disturbing degree of their widespread use. On their own, the drugs are capable of inducing physical dependence in their users. When a person has to deal with chronic pain or the threat of a panic attack on a daily basis, the sensations of calm and rest brought about by benzodiazepines can be alluring to the point of temptation. It is entirely possible for a person to start taking their medication outside of the prescribed boundaries, without even wanting to, or realizing it.
In an attempt to control for this risk, Medline Plus says that doctors prescribe benzodiazepines for three or four months at a time, to try and minimize the chances of their patients – who are physically and mentally vulnerable – becoming hooked on a substance that seems to be the answer to all their problems. Taking benzodiazepines for a period of time longer than four months running has a number of adverse effects on patients.
For example, it can develop tolerance for the benzodiazepines they have been prescribed. Tolerance describes the amount of a substance that the person would have to consume in order to feel its effect. A low tolerance would mean that the smallest dose of benzodiazepines would cause the chemical reactions that lead to feelings of peace and bliss, thereby drastically reducing the chances of physical dependence.
High tolerance, on the other hand, would be a situation where the person has to consume larger and larger amounts of the drug to experience the standard effect. As more and more of the benzodiazepine is taken, the brain becomes hooked on it; in time, it becomes impossible for the person to implement any form of self-regulation. Benzodiazepines become the go-to, not just for chronic pain or the fear of panic attacks, but for any form of distress. The more medication is taken like this, the higher the person’s tolerance; the higher the tolerance, the more the medication has to be taken for any effect to be felt.
A person taking higher amounts of benzodiazepines is an obvious sign of abuse, but how additional medication is obtained can also suggest if there is a problem.
People hooked on benzodiazepines resort to faking symptoms, forging prescriptions, going to multiple doctors, or buying their medicines off the street and from the Internet to keep the addiction fed.
Any signs like these are evidence of benzodiazepine abuse.
There are some people who don’t have the stress, anxiety, depression, or fear for which benzodiazepines are usually prescribed, but who take these drugs because it helps them through other problems. A woman writes in New York Magazine of how she turned to Ativan (a benzodiazepine that, at 28 million prescriptions, was the fifth most prescribed psychiatric prescription medication in 2013) to help her cope with the anxiety she felt during her mother’s failing health). In The New York Times, a man confesses to taking Ativan because its antiemetic (anti-nausea) properties help him with his air sickness. A professional therapist and a former pilot laments that more and more air travelers are taking painkillers like candy.
Recreational Benzodiazepine Abuse
People who become addicted to benzodiazepines because of legitimate medical issues are not the only people who abuse the drug. Its properties of powerful relaxing effects have made it a popular choice among those who take it recreationally; that is, they have no health concerns that would warrant a prescription, but they are looking to experience a new high. The fact that benzodiazepines are not illegal, and can be procured from a friend or family member’s purse or medicine cabinet, contributes to the widespread – but dangerous – idea of a “legal high.”
Signs of recreational abuse (which focuses less on pain relief and more on pleasure) might include:
- Chewing benzodiazepine tablets
- Crushing them and snorting the powder
- Dissolving the powder in water and injecting the liquid into the veins
Such methods cause the benzodiazepine to enter the bloodstream much faster than oral consumption (which is the safest method of taking benzos, precisely to avoid the rapid onset of action that recreational users crave).
But however the benzodiazepine is taken, consuming so much of it (beyond the limits prescribed by a doctor) has a terrible effect on the human body. The brain and central nervous system become overwhelmed by the regular flood of a powerful medication, leading to effects like blurred vision, extreme drowsiness, difficulty concentrating, slurred speech, as well as wild mood swings and unpredictable behavior.
Since benzodiazepines’ effectiveness is found in the powerful states of relaxation they induce, extreme abuse can result in respiratory depression, where the brain is unable to carry out the automatic function of regulating breathing. This could lead to death.
The symptoms are exacerbated if the flow of the benzodiazepines is discontinued suddenly, as the brain – hooked for so long on a substance that dictates how it should work – cannot properly function without its chemical crutch. Such withdrawal symptoms include muscle cramping, flu-like symptoms, nausea and vomiting, diarrhea, anxiety, and depression; all of which can make further benzodiazepine abuse very tempting, which is why discontinuation of benzodiazepines should not be attempted without medical supervision.
Benzodiazepine Abuse Treatment
Treating benzodiazepine abuse should be carefully structured, a process known as detoxification, or detox. It is not a simple case of stopping the intake and then waiting out the withdrawal symptoms. A person who goes off a benzodiazepine after a period of abuse is very susceptible to relapsing on the drug, switching to another drug, or acting impulsively and dangerously because of the psychological effects of losing their fix. In addition, dangerous and even life-threatening withdrawal symptoms can develop in some instances.
At a hospital or specialized treatment facility, medical staff can ensure that the person is given a controlled space to detox as safely as possible. This may entail administering anti-anxiety medication in very small doses, so as not to cause the client to develop an unhealthy dependence on the new drugs, while simultaneously tapering off benzodiazepine intake, so as not to trigger too many withdrawal symptoms too quickly.
A number of factors, such as the form of benzodiazepine being abused, the length of abuse, the presence of any other substances of abuse, and the client’s medical and mental health history, can influence how long the detoxification process takes. Without a specific timeline, the process can last anywhere from a week to a couple months, which is another reason that treating benzodiazepine abuse should not be attempted without a doctor’s involvement.
Psychotherapy and Aftercare Support
However long it takes for the client to stabilize physically, treatment then continues to the therapy stage. Therapy addresses the underlying reasons behind the benzodiazepine abuse and helps the client devise strategies for coping with the pain, stress, and temptation that surrounded their addiction.
There are different psychological treatments that can be used to make this happen. One of those commonly used is Cognitive Behavioral Therapy, which helps clients identify the negative thought patterns that typically lead to benzodiazepine abuse, and then implement coping skills to respond to those thought patterns in a way that is more beneficial and positive. The Journal of Clinical and Consulting Psychology writes that such therapy “seemed to facilitate benzodiazepine tapering among patients.”
Long-term treatment for benzodiazepine abuse might entail connecting with an aftercare support group, like a 12-Step program, so the person can share stories, perspectives, successes, and accountability with other people who have gone through the same experience. Aftercare networks provide a vital (and necessary) connection to the fundamentals of treatment, long after the final therapy session. Having trustworthy and reliable friends can be the difference between sobriety and relapse.
Abuse of benzodiazepines is a big problem facing both the medical community and the general public. However, benzodiazepine abuse does not have to be the final word on a person’s life. Treatment is always possible. With love, care, and support from friends and family as well as comprehensive care, a new and better journey through life can be embarked upon.