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The Long-Term Effects of Benzodiazepines

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Benzodiazepines are a class of drugs known to cause central nervous system (CNS) depression. Benzodiazepines are commonly prescribed to treat anxiety, seizures, muscle spasms, and to manage acute alcohol withdrawal syndrome.1,2 They are safe when taken as prescribed for medical conditions; however, when misused or abused, these drugs have negative short- and long-term effects. People may misuse benzodiazepines when they take a medication in ways other than directed by a physician. For example, someone may take greater or more frequent doses of their prescription if they feel that the prescribed dose isn’t working. Others may abuse benzodiazepines with the goal of getting high.

The most commonly prescribed and abused benzodiazepines are: 1

  • Ativan.
  • Klonopin.
  • Valium.
  • Xanax.
  • Halcion.

It is important to understand that this class of drugs can have negative long-term consequences, especially when abused or misused.

Why People Abuse Benzodiazepines

Benzodiazepines have been widely prescribed since their introduction to the medical community in the 1960s.2 It is estimated that there are 4 million daily users of benzodiazepines, many of whom have developed a dependence to these drugs.3

People abuse benzodiazepines for their desired effects, such as euphoria, anxiety-relief, and sedation.1 Benzodiazepines are commonly abused with other drugs, such as cocaine or heroin.1 Some users may take benzodiazepines with cocaine in an attempt to relieve the side effects of cocaine binges. Benzodiazepines may be abused with heroin to increase the high. This practice of mixing substances increases the risk of experiencing harmful short- and long-term effects.

Benzodiazepine users commonly take doses in excess of recommended therapeutic doses. Users may obtain these drugs by going to multiple physicians to obtain prescriptions, forging prescriptions, or purchasing pharmaceutical products on the illicit market.1

Short-Term Risks

Misusing or abusing benzodiazepines may not only be dangerous, but deadly. Benzodiazepines alone are rarely fatal; however, when combined with other CNS depressant drugs, such as opioids or alcohol, fatality is a risk. Common adverse or unwanted short-term side effects of benzodiazepines include:1,4

  • Amnesia.
  • Inattention.
  • Slowed reaction time.
  • Coordination problems.
  • Accidental injuries or automobile accidents.
  • Impaired judgment.
  • Inappropriate sexual or aggressive behavior.
  • Nightmares.
  • Irritability.
  • Hostility.
  • Mood swings.
  • Slurred speech.
  • Stupor or coma.

A benzodiazepine overdose can be serious. Due to its depressant effects on the central nervous system, taking too much of these drugs may decrease the user’s awareness of their surroundings and cause shallow, rapid breathing, reduced heart rate, coma, and even death.1 If you think someone has overdosed on benzodiazepines, seek immediate medical attention by calling 911.

Long-Term Consequences

The longer someone abuses benzodiazepines, the higher the risk of experiencing adverse consequences that not only affect the body, but also negatively impact the emotional and social well-being of the user.

Common long-term consequences of benzodiazepine abuse include:1,3,4

  • Chronically elevated risk of respiratory arrest (especially in the setting of polysubstance use).
  • Marked tolerance, or the need to increase the dose of the drug to achieve the same effect.
  • Increased risk of overdose should use increase to overcome tolerance.
  • Dependence, and increased likelihood of a lengthy and difficult course of withdrawal upon cessation of use.
  • Addiction development.
  • Excessive absences at school or work.
  • Neglect of children or the household.
  • Legal problems resulting from use.
  • Withdrawal from family, friends, work, and/or school.
  • Avoidance of hobbies or other previously enjoyable activities.
  • Cognitive impairment, increased reaction time, motor incoordination.
  • Increased risk of car crashes.
  • Increased risk of hip fractures in the elderly.

One particularly distressing risk of long-term use is that of protracted withdrawal once a chronic benzodiazepine user has quit. These uncomfortable or unpleasant symptoms can last well past the timeframe over which many acute withdrawal symptoms have resolved, which may increase the risk of relapse.

Protracted or Post-Acute Withdrawal

Acute withdrawal is the onset of predictable symptoms following a sudden decrease in the dose of or discontinuation of a drug.6 Allowing time and sustained abstinence from the drug, these symptoms will likely resolve; however, the user may experience symptoms of protracted withdrawal. Protracted withdrawal may share some symptoms with that of the acute withdrawal syndrome but persists for well beyond the expected timeline of acute withdrawal.

Symptoms of protracted benzodiazepine withdrawal commonly wax and wane in intensity and are new to the user, as opposed to the return of symptoms that were present before benzodiazepine use, such as anxiety.6 The symptoms, once they begin, may last for months, but they gradually subside with prolonged abstinence from the drug.6 As these symptoms persist, the user may struggle with functioning without the drug, causing an increased risk of relapse. Protracted benzodiazepine withdrawal symptoms may mimic the symptoms of other mental health disorders, such as:6

  • Agitated depression.
  • Generalized anxiety.
  • Panic disorders.
  • Obsessive-compulsive disorders.
  • Schizophrenia.

Detox and Substance Abuse Treatment

For safety reasons, benzodiazepine withdrawal should be completed in a formal medical detox program. Supervised medical detox may prevent life-threatening complications, such as seizures, that may occur if the patient was left untreated.4,9

Detox is the first step on the continuum of care in which the drug is eliminated from the body while professionals utilize interventions to manage withdrawal symptoms.7  During detox treatment, it is important to begin to form a plan for comprehensive substance abuse treatment, which addresses the underlying issues of drug abuse.

There are 3 essential components to detox treatment. These components may occur concurrently or as a series of steps. They are:9

  • Evaluation: During this phase, information is gathered so the treatment team can create a substance abuse treatment plan to be followed once detox has been completed. During this step, blood tests may be obtained to test for substances, measure levels, and screen for mental and physical conditions. A comprehensive assessment may be performed to assess the user’s medical and psychological conditions and social situation in order to determine an appropriate level of care after detox.
  • Stabilization: In this phase of detox, assistance is provided to the user through both acute intoxication and withdrawal, until a stable, substance-free state is achieved. Important actions during stabilization include the user understanding their role during treatment and recovery and identifying those people who will create the user’s support system, such as friends, family, and coworkers.
  • Fostering the patient’s entry into treatment: The goal of this phase of detox is to prepare the user to enter a substance abuse treatment. If the user has started treatment in the past without successful completion, the treatment center may require the user to sign a contract, which is used to encourage completion of all steps of treatment.

Because addiction is a chronic, relapsing condition, simply stopping the drug is not enough—the user may need long-term or repeated care.8 Addiction treatment will help the user to obtain and maintain sobriety in the long run. Successful addiction treatment includes detox, behavioral counseling, evaluation and treatment for comorbid physical or mental health conditions, and long-term follow-up care, such as support groups or ongoing therapy.8

Sources

  1. Drug Enforcement Administration. (2013). Benzodiazepines.
  2. National Institute on Drug Abuse. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
  3. Johnson, B., Streltzer, J. (2013). Risks Associated with Long-Term Benzodiazepine Use. American Family Physician.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. Semel Institute for Neuroscience and Human Behavior. (2017). Post-Acute Withdrawal Syndrome (PAWS).
  6. U.S. Department of Health and Human Services. (2010). Substance Abuse Advisory. News for the Treatment Field. Protracted Withdrawal.
  7. National Institutes on Drug Abuse. (2017). Frequently Asked Questions.
  8. National Institutes on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
  9. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment.

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