Benzodiazepine Addiction: Signs and Side Effects of Benzodiazepine Abuse

Benzodiazepines are sedatives often prescribed for treating anxiety, panic attacks, insomnia and seizures. Common brand names and their generic versions include Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam) and Valium (diazepam).

On the street, benzodiazepines are known by many names, including benzos, xannies, bars, blues and downers. And, while benzodiazepine misuse, sometimes referred to as abuse, often starts with a valid prescription, it can take a turn when someone takes them in higher doses or frequencies or mixes them with other substances.

These medications can be beneficial when used as directed in the short term, but they can become harmful when abused or used for longer periods than intended. Over time, this misuse can lead to tolerance, dependency and addiction, officially known as a benzodiazepine use disorder.

This guide explores the warning signs and health effects of benzodiazepine abuse, including what makes them addictive, withdrawal symptoms and benzo side effects.

Benzodiazepines work by increasing GABA activity in the brain and central nervous system, which creates calmness, relaxation and sedation. These GABA benzodiazepine effects come on quickly, with most users feeling the onset of effects within 15 minutes to an hour.

Within a few days or weeks of benzo use, a tolerance can start to develop, and people usually experience withdrawal symptoms if they try to stop or lessen their use. They can also develop a psychological dependence if they believe they can’t sleep, relax or manage their stress without benzos.

Factors that can lead someone to misuse or abuse benzodiazepines include:

• They provide fast relief of anxiety and panic symptoms, so people may rely on them during high-stress periods.
• A benzodiazepine tolerance can build quickly, leading people to use higher doses over time to feel the same anxiety or sleep relief.
• Since they’re to be taken “as needed,” people may not understand their limits.
• Using them recreationally or along with other substances, especially other depressants, can enhance their effects.
• They might lack healthy coping skills for mental health disorders and triggers.

Benzodiazepine abuse occurs when someone takes them outside of a prescription, more frequently, in higher doses than prescribed or recreationally to enhance the effects of other substances.

Addiction occurs when a person experiences:

• A loss of control
• Strong cravings
• Compulsive use
• An inability to stop even after experiencing negative consequences

Benzo misuse patterns often start innocently, with people looking for a little extra help to sleep or to deal with stress. Before they know it and without warning, they shift into a pattern that’s difficult to stop.

Examples of benzodiazepine abuse include:

• Taking a double dose of a prescribed benzo because of a stressful day
• Taking a benzo before going out to drink with friends because it enhances the alcohol’s effects
• Crushing and snorting a pill to make the effects stronger and come on faster
• Doctor shopping to obtain multiple prescriptions

Examples of benzodiazepine addiction include:

• Trying several times to cut back or quit without success
• Continuing to take benzos despite the prescription having already ended
• Continuing to use benzos even after experiencing frequent accidents or after loved ones have expressed concern
• Having a strong fear of what life would be like without the benzos to rely on daily

Benzodiazepines can cause both physical and psychological dependence. While dependence isn’t the same thing as addiction, it can be a major warning sign.

The types of dependence include:

• Physical dependence occurs after the nervous system adapts to benzodiazepine exposure, resulting in withdrawal symptoms when people attempt to stop using them.
• Psychological dependence is when a person believes they need the benzos to feel calm, safe or “normal.”

The risk for both types of dependence grows with continued use of benzos. These risks are even higher with high and frequent doses, long-term use or when using short-acting benzos, such as Xanax or Ativan.

Benzo addiction symptoms can manifest in several ways, some of them more obvious than others. In addition to the signs below, people should also look for red flags of more dangerous use. These include mixing benzos with alcohol or other sedatives or driving while impaired.

Behavioral Signs

Behavioral changes are often one of the first signs that a physical dependency has developed or is developing and professional intervention may be needed.

Behavioral signs of benzodiazepine addiction include:

• Taking more than intended
• Running out early or getting early refills
• Using escalating doses over time
• Hiding or denying use
• Buying pills outside of a prescription
• Not being able to sleep, socialize or manage stress without benzos
• Downplaying use because it’s a prescription medicine

Physical Signs

It’s not uncommon for people and their loved ones to notice physical changes after someone misuses benzos for a period of time. These physical signs are sometimes most noticeable in between doses as the body craves more of the drug.

Physical signs of benzodiazepine addiction include:

• Drowsiness
• Poor coordination
• Slowed reaction time
• Slurred speech
• Frequent falls or accidents
• Headaches
• Dizziness
• Sweating

Cognitive Signs

The cognitive signs of benzodiazepine addiction often develop gradually and can be easy to miss, especially when you’re taking medication prescribed for you.

Cognitive signs of benzodiazepine addiction include:

• Memory problems
• Confusion
• Attention issues
• Next day “brain fog”
• Medication-centered thinking

Emotional Signs

The emotional signs of benzo addiction are usually more obvious to the person experiencing them than to others. They may appear normal on the outside while secretly hurting on the inside.

Emotional signs of benzodiazepine addiction include:

• Irritability
• Mood swings
• Emotional blunting
• Increased anxiety between doses
• Loss of motivation
• Emotional dependence

Benzodiazepine withdrawal happens when a person’s brain starts to rebound after adapting to the calming effects of the benzo they were taking. The intensity of this experience varies depending on the size, frequency and duration of doses taken and can be uncomfortable for those who were heavy users.

Benzo withdrawal symptoms include:

• Rebound anxiety
• Depression
• Restlessness
• Insomnia
• Sweating
• Irritability
• Tremors
• Headaches
• Sweating
• Chills

While these symptoms are somewhat common, people can also experience more severe and even life-threatening symptoms.

Severe withdrawal symptoms include:

• Panic attacks
• Hallucinations
• High blood pressure
• Seizures
• Confusion

Any time benzodiazepines are misused or abused, the side effects can be severe and far-reaching. Benzodiazepine side effects can be short-term or long-term while affecting people physically, cognitively and emotionally.

Short-Term Effects

The fast-acting effects of benzos make them both appealing and risky, despite the fast relief they can provide for insomnia, stress or anxiety. Understanding these short-term effects helps explain why misuse can escalate before a person even realizes it.

Short-term effects of benzodiazepine abuse include:

• Sedation
• Dizziness
• Slowed thinking
• Impaired coordination
• Poor judgment
• Slurred speech
• Nausea or vomiting

Benzos can also have mental and emotional effects on a person. Over time, these effects can be cognitive and more difficult to reverse, even after benzo use has discontinued.

Cognitive effects of benzodiazepine abuse include:

• Memory impairment
• Reduced concentration and focus
• Confusion
• Impaired decision-making and judgement
• Reduced problem-solving skills
• Language and verbal problems

Emotional effects of benzodiazepine abuse include:

• Mood swings
• Depression symptoms
• Irritability
• Emotional numbness
• Loss of motivation
• Heightened sensitivity to stress

Long-Term Concerns

You should only take benzodiazepines for short periods of time. Any time they’re used longer than recommended by a medical professional, it can affect your brain and body in lasting ways. This is especially true if you’re mixing them with other substances. Knowing these potential long-term benzo effects highlights the importance of early intervention.

Long-term effects of benzodiazepine abuse include:

• Tolerance build-up
• Dependency and addiction
• Worsening anxiety over time
• Higher risk of accidents and injury
• Chronic memory problems
• Sleep disturbances
• Respiratory depression
• Increased risk of benzodiazepine overdose

While it’s true that benzodiazepine addiction can happen to anyone, the actual risk for benzodiazepine addiction isn’t the same for everyone. A person’s level of risk usually depends on their personal history, mental health and daily behaviors.

Mental Health Factors

People with certain types of co-occurring disorders or mental health issues may be tempted to self-medicate with benzos, especially because they’re so fast-acting. Unfortunately, long-term use can make these issues worse and further perpetuate the negative cycle.

Mental health benzo misuse risk factors include:

• Anxiety disorders
• Panic symptoms
• Post-traumatic stress disorder (PTSD)
• Depression
• Chronic stress
• Undiagnosed mental health symptoms

Behavioral Factors

Behavioral risk factors for benzo addiction can be especially dangerous because they tend to accelerate tolerance and reinforce psychological dependence. These behaviors can also make withdrawal more severe and more dangerous.

Behavioral benzo misuse risk factors include:

• Using benzos to cope with stress or uncomfortable emotions
• Using benzos to sleep on a nightly basis
• Using benzos past the prescribed or recommended period
• Mixing benzos with other substances to enhance their relaxation or sedation effects
• Ignoring or minimizing the risks or warning signs

Substance History Factors

A history of substance use or abuse can change the way the brain’s reward system works, which can make benzodiazepine misuse even more reinforcing and harder to stop. It can be especially difficult for those with a previous history of abusing benzos.

Substance history risk factors include:

• Having a previous history of substance abuse, especially with alcohol, opioids or other sedatives
• Having family members with a previous history of substance abuse
• Early exposure to prescription or over-the-counter sedatives

Medication and Access Factors

Ease of access and certain characteristics of the medication make it easy to misuse and build up a tolerance. Unfortunately, this can be true even in people who take benzos exactly as directed.

Medication and access risk factors include:

• Long-term prescriptions
• Higher doses
• Rapid dose changes
• Using without close follow-up or monitoring
• Using when there are safer alternatives available
• Leftover prescriptions
• Shared pills or easy availability through social circles

Before moving forward with addiction treatment for benzodiazepine use disorder, it’s essential to receive an official diagnosis from a health care provider. The clinician diagnoses you based on substance abuse disorder criteria and patterns in your usage. People try to downplay their misuse due to benzos being a prescription medication, but it’s important to be honest during this evaluation so recognition isn’t delayed.

Your clinician will evaluate you based on:

• Loss of control
• Cravings
• Tolerance
• Withdrawal
• Risky use
• Continued use despite harm

In addition to your diagnosis, a clinician may also perform a mental health screening and risk assessment. This assessment looks at drug abuse behaviors, such as mixing substances, driving while impaired or having frequent falls and accidents. After diagnosis, you can consider the treatment options, such as inpatient rehab and outpatient rehab.

Benzodiazepine dependence can happen to anyone and isn’t a personal failure. However, it can be dangerous, and you should take immediate action if you or a loved one mixes it with other medications or experiences withdrawal symptoms, memory problems, falls or escalating use.

Help.org offers free, confidential services to help you find a rehab in your area that treats benzo addiction. No one has to go through benzo addiction alone. Call us on our helpline as soon as you’re ready to get started.