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Benzodiazepines: Uses, Effects, Risks, Withdrawal

Last Updated: January 6, 2025

Benzodiazepines are a class of psychoactive drugs that enhance the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that calms the nervous system. They are widely prescribed for anxiety, insomnia, and seizure disorders, making them one of the most commonly used medications in the world.

In the U.S., approximately 12.6% of adults have used benzodiazepines at some point, with 2.1% engaging in misuse, according to the National Institute on Drug Abuse (NIDA). Misuse rates are higher among younger populations, while older adults are more likely to use these drugs for legitimate medical reasons, reflecting a dual demographic challenge.

Table Of Contents:

What are Benzodiazipines?
What are the Types of Benzodiazepines?
What Medical Conditions Are Benzodiazepines Used to Treat?
What are the Side Effects of Benzodiazepines?
How are Benzodiazepines Taken?
Who is at Risk of Miusing Benzodiazepines?
What are the Overdose Effects of Benzodiazepines?
Do you Need to Detox from Benzodiazepines?
How Do Benzodiazepines Affect the Brain and Body?

Medically, benzodiazepines are important for the short-term management of conditions like severe anxiety, insomnia, and alcohol withdrawal. They are also used in surgery for sedation and as anticonvulsants in epilepsy.

Common effects of benzodiazepines include relaxation, sedation, and reduced anxiety, which make them effective but also contribute to misuse.

Frequent or long-term use leads to dependence, as the brain adapts to their presence, increasing the risk of addiction when taken outside prescribed guidelines.

Withdrawal from benzodiazepines is severe, with symptoms such as insomnia, anxiety, and tremors being among the most commonly reported, highlighting the risks associated with discontinuation.

What are Benzodiazipines?

Benzodiazepines are a class of psychoactive drugs commonly prescribed to treat anxiety, insomnia, seizures, and muscle spasms. According to the National Cancer Institute, Benzodiazepine is defined as “a type of drug used to relieve anxiety and insomnia (trouble sleeping). Benzodiazepines relax muscles and prevent seizures. They increase the effect of a chemical in the brain called GABA, which is a neurotransmitter (a substance that nerves use to send messages to one another). This causes brain activity to slow down. Benzodiazepines are a type of CNS depressant.”

Benzodiazepines are widely used for their fast-acting relief of symptoms and are classified as central nervous system (CNS) depressants.

Chemically, benzodiazepines consist of a benzene ring fused to a diazepine ring, forming their distinct structure. They bind to GABA-A receptors in the brain, increasing the receptor’s affinity for GABA and leading to an enhanced inhibitory effect on neuronal activity. This results in reduced anxiety, sedation, and muscle relaxation.

Examples of benzodiazepine include diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax). While effective, prolonged use of benzodiazepine leads to tolerance, dependence, and withdrawal symptoms, making careful medical supervision necessary.

How do Benzodiazepines Work?

Benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits excessive brain activity and promotes calmness. They bind to specific sites on GABA-A receptors in the central nervous system, increasing the receptor’s ability to bind with GABA, according to the European Union Drug Agency (EUDA) in “Benzodiazepines Drug Profile.” This enhanced binding amplifies the inhibitory effect of GABA and allows more chloride ions to flow into the post-synaptic neuron. This depresses the nerve impulses, causing them to slow down or stop, leading to a reduction in nerve impulses and producing sedative, anxiolytic (anti-anxiety), muscle-relaxing, and anticonvulsant effects.

The action of benzodiazepines results in the suppression of overactive neural circuits, which is why they are commonly prescribed for conditions like anxiety disorders, insomnia, epilepsy, and muscle spasms. These effects occur rapidly, making benzodiazepines effective for acute symptom relief. However, long-term use leads to tolerance, dependence, and withdrawal, requiring careful monitoring by healthcare providers.

What are the Types of Benzodiazepines?

The types of benzodiazepines include Alprazolam (Xanax), Diazepam (Valium), and Clonazepam (Klonopin). Alprazolam is a short-acting benzodiazepine prescribed for anxiety and panic disorders due to its rapid onset of action. Diazepam, a long-acting option, is used for anxiety, muscle spasms, and alcohol withdrawal, offering sustained relief. Clonazepam, another long-acting benzodiazepine, is primarily prescribed for seizures and panic disorders, with its extended effects making it suitable for chronic management. These medications vary in duration and intensity, addressing different therapeutic needs while carrying a risk of dependence.

The types of benzodiazepines are as follows:

Alprazolam (Xanax): Alprazolam is a short-acting benzodiazepine commonly prescribed for managing anxiety disorders and panic attacks. Alprazolam works by enhancing the activity of GABA, a calming neurotransmitter in the brain, to reduce nervous system hyperactivity. Alprazolam’s rapid onset makes it effective for acute episodes of anxiety; however, its short duration of action leads to frequent dosing and increased risks of dependence and withdrawal symptoms with prolonged use. According to the National Institute on Drug Abuse (NIDA), in 2020, 1.2% of individuals aged 12 and older misused Xanax, with young adults (18-25) showing the highest abuse rate at nearly 11%. Over 50 million prescriptions are written annually for Xanax, yet misuse contributes to almost 125,000 emergency room visits for overdose. The starting oral dosage of Xanax for treating Generalized Anxiety Disorder (GAD) ranges from 0.25 mg to 0.5 mg, taken three times daily, with a maximum recommended daily dosage of 4 mg, divided into smaller doses. However, exceeding 3 mg daily increases the risk of overdose.
Diazepam (Valium): Diazepam is a long-acting benzodiazepine used to treat anxiety, seizures, muscle spasms, and symptoms of alcohol withdrawal. It provides sustained symptom relief due to its long half-life, lasting several hours. Its sedative and muscle-relaxant properties make it versatile, but long-term use leads to accumulation in the body and potential dependence. Diazepam is one of the most commonly prescribed benzodiazepines, with 71,000 people aged 12 or older misusing diazepam in 2020, according to the National Survey on Drug Use and Health in the United States. For managing anxiety, diazepam is prescribed at an initial dose of 2 mg, taken three times daily. If needed, the dose is increased to a range of 5 mg to 10 mg, taken three times daily, depending on the individual’s response and severity of symptoms. Treatment duration is short-term, ideally not exceeding four weeks, to minimize the risks of dependency and side effects.
Clonazepam (Klonopin): Clonazepam is a long-acting benzodiazepine prescribed primarily for seizures and panic disorders. It stabilizes electrical activity in the brain, making it effective for managing epilepsy and anxiety. Its extended half-life allows for less frequent dosing compared to short-acting benzodiazepines, but prolonged use increases the risks of tolerance, dependence, and withdrawal. According to the National Institute on Drug Abuse (NIDA), in 2020, 6.2 million people in the U.S. misused Klonopin, with over 75,000 emergency room visits in 2011 linked to its complications. For panic disorder, Klonopin is prescribed at an initial dose of 0.25 mg twice daily, with gradual increases up to a maximum of 4 mg/day over 6-9 weeks, followed by a gradual taper for discontinuation.
Lorazepam (Ativan): Lorazepam is a short-to-intermediate-acting benzodiazepine commonly prescribed for anxiety, insomnia, and seizures. It is frequently used in medical settings for acute agitation or pre-procedural sedation. Its fast action and predictable effects make it effective, but it should be used with caution as dependence develops with long-term use. In 2020, 4.8 million people in the U.S. aged 12 and older misused lorazepam and other benzodiazepines, though not all developed addiction, according to the Substance Abuse and Mental Health Services Administration, 2021. Lorazepam is prescribed for anxiety at 1-4 mg daily for short-term use, ranging from a few days to four weeks.
Chlordiazepoxide (Librium): Chlordiazepoxide is a long-acting benzodiazepine frequently used to manage alcohol withdrawal symptoms and anxiety. Its prolonged action helps smooth withdrawal effects over time, reducing the likelihood of severe withdrawal-related complications. Due to its slower onset, it is less prone to misuse compared to faster-acting benzodiazepines.
Temazepam (Restoril): Temazepam is a short-acting benzodiazepine primarily prescribed for insomnia. It helps induce and maintain sleep by slowing down brain activity. While effective for short-term treatment, its sedative effects carry over into the next day if misused or used in higher-than-prescribed doses.
Triazolam (Halcion): Triazolam is a very short-acting benzodiazepine mainly prescribed for severe insomnia. Its rapid onset helps users fall asleep quickly, but its effects wear off within a few hours, making it suitable for those who struggle to initiate sleep. Its potency and short duration make it less ideal for long-term use due to its potential for dependence.
Midazolam (Versed): Midazolam is a short-acting benzodiazepine used in medical procedures to induce amnesia during surgeries and for sedation. Its quick onset and short half-life make it ideal for controlled, short-term medical use. It is rarely prescribed for long-term treatment outside of procedural contexts.
Oxazepam (Serax): Oxazepam is a short-acting benzodiazepine commonly prescribed for anxiety and alcohol withdrawal symptoms, particularly in patients with liver impairment. Its slower onset reduces the likelihood of misuse while effectively calming the nervous system. It is chosen for patients requiring a safer metabolism pathway.
Flurazepam (Dalmane): Flurazepam is a long-acting benzodiazepine used to treat chronic insomnia. It helps patients fall asleep faster and stay asleep longer, but due to its extended duration, it results in next-day drowsiness. It is most effective for short-term use to avoid tolerance and dependence.
Clobazam (Onfi): Clobazam is primarily used to treat seizure disorders such as Lennox-Gastaut syndrome. It has anticonvulsant properties and a milder sedative effect compared to other benzodiazepines, making it suitable for managing epilepsy. Its controlled action minimizes excessive sedation while stabilizing brain activity.
Estazolam (ProSom): Estazolam is a medium-acting benzodiazepine prescribed for short-term management of insomnia. It helps patients fall asleep faster and reduces nighttime awakenings. Its sedative effects are effective for those with transient sleep issues but carry risks of dependence with prolonged use.
Nitrazepam (Mogadon): Nitrazepam is a long-acting benzodiazepine used to manage severe insomnia and certain seizure disorders. It is highly effective in inducing sleep and controlling epileptic activity but is less commonly prescribed in the U.S. due to concerns about next-day drowsiness and dependence.
Bromazepam (Lectopam): Bromazepam is an intermediate-acting benzodiazepine used for anxiety management. It has a moderate onset and duration, providing calming effects without causing extreme sedation. Its use requires caution to prevent dependence, especially with prolonged or high-dose therapy.

More About Benzodiazepines:

What Medical Conditions Are Benzodiazepines Used to Treat?

The medical conditions benzodiazepines are used to treat are anxiety disorders, panic disorder, and generalized anxiety disorder (GAD). These medications are also commonly prescribed for conditions like insomnia and seizure disorders, where they help manage symptoms and improve quality of life.

The medical conditions benzodiazepines are used to treat are as follows:

Anxiety Disorders: Benzodiazepines are prescribed to treat various anxiety disorders, including panic disorder and social anxiety disorder. They work by calming the central nervous system and providing immediate relief from acute anxiety symptoms. Anxiety disorders affect over 40 million adults in the U.S. (19.1%), according to the National Alliance on Mental Illness. The lifetime prevalence of anxiety disorders among American adults is 28.8%. Benzodiazepines like Xanax and Ativan are effective for short-term management of severe anxiety disorder.
Panic Disorder: Panic disorder is characterized by recurrent and unexpected panic attacks, which are debilitating. Benzodiazepines such as Klonopin and Ativan help reduce the intensity and frequency of panic attacks by acting quickly on the brain’s GABA receptors, which induce a calming effect. According to the National Institute of Mental Health, panic disorder affects 2–3% of Americans annually, with women being twice as likely as men to develop the condition.
Generalized Anxiety Disorder (GAD): GAD involves excessive, uncontrollable worry that interferes with daily life. Benzodiazepines alleviate these symptoms in the short term by inducing relaxation and reducing excessive nervous energy. Generalized Anxiety Disorder (GAD) affects 6.8 million adults, or 3.1% of the U.S. population, annually, with women being twice as likely as men to experience it, according to a report by the Anxiety and Depression Association of America, 2022. Over a lifetime, an estimated 5.7% of U.S. adults will experience GAD at some point in their lives.
Insomnia: Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early and not being able to get back to sleep. Insomnia is described as acute (short-term) or chronic (lasting at least three times a week for three months or more). Insomnia leads to daytime fatigue, mood disturbances, and difficulty concentrating, affecting overall well-being. Benzepines like Temazepam are commonly used for treating insomnia by helping patients fall asleep faster and stay asleep longer. According to the National Institute of Neurological Disorders and Stroke (NINDS), insomnia is common, with up to 30% of adults experiencing short-term insomnia and around 10% suffering from chronic insomnia. Benzodiazepines are commonly prescribed for short-term use due to risks of tolerance and dependence.
Seizure disorders (e.g., epilepsy): Seizure disorders, such as epilepsy, are neurological conditions that cause recurrent, unprovoked seizures. A seizure occurs when there is a sudden, abnormal electrical activity in the brain, leading to symptoms like convulsions, muscle spasms, or altered consciousness. Seizure disorders vary in severity, from mild episodes that last only a few seconds to more severe seizures that lead to loss of consciousness and injury. Benzodiazepines, such as Valium and Ativan, are prescribed to manage seizures by stabilizing electrical activity in the brain. They help by calming neuronal activity and preventing seizure onset during acute episodes. Seizures affect approximately 1 in 26 people in the U.S., according to the Epilepsy Foundation. Anti-seizure medications, including benzodiazepines, control seizures in about 60% to 70% of people with epilepsy, as reported by
Alcohol Withdrawal Syndrome: Alcohol Withdrawal Syndrome (AWS) occurs when a person who has been heavily drinking for a prolonged period suddenly stops or reduces alcohol consumption. The symptoms range from mild to severe, including tremors, anxiety, sweating, nausea, and seizures. In some cases, more serious conditions such as delirium tremens (DTs), which involve confusion, hallucinations, and potentially life-threatening symptoms, also occur. Benzodiazepines are considered the gold-standard treatment for alcohol withdrawal syndrome (AWS). Benzodiazepines, such as Chlordiazepoxide (Librium), Diazepam (Valium), and Lorazepam (Ativan), work by calming the central nervous system, reducing anxiety, preventing seizures, and stabilizing the patient’s condition during the withdrawal process. Benzos help prevent complications like DTs and alleviate the discomfort associated with alcohol withdrawal. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), up to 20% of individuals with alcohol dependence experience severe withdrawal symptoms.
Muscle Spasms: Muscle spasms occur when muscles contract uncontrollably, causing pain and discomfort. These spasms are commonly associated with conditions such as multiple sclerosis, spinal cord injuries, or other neurological disorders. Benzodiazepines, like Diazepam (Valium) and Clonazepam (Klonopin), are used to treat muscle spasms due to their ability to relax muscles and alleviate pain. These medications work by acting on the central nervous system to reduce muscle tension and improve overall mobility. Benzodiazepines are particularly helpful in managing the chronic pain and discomfort associated with conditions that affect the muscles and nerves.
Restless Legs Syndrome (RLS): Restless Legs Syndrome (RLS) is a condition characterized by an uncontrollable urge to move the legs, accompanied by discomfort or an unpleasant sensation in the evening or at night. Benzodiazepines, such as Clonazepam (Klonopin), are sometimes prescribed to manage the anxiety and pain associated with RLS. Benzos help calm the central nervous system, reducing the need to move and improving sleep quality. The prevalence of Restless Legs Syndrome (RLS) in the general population ranges from 5% to 15%, according to research by Ohayon MM et al. 2012, titled “Epidemiology of restless legs syndrome: A synthesis of the literature.” Among primary healthcare patients, the prevalence of RLS is reported to be as high as 5.2%, with individuals between 45 and 60 years of age being most affected.
Post-traumatic Stress Disorder (PTSD): Post-traumatic Stress Disorder (PTSD) is a mental health condition that develops after an individual experiences a traumatic event. PTSD is characterized by symptoms such as flashbacks, nightmares, severe anxiety, and insomnia. Benzodiazepines, such as Lorazepam (Ativan), are used short-term to alleviate distressing feelings in PTSD patients, although other treatments like therapy and antidepressants tend to be more effective in the long term. Approximately 7-8% of the U.S. population will experience PTSD at some point in their lives, according to the National Institute of Mental Health (NIMH).
Preoperative Sedation: Preoperative sedation involves using medications to prepare patients for surgery by reducing anxiety, inducing relaxation, and promoting sedation. Benzodiazepines, such as Midazolam (Versed), are commonly prescribed in these settings for their rapid onset and calming effects. They help ensure a smoother procedure by calming nervous patients and minimizing the stress response during surgery. Preoperative sedation is particularly important for patients undergoing invasive or high-stress procedures, contributing to a better surgical experience for both the patient and healthcare providers.
Agitation in Acute Psychosis: Agitation in acute psychosis refers to a state of extreme restlessness, confusion, and behavioral disturbance seen in psychiatric conditions such as schizophrenia or bipolar disorder. Benzodiazepines, such as Lorazepam (Ativan), are commonly used in emergency settings to calm the individual and reduce agitation rapidly. These medications help prevent harmful behaviors by stabilizing the patient during psychiatric crises, making them important in managing acute episodes. According to research from the Journal of Clinical Psychopharmacology, benzodiazepines are considered a first-line treatment for agitation in psychiatric emergencies.
Status Epilepticus: Status epilepticus is a medical emergency where seizures last for an extended period or occur in rapid succession without recovery between them. Benzodiazepines, particularly Diazepam (Valium) and Lorazepam (Ativan), are the first-line treatments due to their ability to suppress seizures and stabilize the patient rapidly. These medications prevent prolonged brain activity, reducing the risk of brain damage or death.
Bipolar Disorder (for Acute Agitation or Insomnia): In patients with bipolar disorder, benzodiazepines like Lorazepam (Ativan) are used to manage acute symptoms of agitation or insomnia. While these drugs provide short-term relief, they are used in conjunction with mood stabilizers or antipsychotics for long-term management of the disorder. Benzodiazepines help reduce the anxiety and sleep disturbances that exacerbate mood swings, particularly during manic or depressive episodes. Bipolar disorder affects approximately 2.8% of U.S. adults, according to the National Institute of Mental Health (NIMH), and while benzodiazepines are useful for immediate symptom control, they are not a long-term solution due to the risk of dependency.
Vertigo (to Manage Associated Anxiety): Vertigo, a condition caused by inner ear disturbances, leads to intense dizziness and anxiety. Benzodiazepines such as Diazepam (Valium) are sometimes prescribed to help alleviate these symptoms by calming the central nervous system, reducing the anxiety associated with dizziness, and improving overall balance. Benzodiazepines provide quick relief, but they are considered a short-term treatment while addressing the underlying cause of vertigo, such as benign paroxysmal positional vertigo (BPPV) or Meniere’s disease.

What are the Side Effects of Benzodiazepines?

The effects of benzodiazepines include drowsiness, dizziness, and confusion, which are neurological side effects that impair mental functioning and coordination. Drowsiness is a common side effect of benzodiazepines, experienced shortly after taking the medication, as the drug depresses the central nervous system. Dizziness occurs as a result of reduced blood pressure or sedation, making individuals feel lightheaded or unsteady. These side effects are temporary, but they are more severe in individuals who take high doses or misuse benzodiazepines.

The effects of benzodiazepines are as follows:

Drowsiness: Drowsiness is a common side effect caused by benzodiazepines depressing the central nervous system (CNS). According to Mind in “Side effects of benzodiazepines,” 44.7% of benzodiazepine users experience drowsiness, which impairs daily activities such as driving or operating machinery. This effect is experienced shortly after taking the medication and lasts for several hours, especially if the dosage is high. It is considered a physical side effect.
Dizziness: Dizziness is a neurological side effect that is caused by benzodiazepines’ CNS-depressing properties. It manifests as lightheadedness or a sensation of imbalance and occurs soon after taking the drug. Prolonged use or misuse increases the risk of more severe dizziness.
Confusion: Confusion refers to impaired thinking, poor judgment, and difficulty concentrating. It is a neurological side effect experienced with regular use of benzodiazepine, especially with higher doses or long-term use. A prospective cohort study by Foy A et al. 1995, titled “Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients,” involving 418 inpatients aged 59-88 years with normal cognitive function at admission found that 10.8% of patients developed cognitive impairment during their hospital stay. This study highlighted that those using benzodiazepines at doses equivalent to 5 mg or more of diazepam had a significantly higher risk of cognitive impairment, with benzodiazepine use accounting for 29% of the cases. The study also identified other factors, such as alcohol consumption, CNS disease, and hypoxia, as contributing to cognitive decline and delirium, with the latter affecting 5% of patients.
Memory Impairment: Memory problems, including short-term memory loss, occur because benzodiazepines interfere with brain function, especially at higher doses. These physical side effects are distressing and persist even after the drug is discontinued, depending on the duration of use. In a study by Gray SL et al. 2016, titled “Benzodiazepine use and risk of incident dementia or cognitive decline: a prospective population-based study,” of 3,434 participants aged 65 and older, 23.2% developed dementia over a mean follow-up of 7.3 years. This study found that even minimal benzodiazepine exposure (1-30 standardized daily doses) was associated with a slightly higher risk of dementia, with a hazard ratio of 1.25.
Blurred Vision: Blurred vision is a physical side effect of benzodiazepine use caused by the drug’s sedative properties. It occurs shortly after taking the drug, as it affects the nervous system and impairs the ability to perform tasks requiring clear vision, such as reading or driving. In a study of 30 long-term benzodiazepine users by Stafanous SN et al. 1999, titled “The effect of long-term use of benzodiazepines on the eye and retina,” 63.3% reported vision-related symptoms, but none had reduced visual acuity, except for two cases of longstanding amblyopia. Thirteen patients exhibited retinal changes, though electroretinography (ERG) tests showed no abnormal results related to the medication, suggesting that long-term use has minimal impact on retinal function.
Fatigue: Fatigue is another common side effect and occurs with both short- and long-term benzodiazepine use. This symptom results from CNS depression, which induces a sense of tiredness or lack of energy and lasts for hours after the drug is taken.
Muscle Weakness: Muscle weakness occurs as a result of the sedating effects of benzodiazepines, especially when taken in higher doses. This affects a person’s ability to carry out physical activities, and it is more severe in those who misuse the drug or combine it with other CNS depressants.
Slurred Speech: Slurred speech is a physical side effect that occurs shortly after taking benzodiazepines. It results from CNS depression, which impairs motor control and coordination, making speech unclear or difficult to understand.
Nausea: Nausea is a common side effect of benzodiazepine use, especially at higher doses. It is short-lived, though it is uncomfortable, and it occurs alongside other digestive issues like dry mouth or constipation.
Headache: Headaches are a side effect of benzodiazepine use. They are caused by dehydration or the way the drug interacts with the brain. The severity varies from mild to moderate and lasts for a few hours after taking the benzodiazepine.
Dry Mouth: Dry mouth is a physical side effect caused by benzodiazepines’ sedative effects, which reduce saliva production. This symptom is unpleasant and leads to difficulty swallowing or speaking.
Depression: Depression develops as a side effect of long-term benzodiazepine use, according to a study by Lim B et al. 2020, titled “Understanding the effects of chronic benzodiazepine use in depression: a focus on neuropharmacology.” The medication alters neurotransmitter levels in the brain, leading to feelings of sadness, hopelessness, and emotional blunting. This requires adjusting the dosage or discontinuing use.
Reduced Coordination: Benzodiazepines use impairs motor coordination, leading to clumsiness or difficulty with balance. This neurological side effect makes tasks like walking or driving dangerous and is more severe at higher doses.
Irritability: Irritability is a benzodiazepine withdrawal symptom that occurs when reducing or stopping benzodiazepine use, especially after long-term usage. The brain becomes accustomed to the calming effects of the drug, and without it, the individual experiences heightened agitation or frustration.
Dependence: Dependence is a significant risk with long-term benzodiazepine use. It is a psychological and physical adaptation of the body to the drug, leading to withdrawal symptoms when the drug is discontinued or reduced. It develops after prolonged use and leads to tolerance, requiring higher doses to achieve the same effect.
Withdrawal Symptoms: Benzodiazepine withdrawal symptoms include anxiety, sweating, shaking, and, in severe cases, seizures. These symptoms occur when someone becomes dependent on benzodiazepines and attempts to stop using them abruptly. About 40% of people who take benzodiazepines for more than six months experience moderate to severe withdrawal symptoms if they stop suddenly, according to Verywell Mind in “How Long Does Withdrawal From Benzodiazepines Last?” Withdrawal is life-threatening and should be managed by a medical professional.
Respiratory Depression (with High Doses): Respiratory depression is a serious side effect that occurs when high doses of benzodiazepines are taken, especially if combined with other depressants like alcohol or opioids. It reduces the body’s ability to breathe properly and is fatal if not treated immediately.
Impaired Judgment: Impaired judgment is a side effect of benzodiazepines that affects decision-making and the ability to assess risks. This occurs because of the CNS depression induced by the drug, which leads to risky behavior or poor choices, such as driving under the influence.
Reduced Libido: Reduced libido, or sexual dysfunction, is a side effect that occurs with benzodiazepine use, particularly with long-term use. It is thought to be related to the drug’s impact on the central nervous system and its ability to alter hormone levels, leading to decreased sexual desire or performance.

How are Benzodiazepines Taken?

Benzodiazepines are consumed in various forms, most commonly as oral tablets, capsules, or gel capsules taken with water. Depending on the specific medication and the condition being treated, they are prescribed for use once, twice, or multiple times daily. For instance, short-acting benzodiazepines like Triazolam are recommended before bedtime for insomnia, while longer-acting benzodiazepines like Diazepam are taken at regular intervals for anxiety or seizures.

Other forms of administration include intravenous (IV) or intramuscular (IM) injections, used in hospital settings for acute conditions like seizures or severe agitation. Some benzodiazepines are also administered rectally (as suppositories) for rapid absorption in emergencies. In rare cases, powdered forms are dissolved for customized dosing or specific medical needs. Regardless of the form, benzodiazepines should always be taken under medical supervision, as improper use leads to dependency or adverse effects.

Who is at Risk of Miusing Benzodiazepines?

People at risk of misusing benzodiazepines include individuals with a history of substance abuse, those with untreated mental health conditions such as anxiety or depression, and individuals experiencing chronic stress or insomnia. Misuse is also common among individuals who take benzodiazepines without a prescription or exceed the prescribed dosage.

Young adults aged 18–25 are particularly vulnerable, with an estimated 2.4% misusing these medications in the past year, according to results from the 2013 National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration.

According to the National Institute on Drug Abuse (NIDA), in “Benzodiazepines and Opioids,” a significant proportion of benzodiazepine misuse occurs among those using the drug to self-medicate for emotional distress or sleep disorders. Additionally, healthcare professionals or individuals with easy access to prescription medications are at increased risk due to availability.

Socioeconomic factors, such as unemployment or low income, also contribute to misuse, as these stressors lead individuals to seek relief through readily accessible medications. Older adults are another at-risk group, as long-term use of benzodiazepines for sleep or anxiety leads to physical dependence and accidental misuse due to cognitive decline or medication interactions.

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What are the Overdose Effects of Benzodiazepines?

The overdose effects of benzodiazepines are extreme drowsiness, confusion, and respiratory depression. These symptoms arise from the sedative effects of benzodiazepines on the central nervous system (CNS), which severely impair vital bodily functions. Benzodiazepine overdose is rarely fatal when taken alone but becomes significantly more dangerous when combined with alcohol or opioids. In 2020, over 12,000 deaths in the U.S. involved benzodiazepines in combination with other drugs, according to the National Institute of Drug Abuse (NIDA), reflecting the serious risks associated with misuse and overdose.

The overdose effects of benzodiazepines are as follows:

Extreme Drowsiness: Drowsiness is the most common effect of benzodiazepine overdose and is characterized by profound sedation and difficulty staying awake. It occurs due to the overactivation of gamma-aminobutyric acid (GABA) receptors in the brain, leading to excessive CNS depression. While not immediately fatal, extreme drowsiness escalates into unresponsiveness without prompt medical intervention.
Confusion: Confusion arises from the drug’s impact on cognitive and neurological functions, impairing memory, concentration, and orientation. It happens because benzodiazepines reduce neuronal activity excessively. This condition is particularly dangerous as it leads to accidents or risky behaviors, especially in older adults.
Slurred Speech: Slurred speech happens because benzodiazepines reduce muscle control in the mouth and vocal cords. This symptom is an early indicator of overdose severity and escalates to respiratory depression in acute cases.
Weakness: Weakness occurs due to impaired neuromuscular transmission. This hinders mobility and coordination, making even basic tasks challenging. Prolonged weakness in an overdose scenario signifies worsening CNS depression.
Blurred Vision: Blurred vision is caused by the drug’s effect on ocular muscles and neural pathways controlling vision. Although temporary, it contributes to accidents if an individual attempts to drive or operate machinery.
Difficulty Breathing: Benzodiazepines suppress the respiratory centers in the brainstem, leading to slow, shallow, or irregular breathing. This is particularly life-threatening when paired with other CNS depressants.
Unresponsiveness: Unresponsiveness signals a severe overdose stage. At this point, the brain’s ability to respond to external stimuli is critically diminished. This condition requires immediate medical intervention.
Coma: In severe overdose cases, individuals fall into a coma, where they remain unconscious and unresponsive. This happens due to profound CNS suppression and requires immediate medical attention to prevent long-term damage or death, according to a study by Hojer J, Baehrendtz S. et al. 1988, titled “The effect of flumazenil (Ro 15-1788) in the management of self-induced benzodiazepine poisoning. A double-blind controlled study.”
Low Blood Pressure: Hypotension occurs due to the drug’s depressant effect on the cardiovascular system. If not treated promptly, it results in dizziness, fainting, or even shock.
Slow Reflexes: Overdose disrupts the CNS, reducing reflex response times. This is dangerous, particularly in situations requiring quick reactions, such as driving.
Respiratory Depression: Respiratory depression is a potentially fatal effect that results when benzodiazepines suppress the brain’s respiratory centers, leading to shallow or slowed breathing. It is most severe when benzodiazepines are mixed with other CNS depressants like alcohol or opioids. In such cases, the risk of fatal overdose increases significantly.
Death (Rare, in Isolated Use): While benzodiazepines alone rarely cause fatal overdoses, the risk of death rises sharply when combined with other substances. Multi-drug toxicity is a leading factor in benzodiazepine-related fatalities. Between January 2019 and June 2020, benzodiazepines were involved in 6,982 (16.8%) of 41,496 reported overdose deaths across 23 states, according to the CDC. Notably, opioids contributed to 91.4% (6,384) of these benzodiazepine-related deaths, emphasizing the significant risk associated with their combined use, according to “Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines — 38 States and the District of Columbia, 2019–2020”).”

Do you Need to Detox from Benzodiazepines?

Yes, detoxing from benzodiazepines is necessary for individuals who have developed dependence or are misusing the medication. Benzodiazepine detox involves a carefully managed process of gradually tapering off the drug to avoid severe withdrawal symptoms such as seizures, anxiety, or life-threatening complications. This process is usually performed under medical supervision in a medical detox center to ensure safety and provide supportive care.

Holistic detox approaches complement medical detox, focusing on physical, mental, and emotional well-being through techniques like nutrition therapy, exercise, mindfulness, and counseling. The detox process varies depending on the individual’s level of dependence, the duration of use, and the specific benzodiazepine taken, emphasizing the importance of a tailored, supervised approach.

How Does Benzodiazepine Detox Work?

Benzodiazepine detox works by gradually reducing the dosage of the medication to minimize withdrawal symptoms while safely removing the drug from the body. This process, known as tapering, is designed to avoid sudden discontinuation, which leads to severe symptoms such as seizures, anxiety, and insomnia, according to a study by Alexander B., Perry PJ. et al. 1991, titled “Detoxification from benzodiazepines: schedules and strategies.”

Detoxification is done at home under strict medical supervision for individuals with mild dependence, but clinical detox programs are recommended for more severe cases. In clinical settings, healthcare professionals monitor the patient’s condition, provide medications to manage symptoms, and offer psychological support. These programs also connect patients with recovery resources such as counseling and addiction treatment plans. Both at-home and clinical detox approaches prioritize safety and comfort, making medical guidance necessary for a successful and sustainable recovery.

How Do Benzodiazepines Affect the Brain and Body?

Benzodiazepines affect the brain and body by enhancing the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the central nervous system. They bind to specific sites on GABA-A receptors, increasing GABA’s ability to induce neuronal relaxation and reduce excitability. This action leads to various effects, such as sedation, muscle relaxation, anxiolysis (reduction of anxiety), and anticonvulsant properties, according to a study by Griffin CE 3rd et al. 2013, titled “Benzodiazepine pharmacology and central nervous system-mediated effects.”

Chemically, benzodiazepines are characterized by a benzene ring fused to a seven-membered diazepine ring, which allows them to interact with GABA-A receptors effectively. While their primary influence is on the GABAergic system, benzodiazepines also indirectly affect other neurotransmitters like serotonin and dopamine by modulating overall brain activity and reducing anxiety levels. These interactions contribute to their therapeutic benefits in treating conditions such as anxiety disorders, insomnia, seizures, and muscle spasms, but they also highlight the potential for side effects and dependence with prolonged use.

Why Does Benzodiazepine Use Lead to Addiction?

Benzodiazepine use leads to addiction because it alters the brain’s reward system, particularly by affecting neurotransmitters like GABA, dopamine, and serotonin. This results in a reinforcing cycle, where users feel compelled to take higher doses to achieve the same effect or prevent withdrawal symptoms.

Benzodiazepines lead to addiction, especially when used for extended periods or in high doses. A study published in Addiction Biology highlighted that long-term benzodiazepine use is associated with changes in brain circuits involved in memory, emotion, and reward, which contribute to addictive behaviors. Additionally, the National Institute on Drug Abuse (NIDA) has noted that while benzodiazepines are effective for short-term treatment, misuse leads to significant dependence, with withdrawal symptoms such as anxiety, seizures, and even death in severe cases.

Benzodiazepine addiction is more likely to develop in individuals with a history of substance use disorders, mental health conditions, or those who misuse benzodiazepines for recreational purposes or to self-medicate. For example, a teenager dealing with anxiety might begin misusing benzodiazepines prescribed for panic attacks to cope with academic stress or peer pressure, increasing their risk of dependency. Similarly, middle-aged adults struggling with insomnia overuse benzodiazepines as a quick fix for sleep, unintentionally enabling addiction. Individuals recovering from other substance use disorders misuse benzodiazepines to alleviate withdrawal symptoms or enhance other substances’ effects, putting them at a higher risk of dependency.

In the United States, around 1.4% of the population, or approximately 3.9 million people, reported misusing benzodiazepines in the past year, according to the National Institute for Drug Abuse (NIDA) in “What is the scope of prescription drug misuse in the United States?” The American Psychiatric Association (APA) and other health organizations emphasize the importance of using benzodiazepines only as prescribed and for the shortest duration possible to minimize the risk of addiction.

What is Benzodiazepine Dependence?

Benzodiazepine dependence occurs when prolonged use of the drug causes physical reliance and tolerance, requiring continued use to prevent withdrawal symptoms like anxiety, tremors, or seizures. Unlike addiction, dependence focuses on physical adaptation, as the brain adjusts to the drug’s effects on neurotransmitters, particularly GABA, which regulates neural calmness. Studies, such as Ashton CH et al. 1997 in “Benzodiazepine Dependency,” report that 20–100% of patients taking benzodiazepines long-term at therapeutic doses develop dependence. The risk of Benzodiazepine dependence increases with usage beyond four weeks, as highlighted by Kennedy KM et al. (2019). Gradual tapering under medical supervision is recommended to mitigate withdrawal symptoms effectively.

What are the Withdrawal Symptoms of Benzodiazepines?

The withdrawal symptoms of benzodiazepines include anxiety, insomnia, tremors, and muscle pain. Withdrawal refers to the physical and psychological symptoms that occur when someone who has developed a dependence on a drug abruptly stops or significantly reduces its use, according to “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.”

These symptoms arise because the body has adapted to the drug’s presence and struggles to regain balance when the drug is removed. Symptoms range from mild discomfort to severe, life-threatening complications, particularly for long-term or high-dose users. Managing withdrawal requires gradual tapering under medical supervision to minimize risks and ensure safety.

Is Benzodiazipine Addiction Treatable?

Yes, benzodiazepine addiction is treatable with a combination of medical, psychological, and social support interventions. Effective treatment starts with a medically supervised tapering process to reduce dependence safely, combined with therapy to address the psychological aspects of addiction. According to SAMHSA, 68% of people who complete drug and alcohol detox programs report that their treatment was successful.

Cognitive-behavioral therapy (CBT), group therapy, and holistic approaches such as stress management techniques are recommended to treat benzodiazepine addiction effectively. According to Verywell Mind, 60% of people maintain recovery from alcohol or drug addiction for a year after Cognitive Behavioral Therapy.

Medications like antidepressants are prescribed to manage withdrawal symptoms or co-occurring disorders like anxiety and depression. Treatment in specialized rehabilitation centers ensures access to tailored support. According to the National Institute on Drug Abuse (NIDA), an integrated approach combining medical detoxification and behavioral therapies helps 40–60% of people achieve sustained sobriety or a significant reduction in substance use.

Are Benzodiazepines Safe?

Yes, benzodiazepines are safe when used as prescribed and for short-term treatment. However, prolonged use or misuse leads to dependence, withdrawal symptoms, and potential side effects, including drowsiness, confusion, or respiratory depression. Their safety profile requires careful monitoring by a healthcare provider, especially for individuals with a history of substance abuse.

Do People Get Addicted to Benzodiazepines?

Yes, people get addicted to benzodiazepines because of long-term use, even at prescribed doses. Benzodiazepine develops physical and psychological dependence by altering brain chemistry, such as reduced GABA receptor sensitivity. Addiction is more likely in those using high doses or misusing the medication.

What is the Difference Between Benzodiazepine Tolerance and Dependence?

The main difference between tolerance and dependence is that tolerance refers to needing higher doses to achieve the same effect, while dependence involves experiencing withdrawal symptoms when stopping use. Tolerance occurs as the body adapts to the benzodiazepine, reducing its effectiveness over time. Benzodiazepine dependence develops when the body becomes reliant on the drug to function normally, and discontinuation results in physical or psychological withdrawal symptoms. Both conditions coexist with long-term benzodiazepine use.

What is the Difference Between Benzodiazepines and Barbiturates?

The main difference between benzodiazepines and barbiturates is their safety profile and mechanism of action. Benzodiazepines act on GABA receptors and are safer, with a lower risk of fatal overdose. Barbiturates, also acting on GABA receptors, have a narrower therapeutic window, making them more dangerous and rarely prescribed today. Benzodiazepines are commonly used for anxiety, insomnia, and seizures, while barbiturates were once used for similar purposes but are now mostly limited to specific medical cases like anesthesia.

How are Benzodiazepines Used for Treatment?

Benzodiazepines are used for treatment by administrating orally as tablets or capsules for conditions requiring ongoing management, such as generalized anxiety disorder or sleep disorders. In acute or emergencies, such as severe seizures or preoperative sedation, benzodiazepines are used intravenously or intramuscularly to achieve rapid effects. These medications are prescribed for short-term use to minimize the risk of dependence, with careful monitoring of dosage and gradual tapering to prevent withdrawal symptoms when discontinuing.

What Is the History of Benzodiazepines?

The history of benzodiazepines dates back to the mid-20th century. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally in 1955 by chemist Leo Sternbach and introduced for medical use in 1960. Shortly after, diazepam (Valium) became available, leading to the widespread use of benzodiazepines due to their perceived safety and efficacy compared to barbiturates. These drugs were primarily prescribed for anxiety, insomnia, and seizure disorders and quickly became some of the most commonly used medications globally.

In the U.S., benzodiazepines are classified as Schedule IV controlled substances under the Controlled Substances Act due to their potential for abuse and dependence. Legal and regulatory measures have since evolved to curb misuse, particularly as their combination with opioids has been linked to increased overdose risks. Efforts by organizations like the Drug Enforcement Administration (DEA) aim to educate and manage benzodiazepine use within safe guidelines.

How Long Does Benzodiazepines Stay in Your System?

Benzodiazepines stay in your system from 6 hours to 6 weeks, depending on the specific drug, dosage, individual metabolism, and how the test is being conducted to detect the drug in the body. Benzodiazepines remain detectable in urine for 1-6 weeks, in blood for 6-48 hours, and in hair follicles for up to 90 days, according to the Mayo Clinic. For example, long-acting benzodiazepines like diazepam take weeks to clear, while shorter-acting ones like lorazepam are eliminated more quickly within a few hours. The detection window also depends on the testing method used.

How is Benzodiazepines Eliminated from the Body?

Benzodiazepines are eliminated from the body primarily through the liver, where enzymes, especially cytochrome P450, metabolize them. The metabolites are excreted through urine. Factors such as age, liver function, and the specific benzodiazepine influence the rate of elimination.

How are Benzodiazepines Classified?

Benzodiazepines are classified as short-acting, intermediate-acting, and long-acting based on their duration of action, which is determined by their half-life. Short-acting ones like triazolam are used for sleep initiation, intermediate ones like lorazepam for anxiety, and long-acting ones like diazepam for conditions like seizures and alcohol withdrawal.

Are Benzodiazepines Legal?

Yes, benzodiazepines are legal for medical use when prescribed by a licensed healthcare provider. However, due to their potential for misuse, they are classified as Schedule IV controlled substances in the U.S., regulated under the Controlled Substances Act by the Drug Enforcement Administration (DEA).

How are Benzodiazepines Made?

Benzodiazepines are made through a synthetic chemical process involving the fusion of a benzene ring with a diazepine ring. This process includes steps like nitration, amination, and cyclization, carried out under controlled laboratory conditions to ensure purity and efficacy. The manufacturing is highly regulated to meet pharmaceutical standards.

What are Street Names for Benzodiazepines?

The most common street name for benzodiazepine is benzo. Other street names vary by region and the specific drug but are used to disguise their illegal trade or recreational use. The street names highlight their sedative effects or their appearance.

Common street names for benzodiazepines are as follows:

Benzos
Downers
Tranks
Nerve Pills
Zannies
Z-Bars
V’s
Candy
Sleepers
Chill Pills
Blues
Dead Flower Powers

Should You Take Benzodiazepines While Your Pregnant?

No, you should not take benzodiazepines while pregnant unless absolutely necessary and prescribed by a healthcare provider. These medications cross the placenta and pose risks to the developing fetus, including congenital malformations, low birth weight, and neonatal withdrawal syndrome. The use of benzodiazepines during pregnancy, especially in the first trimester, increases the risk of congenital disabilities such as cleft lip and palate and neurodevelopmental issues, according to a study by Noh Y et al. 2022, titled “First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea.”

According to the U.S. Food and Drug Administration (FDA), benzodiazepines are categorized as a Pregnancy Category D or X drug, indicating there is evidence of risk to the fetus. It’s important that pregnant women only take these medications when the benefits outweigh the potential risks and under the guidance of a doctor who will evaluate safer alternatives.

How Do Benzodiazepines Interact with Alcohol?

Benzodiazepines dangerously interact with alcohol, as both substances are central nervous system (CNS) depressants. When combined, they enhance each other’s sedative effects, leading to an increased risk of severe drowsiness, respiratory depression, coma, and even death. The combination also impairs judgment and motor skills more significantly than either substance alone, increasing the likelihood of accidents or overdose. These risks are particularly high in individuals with a history of alcohol use or those who consume large amounts of alcohol.

What is the Difference Between Short-acting and Long-acting Benzodiazepines?

The main difference between short-acting and long-acting benzodiazepines is their duration of effect. Short-acting benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan), have a quicker onset but are cleared from the body more rapidly, making them suitable for acute anxiety or panic attacks. Long-acting benzodiazepines, like diazepam (Valium) and clonazepam (Klonopin), remain active in the body for a longer time and are used for conditions requiring sustained effects, such as generalized anxiety disorder or seizure management.

Can Benzodiazepines be Combined with Other Medications?

Yes, benzodiazepines can be combined with other medications, but this should only be done under the supervision of a healthcare provider. Certain medications, like antidepressants or antipsychotics, are prescribed alongside benzodiazepines for managing co-occurring conditions. However, combining benzodiazepines with other CNS depressants, such as opioids or alcohol, significantly increases the risk of respiratory depression, overdose, and other serious side effects. It’s important always to inform healthcare providers of all medications being taken to avoid harmful interactions.

Are There Alternatives to Benzodiazepines for Anxiety or Insomnia?

Yes, there are alternatives to benzodiazepines for anxiety and insomnia. Cognitive-behavioral therapy (CBT) is an effective, non-pharmacological treatment for anxiety and insomnia. Medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are used for long-term management of anxiety. For insomnia, non-benzodiazepine sleep aids like zolpidem (Ambien) or melatonin supplements are recommended. These alternatives have a lower risk of dependency and fewer side effects.

Can Benzodiazepines be Used for Children?

Yes, benzodiazepines can be used for children in certain circumstances, but this is only done under strict medical supervision and for short-term use. In pediatric patients, benzodiazepines are sometimes prescribed for severe anxiety, seizures, or to manage muscle spasms. However, the risks of sedation, respiratory depression, and developmental impact must be carefully considered. Long-term or frequent use in children is generally avoided due to the potential for dependence, tolerance, and adverse effects on cognitive development. Always consult a pediatrician before using benzodiazepines in children.

What are Nonbenzodiazepines?

Nonbenzodiazepines are a class of medications that are used to treat conditions like insomnia and anxiety, but they work differently than benzodiazepines, according to a study by
“Principles and Practice of Sleep Medicine (Fourth Edition).” These drugs are referred to as “Z-drugs” and include medications like zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). They are designed to have similar sedative effects as benzodiazepines but are chemically distinct, offering a lower risk of dependence and withdrawal symptoms in the short term. However, they still carry some risks, especially with long-term use, and cause side effects like dizziness or memory problems.

Can I Work or Drive While Taking Benzodiazepines?

No, you can not work or drive while taking benzodiazepines. These medications cause drowsiness, dizziness, and impaired coordination, which significantly affect your ability to perform tasks that require focus and motor skills, such as driving or operating machinery. The sedative effects of benzodiazepines last for hours and, in some cases, even the next day. It is important to follow your healthcare provider’s advice regarding activities like driving while on these medications. According to the National Institute on Drug Abuse (NIDA), driving under the influence of benzodiazepines impairs reaction time and judgment, increasing the risk of accidents. Always check the warnings and guidelines of the specific benzodiazepine you are prescribed.

What are the Most Commonly Prescribed Benzodiazepines?

The most commonly prescribed benzodiazepines are Lorazepam, Clonazepam, Diazepam, and Alprazolam, according to Cleveland Clinic data. Lorazepam is the most frequently prescribed, accounting for 51% of benzodiazepine prescriptions. Clonazepam follows at 20%, while both Diazepam and Alprazolam are prescribed 14% of the time. These medications are commonly used to treat conditions such as anxiety, panic disorders, and insomnia, as well as for muscle spasms and seizures. Each medication has unique properties that make it suited for specific clinical situations, such as Lorazepam’s shorter duration of action, which makes it suitable for treating acute anxiety, or Clonazepam’s longer duration, ideal for managing conditions like epilepsy.

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Published on: March 15th, 2017

Updated on: January 6th, 2025

Benzodiazepines: Uses, Effects, Risks, Withdrawal