Benzodiazepine Dependency (Sleeping pill addiction)

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Sleeping pill addiction intro

  • Benzodiazepines are sedative medications for first-line treatment in depression and other mental illnesses such as seizures, anxiety, insomnia, panic attacks, alcohol withdrawal, etc. 
  • Benzodiazepines are one of the most commonly prescribed medicines in the USA.
  • Short-term use of benzodiazepines is safe and effective but long-term use can lead to functional changes in the brain causing tolerance by decreasing the responsiveness to the use of the drug.
  • Individuals who develop tolerance require larger doses of the drug to achieve the desired effect. 
  • Over time, consuming larger doses of the drug induces the onset of dependency and addiction.
  • When the brain does not get the desired dose or these drugs are stopped abruptly, withdrawal syndrome is triggered that can be dangerous and fatal.
  • Benzodiazepine addiction occurs when a person takes drugs for more than 6 months and this leads to a negative impact on physical and mental health, occupational and social functioning, as well as increases the risk of serious injuries.

How do benzodiazepines act on our bodies?

  • Benzodiazepines act widely in the brain affecting emotional reactions, memory, thinking, control consciousness, muscle tone, and coordination.
  • These drugs stimulate the activity of the neurotransmitter, gamma-aminobutyric acid (GABA) in the brain by acting on their receptors. Gamma-aminobutyric acid enhances the inhibitory brain signals thus depressing the central nervous system resulting in reduced brain activity, sedation, and relaxation.

Commonly used benzodiazepines are

  • Lorazepam 
  • Alprazolam 
  • Clonazepam 
  • Diazepam
  • Clobazam
  • Midazolam

When does an individual get benzodiazipine dependency?

Abuse of a prescription-

Benzodiazepines are normally prescribed by a physician for legitimate medical conditions such as anxiety, insomnia, etc. Addiction occurs when-

    • Drugs are taken more frequently than prescribed
    • Taken in a larger dose than prescribed
    • Missed dose
    • Mixing medications with other drugs or alcohol
    • Saving pills to take later for recreational purpose

Recreational Abuse-

Benzodiazepines can be obtained from a drug dealer on the street. These are often taken for euphoric and relaxation purposes without any medical illness. Such as- peer pressure, to cope with stressful conditions, etc.

Benzodiazepine Dependency

Signs and symptoms of benzodiazepine dependency

Physical/Mental changes:

    • Anorexia
    • Fatigue
    • Blurred vision
    • Drowsiness
    • Hallucinations
    • Confusion
    • Decreased libido
    • Respiratory depression

 

Behavioral changes:

    • Impaired memory and attention
    • Poor concentration
    • Poor judgment and thinking capacity
    • Poor performance in work and study
    • Absent from work/school
    • Loss of relationships
    • Familial problems, such as domestic abuse, child neglect, or divorce
    • Lack of interest in activities that were once enjoyable
    • Risk of accidental injuries such as car crash, fall, etc.
    • Risk of overdose
    • Self-harm and Suicidal tendency
    • Polysubstance abuse with alcohol, cannabinoids (marijuana), etc

Benzodiazepines withdrawal

Withdrawal symptoms occur when an individual taking drugs in a small amount for a long duration or larger doses for a short time suddenly stops the drugs. It starts 1-4 days after the last dose. Symptoms include-

    • Sleeping difficulty
    • Irritability
    • Anxiety
    • Panic attacks/seizures
    • Hand tremors
    • Palpitations, increased heart rate
    • Headache
    • Muscle pain and stiffness

Treatment of benzodiazepine dependency

  • Psychotherapy and counseling to help address the underlying cause of the addiction
  • Cognitive behavioral therapy (CBT)
  • Rehabilitation centers
  • Social support from friends are family
  • Detox-

The addictive medication is gradually withdrawn by initially lowering the dose (slow taper) until total abstinence and the symptoms associated with the withdrawal are managed using a substitute drug followed by a rehabilitation program. Tapering can be done with a longer-acting agent, e.g., diazepam/clonazepam, or with the agent that the patient is taking. Tapering can be done is the following ways-

    • Reduce the dose by less than 10% of the original dose every 1–2 weeks until the dose is at 20% of the initial dose, then taper by 5% every 2–4 weeks. 
    • After substituting a longer half-life drug (eg. diazepam), calculate the benzodiazepine equivalence and give 50 percent of the original dosage. For example, Alprazolam/Clonazepam 0.5 mg and Lorazepam 1 mg is equivalent to 10 mg Diazepam. (equivalent chart is given below)

This will ensure that a person can quit benzodiazepine abuse without suffering from major withdrawal symptoms. 

  • Use of benzodiazepines alternatives- 
    • Antidepressants (SSRI, eg. sertraline) 
    • Buspirone

How long does it take to overcome benzodiazepine dependency?

The duration of detox depends on the duration of addiction. 

  • 8 week- 6 months of addiction duration: slow taper over 2-3 weeks
  • 6 months-1 year of addiction duration: slow taper over 4-8 weeks
  • More than 1 year of addiction duration: 2-4 months

Conclusion

  • Benzodiazepine addiction symptoms tend to grow more and more severe as long as they are not treated comprehensively. 
  • Symptoms do not simply go away. It is vital to seek medical help from a physician.
  • Families/friends must take action immediately when they see their closed person suffering from addiction. 
  • With help, he/she may be able to stop abusing these medications.

Author

  • Dr. Samanta Meharin Priam MBBS (University of Dhaka), MRCS-P1. Trained in basic surgery skills. Has special interest and experiences in providing breast care and breast disease management. She is currently providing telemedicine consultation during COVID 19 Response. She is working as a Medical Doctor in a tertiary level hospital.

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