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.
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