Benzodiazepines (commonly referred to as “benzos”) are a class of medications that act as central nervous system (CNS) depressants, which exert sedative, hypnotic, and anxiolytic effects.1, 2, 3
While benzodiazepines have several medical uses, they also have the potential for dependence and misuse.4 In the 2020 National Survey on Drug Use and Health, approximately 4.8 million people aged 12 years or older reported misuse of benzos in the past year.5
This article will discuss how benzodiazepines work, their potential for misuse, benzodiazepine withdrawal symptoms, adverse side effects of benzos, and treatment options for benzodiazepine addiction.
What are Benzodiazepines?
Benzodiazepines are a widely prescribed class of medications known as CNS depressants typically prescribed to treat anxiety and insomnia.1, 2 In addition to treating anxiety and anxiety-related conditions (such as acute stress reactions and panic attacks) and sleep problems (such as insomnia), benzos can also be prescribed to alleviate muscle spasms and reduce the occurrence of seizures.2, 6
Benzos are typically found in the form of pills or capsules, and most people take benzodiazepines orally.1 They can be misused by those with a prescription (or multiple prescriptions) in the following ways:2, 3
- Taking them at higher doses than prescribed
- After being purchased on the street.
- Taken intranasally (commonly referred to as “snorting”) by crushing the pills.
Benzos are typically prescribed for short-term use due to an elevated risk of developing tolerance, dependence, or addiction with regular use.7 Benzos are Schedule IV substances, which means they have the potential for physiological dependence even if a person is taking them as prescribed.1, 4
Common side effects of benzodiazepines include: 2, 3, 8
- Slurred speech
- Difficulty concentrating
- Problems with movement and memory
- Decreased blood pressure
- Slowed breathing
A medical provider may prescribe benzodiazepines for their anti-anxiety, sedative-hypnotic, muscle relaxant, or anti-convulsant (anti-seizure) effects.1
The most commonly prescribed benzodiazepines include:2
Other benzodiazepines that a medical provider may prescribe include:1, 2
- Versed (midazolam)
- Restoril (temazepam)
- Librium (chlordiazepoxide)
- Tranxene (clorazepate)
- Doral (quazepam)
How Do Benzodiazepines Work?
Benzodiazepines lead to central nervous system depression by increasing the transmission of the neurotransmitter (a chemical messenger in your brain) known as gamma-aminobutyric acid (GABA), the brain’s major inhibitory neurotransmitter. This decreases excitation in the brain.1, 8 In other words, benzodiazepines calm an overexcited nervous system.8
Benzodiazepines are classified into 2 groups based on how quickly they are processed and eliminated from the body.8 Short-acting benzodiazepines (alprazolam, lorazepam, midazolam, triazolam, temazepam) are processed and eliminated more quickly from the body.2 Studies have shown that treatment for longer periods with high-dosage, short-acting benzodiazepines contribute to more severe withdrawal effects.
Long-acting benzos (diazepam, chlordiazepoxide, and clonazepam) take longer for the body to process and be eliminated from the body.2, 8 One study found a withdrawal rate of approximately 40% in those who abruptly stopped taking long-acting benzos after six or more months of use.20
Are Benzodiazepines Addictive?
There is potential for benzodiazepine addiction and dependence, and with regular use, a person may still develop a physical dependence on benzos even when taken as directed by a doctor.1 This can also happen for people who misuse benzos, particularly if they are taken in high doses.1
When someone is physically dependent on benzos, they experience withdrawal symptoms if they stop taking benzos or significantly reduce the amount they are taking. People may continue to use benzos to avoid withdrawal symptoms.1
People who misuse benzodiazepines often misuse other substances like cocaine, heroin, prescription opioids, or alcohol.2 Taking 2 or more drugs at the same time is known as polysubstance use.9 This can increase the risk of negative effects, such as an overdose, particularly when combining benzodiazepines with other drugs that slow breathing, such as alcohol, z-drugs (i.e., sleep aids like zolpidem, eszopiclone, and zaleplon), and opioids.18
Signs of Benzodiazepine Addiction
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used by medical professionals to guide the diagnosis of mental health issues, including substance use disorders.10 In the DSM-5, benzodiazepine addiction is classified as “Sedative, Hypnotic, or Anxiolytic Use Disorder.” Diagnostic criteria include:10
- Taking sedatives in larger quantities or for a longer duration than intended.
- Having a strong desire to reduce or control sedative use, but efforts to do so are unsuccessful.
- Spending a lot of time trying to obtain, use, or recover from the effects of sedatives.
- Craving to use sedatives.
- Failing to meet major role obligations and responsibilities at home, work, or school because of sedative use.
- Continuing to use sedatives even though doing so results in interpersonal or social problems.
- Giving up or reducing important social, recreational, or occupational activities because of sedative use.
- Using sedatives in dangerous situations, such as when driving or operating machinery.
- Continuing to use sedatives even though there are recurrent physical or psychological problems caused or made worse by sedative use.
- Developing a tolerance to sedatives (needing a higher dosage of sedatives to achieve its effects or diminished effects when continuing to use the same dose of sedatives).
- Experiencing symptoms of sedative withdrawal or needing to take sedatives or a similar substance to avoid withdrawal symptoms.
Like other substance use disorders, sedative, hypnotic, or anxiolytic use disorder is diagnosed on a continuum of severity. If someone is experiencing 2 to 3 of the above criteria, they would meet diagnostic criteria for a mild substance use disorder; 4 to 5 would be a moderate substance use disorder; 6 or more would be classified as a severe substance use disorder.10
Adverse Effects of Benzodiazepines
Taking benzodiazepines can result in adverse side effects. Some of the common adverse effects experienced related to benzo use include:3, 7
- Problems with physical coordination and movement
- Slowed reaction time
- Memory problems
- Slurred speech
- Slowed breathing
- Fainting or passing out
Effects of Benzodiazepine Use in Pregnancy and Breastfeeding
Benzodiazepines may have risks for someone who is pregnant or breastfeeding. Some of the benzodiazepines are categorized as a pregnancy Category D, meaning there are known fetal risks for someone who is pregnant and taking benzodiazepines.7
Benzodiazepines cross the placenta and may lead to the development of dependence and consequent withdrawal symptoms in the fetus. Some benzodiazepines (diazepam and chlordiazepoxide) may increase the risk of congenital malformations in the fetus.7, 19 Benzodiazepines are excreted in breast milk and are usually contraindicated in breastfeeding mothers.19
However, when the benefits to the pregnant person outweigh the risks, benzodiazepines may be continued under the care of a doctor, particularly if a pregnant person is taking them to manage seizures.7 Other benzodiazepines are classified as pregnancy Category X drugs (flurazepam and temazepam) and produce effects such as neonatal lethargy and abnormalities in skeletal development.7
A recent study on benzodiazepine use during pregnancy associated benzos with:11
- Increased likelihood of preterm birth.
- Somewhat lower gestational age at delivery.
- Marginally lower birth weight.
- Admission to the neonatal intensive care unit.
- Respiratory stress syndrome in the infant.
Benzodiazepine withdrawal symptoms occur after a person has developed a physiological dependence, which can happen when people stop using benzos after regularly using them for several weeks or months. Benzodiazepine dependence can occur even at therapeutic doses but is more likely to happen sooner when higher-potency benzos are taken at higher doses.
The severity and duration of withdrawal symptoms are influenced by several factors, such as the type of benzodiazepine used, the dose taken, the duration of benzo use, individual factors (a person’s biology and health), and other substances used.1
Benzodiazepine withdrawal can be dangerous, and people can benefit from talking with a doctor before they quit using benzodiazepines. A person at risk of severe withdrawal will likely require medical supervision or oversight to ensure their safety.12
There are medications that may be helpful in managing benzodiazepine withdrawal and techniques used to taper someone off benzos. This is generally evaluated on a case-by-case basis.12, 13 Cognitive and behavioral techniques may also be suggested to help a person through benzo withdrawal and recovery.12
Common benzodiazepine-related withdrawal symptoms include:10
- Increased sweating
- Increased heart rate (i.e., pulse greater than 100 beats per minute)
- Increased respiratory rate
- Increased body temperature
- Hand tremor
- Transient visual, auditory, or tactile hallucinations
- Nausea or vomiting
Benzodiazepine Overdose Risks
From 2019 to 2020, there was a 23.7% increase in benzodiazepine emergency department visits.14 Approximately 21.0% of those overdose visits included benzodiazepines only.14 It is possible, although rare, for someone to die of an overdose solely because of benzodiazepine use.
However, the risk of a fatal overdose is increased when someone mixes benzos with other substances that have respiratory depressing effects. Substances may include opioids or other central nervous system depressants like alcohol, barbiturates, or other benzodiazepines.9, 18 Mixing these drugs can increase the risk of brain and organ damage, overdose, and death.9 In the study mentioned above, 34.4% of benzodiazepine overdoses also included opioids.14
Signs of overdose include:9
- Slowed or stopped breathing
- Weak pulse
- Confusion or altered mental state
- Syncope (fainting or passing out)
If you suspect someone is overdosing from benzodiazepines or any other substance, call 911 immediately.
Treatment for Benzodiazepine Addiction
Treatment for benzo addiction often begins with detoxification (detox) and withdrawal. Medical supervision during withdrawal can help safely manage potentially harmful or uncomfortable withdrawal symptoms, particularly seizures and other symptoms associated with severe withdrawal.15, 16
Ongoing treatment for a substance use disorder can help a person to remain abstinent after detox.17 Treatment options for benzodiazepine addiction may include the following:
- Inpatient/residential treatment: Inpatient treatment typically lasts several weeks or months and involves a person living at the facility for the duration of treatment. Typically, these programs are structured and offer more intensive care than outpatient treatment.16, 17
- Outpatient treatment: Outpatient care is an option for people who want to live at home while receiving treatment interventions at an outpatient facility. Outpatient facilities typically offer the same services as inpatient like detox, therapy, treatment medications, counseling, and mutual support groups.16, 17
- Behavioral therapy. Behavioral therapies are used during inpatient or outpatient treatment and can help people change their thoughts, attitudes, and behaviors about benzodiazepine use and learn healthy coping skills that don’t include substance use.17
Find Addiction Treatment
If you or a loved one are struggling with benzodiazepine addiction or misuse, you are not alone. There are several treatment options available to support you on the road to recovery. American Addiction Centers (AAC) is a top provider of addiction treatment in the U.S. with facilities across the nation. If you’re ready to get treatment or simply have questions, contact our caring team at to learn about treatment options, how to pay with insurance, and to receive addiction-related resources.