Benzodiazepines, sometimes called benzos, are a type of medication known as tranquilizers. These drugs slow down your central nervous system, cause sedation and muscle relaxation, and lower anxiety levels. Often used to treat anxiety or insomnia, they’re some of the most commonly prescribed medications in the U.S. Incorporating additional databases could yield more studies and provide a more comprehensive view of the topic. Another limitation could also be the disproportionate focus on the studies that investigated abuse or inappropriate use of benzodiazepines, as opposed to poisoning or ingestion of excessive doses of benzodiazepines and potential mortality in the elderly.
1. Overview of Findings and Implications
The review found that the onset of the anxiolytic effect was significantly more rapid for alprazolam compared with amitriptyline, and its antipanic effect was significantly more rapid compared with propranolol and imipramine. Alprazolam has been consistently found to approximate the magnitude of anxiolytic effect of other comparable benzodiazepines. Due to the lack of nationally representative data, it has not been possible to date to estimate what proportion of users meet criteria for misuse or use disorders and which users are at greatest risk for benzodiazepine misuse or use disorders. Participants reported an average of nearly 17 years of regular benzodiazepine use (i.e., at least 3 days a week), often without consistent follow-up visits to health care settings where emerging signs of addiction might have noted. Many started with as-needed (pro re nata or PRN) prescriptions and initially thought they “did something good” (P11) by taking the drugs.
Benzodiazepine Effects
Two papers published a decade ago highlight the challenges in defining prescription drug misuse (Barrett et al., 2008; Boyd and McCabe, 2008). Yet, based on the present review, few steps have since been taken to improve upon the classification of benzodiazepine misuse. Future studies separating these different forms of misuse are also needed to determine their relative clinical significance. Urine-confirmed self-report and assessment for current prescriptions is needed in these populations. Much like other prescription drugs (e.g., opioids, stimulants) (McHugh et al., 2015), benzodiazepines are most commonly misused for reasons aligned with the drug’s indication (e.g., sleep, anxiety). Over 75% of NSDUH respondents with past-year tranquilizer misuse reported that they misused prescription tranquilizers to help with conditions for which benzodiazepines are indicated, such as sleep, tension, or emotions (CBHSQ, 2018b).
2. Pharmacologic Management of Withdrawal Symptoms
Once you’re no longer using benzos, you’ll need support from your family and friends and, if possible, from a mental health professional, to prevent relapse. If doctors think you may have overdosed on purpose or are at risk of harming yourself or others, you may see a psychiatrist or addiction specialist before you leave the hospital. Benzodiazepine drugs are also sometimes used as “date rape” drugs because they impair the functions that normally allow a person to resist sexual aggression or assault.
Benzodiazepine use disorders are defined as adults who misused benzodiazepine-only tranquilizers in the past year and had Rx tranquilizer use disorders or who misused benzodiazepine-only sedatives in the past year and had Rx sedative use disorders. All authors participated in reviewing the preliminary themes and organizing the manuscript text. The authors’ different interpretations of the data enriched the collaborative and reflexive rewriting process, which led to the final themes.
Secondary findings
Psychiatric diagnoses have also been linked to one’s ability to discontinue treatment with BZD. One study showed a high co-occurrence with BZD dependence and all psychiatric disorders in general 64,65. Specifically, those with cluster B personality disorders have the worst prognosis in regard to discontinuing BZD. In one study, not a single subject diagnosed with a cluster B personality disorder successfully discontinued BZD use 63. Additionally, younger patients tend to have a decreased success rate of discontinuing BZD use than older patients 66.
Facing deprescription without sufficient support made some participants feel abandoned by the health care system. Another study that tested a different standardized education protocol showed more promising results 73. The experimental group in this study was counseled on the first visit for 15–20 min on the effects, dangers, and alternatives to chronic BZD use and dependence 73. The subjects were interviewed with surgery-based consultations for approximately 10 min 12.
Conversely, there are reports of withdrawal from carbamazepine and clonidine benzodiazepine use, misuse, and abuse: a review with symptoms similar to those seen in alprazolam withdrawal, including psychosis (Adler et al., 1982; Heh et al., 1988) and hyperadrenergic states (Tollefson, 1981). Carbamazepine is metabolized by CYP3A4, and interactions with other drugs that induce, inhibit, or compete for CYP3A4 are relatively common, which may limit its use. Clonidine acts exclusively at the alpha-2 adrenoceptors levels and lacks carbamazepine’s GABAergic function and mood stabilization, thus leaving patients to experience all the other withdrawal symptoms if used alone for detoxification.
Prevalence of benzodiazepine use, misuse, and use disorders among U.S. adults
More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs. There is also a dearth of research on the prevention and treatment of benzodiazepine misuse and use disorder. Most treatment studies have focused on benzodiazepine tapers in people with long-term benzodiazepine prescriptions for anxiety or insomnia, and do not specifically focus on misuse (Morin et al., 2004; Otto et al., 2010). The development of effective interventions to mitigate benzodiazepine misuse is particularly important to reduce overdose risk. Of note, adding cognitive-behavioral therapy (particularly, interoceptive exposure-based treatment) to a slow benzodiazepine taper enhances success among people seeking to discontinue benzodiazepine prescriptions (Otto et al., 2010; Otto et al., 1993). Accordingly, such approaches may also have promise for the treatment of benzodiazepine misuse, particularly given the strong link between anxiety and benzodiazepine misuse (McHugh et al., 2018; McHugh et al., 2017).
- Among individuals with opioid use disorder (OUD), conditional dependence, or the percentage of people with misuse who meet criteria for dependence, for benzodiazepines is lower than for other substances (Wu et al., 2012).
- Although international rates of benzodiazepine misuse and SHA use disorder are similar to those reported in U.S. general population surveys, there is significant variability in methods across these surveys (e.g., definitions of misuse, categorization of prescription drug classes).
- Interestingly, despite ICU care and administration of beta-blockers and alpha-blockers, the pseudo-pheochromocytoma was only successfully treated by alprazolam re-instatement (Orzack et al., 1988).
- Out of 126 hits remaining after removing duplicates, we examined publications at two levels (review of titles and abstracts).
- The study showed that in oxycodone users, combination use with diazepam was the most prevalent 44.
- We restricted our review to the search terms Benzodiazepines and COVID-19 pandemic, so we may have missed relevant studies which did not have these keywords.
- More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs.
- Qualitative and descriptive results indicate that coingesting benzodiazepines with alcohol increases the intoxicating effects of both substances (Calhoun et al., 1996; Dåderman and Lidberg, 1999; Perera et al., 1987).
- Notably, for language ability, Mura et al. used the Isaacs Set Test to explore the effect of BZD abuse (41), and Ros-Cucurull used the Controlled Oral Word Association Test (47).
- If you suddenly reduce your dose of benzodiazepines or stop taking them — even if you’ve been using them as prescribed by a doctor — you could have withdrawal symptoms.
- In conclusion, this meta-analysis indicated no significant global cognition deficit (MMSE scores) in BZD users, but did reveal deficits in elders with BZD abuse behaviors.
The challenge of managing tensions around the prescribing and deprescribing of benzodiazepines has also been acknowledged by prescribers 18. Participants said that they could not live a normal life or do “very basic things” (P9) without what they referred to as the good effect benzodiazepines had on anxiety, panic attacks, worry, and insomnia. Some participants even said that the symptoms they had experienced changed them, whereas with benzodiazepines, “I have, simply, been as I should be” (P3). They described taking a pill in the morning to “feel normal” (P7), “to be able to be out, like a normal person” (P14), and as necessary to facilitate the activities of daily life, including grocery shopping, commuting to school or work, or meeting new people. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations.
Systematic Review Registration
The study found no significant cognitive impairment in adults with long-term use of BZD 20. A study of over 2000 older adults assessed the effects of chronic BZD use on cognition 21. Chronic use of BZD leads to a small but significant change in fluid intelligence, while long-term use of BZD correlates with worse cognitive decline when compared to the effects of using a high dosage 21.