Benzodiazepines
The benzodiazepines include drugs such as Valium, Xanax, Restoril, Dalmane, and Ativan. At one point they were among the most commonly prescribed drugs in the nation. They are remarkably safe from a medical standpoint - they do not cause much in the way of toxic side effects, and they are not nearly as lethal as barbiturates in the case of an overdose.

They are effective for the short-term treatment of anxiety and insomnia. For psychiatric disorders such as panic disorder, they can be used under medical supervision for long periods of time without losing effectiveness.

But they are mood altering, and they have addictive potential. These drugs interact with receptors for the neurotransmitter GABA (gamma amino butyric acid). When GABA is activated, it has a calming effect on the central nervous system, closely related to the brain’s pleasure center, so these drugs have a reinforcing ability similar to that of the barbiturates, but are less potent.

The addictive potential of benzodiazepines is relatively low compared to the barbiturates or to drugs like heroin or cocaine. It is unusual to find a person with addiction whose main drug of choice is a benzodiazepine. Street use of these drugs is usually in combination with other drugs. For example, alcoholics use them to treat hangovers and symptoms of chronic withdrawal; cocaine and amphetamine addicts do so to soften the effects of the “crash” or to modulate the high of the stimulant effect. However, there are cases in which people abuse prescriptions for benzodiazepines. Such individuals are generally relying on the drug’s effects to help them cope with stress, and they tend to increase the prescribed dose or to run out of their prescriptions early. These people often have past problems with substance abuse or have a family history of addiction.

It’s important to mention at this point that the mere fact that a person has a physiological dependence on these medications does not mean that there is an addiction present.

For example, many people with anxiety disorders have been maintained successfully for many years on medications like Ativan or Xanax. There are also people with seizure disorders that are managed with phenobarbital. If they were to stop taking these medications abruptly, they would experience withdrawal symptoms. So whenever these drugs are stopped after more than several months of use, a slow tapering off should be done under medical supervision. A physiological dependence is not in itself a reason to stop the drug if it is being used properly under medical supervision.

Withdrawal from depressant medications is serious business and usually requires hospitalization for detoxification.

Symptoms can include agitation, insomnia, seizures, hallucinations, and confusion. Withdrawal symptoms from some of the benzodiazepines don’t occur immediately, since these drugs take a while to clear out of the system. So it’s not uncommon for extreme discomfort to develop many days after the last dose. And some mild symptoms, like insomnia and uneasiness, can persist for several months. People getting through the first three or four months without benzodiazepines can find it pretty tough going, and I generally approach these patients with a great deal of patience and encouragement, assuring them that if they can just wait, it will get better.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information