How Benzodiazepine Addiction Develops
Healthcare providers prescribe Benzodiazepines for a range of medical and mental health problems, most commonly for anxiety, panic attacks, insomnia, and muscle spasms. Benzodiazepines are central nervous system depressants that relieve anxiety and induce calmness, drowsiness, and sleep.
There are two main routes to Benzodiazepine addiction: prescribed use that develops into addiction and unprescribed recreational use that develops into addiction. Addiction to any psychoactive substance is influenced by a complex interaction of nature (innate factors) and nurture (environmental and social factors).
Some of the biggest risks of Benzodiazepine addiction are:
- Accidents, falls, or physical altercations
- Accidental self-harm
- Accidental overdose
Physical Dependence On Benzodiazepines
People who use Benzodiazepines daily for even a short period of time can develop physical dependence on them. This physical aspect of Benzodiazepine addiction includes tolerance and withdrawal.
Psychological Dependence On Benzodiazepines
Benzodiazepine abuse can result in intense psychological dependence that shapes patterns of Benzodiazepine use. Struggling with mental health disorders increases the risk for developing Benzodiazepine use disorder.
People who develop an addiction to Benzodiazepines typically have an intense psychological dependence on the medication. Sometimes people expect that Benzodiazepines will completely remove all feelings of anxiety, but some level of anxiety or discomfort is a normal and healthy part of life. The expectation of complete relief can make someone take the maximum dose or even more than the maximum prescribed dose, as they try to achieve that unrealistic goal.
People may start to believe that they cannot function without Benzodiazepines, which can escalate feelings of guilt, shame, and secrecy about use. Psychological dependence to Benzodiazepines can cause people to become intensely protective of their pills, overwhelmed by panic if they don’t have access to them, and defensive of their ability to continue using them.
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Emotion Regulation And Distress Tolerance
Although Benzodiazepines are prescribed to treat anxiety, panic, and insomnia, prolonged use of them can worsen a person’s ability to regulate their emotions and deal with emotional distress. This results from a combination of altered brain functioning and overreliance on Benzodiazepines to cope with emotional experiences. This overreliance can lead to emotional instability, exaggerated emotional responses, and severe fluctuations in mood. Unfortunately, that pattern can escalate reliance on Benzodiazepines in a vicious cycle.
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Cognitive Aspects Of Benzodiazepine Addiction
Addiction to Benzodiazepines affects the way a person thinks as well as their specific thoughts and beliefs. Many researchers and clinicians view the cognitive aspects of addiction as even more powerful than physical dependence.
One of the hallmarks of addiction is intense cravings and urges to use the substance. People with Benzodiazepine addiction have frequent thoughts about Benzodiazepines and urges to use them (cravings). These cravings are driven by their beliefs that these medications will help reduce their unpleasant feelings or distress.
Memory And Attention
Benzodiazepine use, even as prescribed, can impair attention and memory while they are active in a person’s brain. However, long-term use can cause attention and memory problems that persist even when the person is not using them. These cognitive effects are more likely in older people, even at low doses. Even short-term use of Benzodiazepines by people over age 65 can cause cognitive impairment.
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Expectancies And Attributions
There are two types of thoughts that strongly influence someone’s decision to use drugs like Benzodiazepines: expectancies and attributions.
Expectancies are beliefs about what Benzodiazepines will do for them and may make the person ask questions like, “How will it make me feel?” and “How risky is it?”
Attributions are beliefs about the drawbacks and benefits of Benzodiazepine use. They cause a person to ask themselves questions like, “Do I get good sleep only when I use Benzodiazepines?” and “Is my Benzodiazepine-related fatigue or memory problems caused by something else?”
Importantly, both expectancies and attributions related to Benzodiazepines change as addiction develops. Typically, expectancies and attributions become distorted in ways that make people overestimate the positive effects and underestimate the negative effects, which then leads them to continue using even when negative consequences are evident to others.
Behavioral Signs Of Benzodiazepine Addiction
Benzodiazepines, particularly those that are fast-acting like Xanax, are highly addictive with tolerance developing quickly. As the effects become less intense, people often increase the amount they use trying to get a stronger effect. Prescribers typically advise people to take the lowest dose as infrequently as possible to keep their symptoms from interfering substantially with their normal functioning.
As Benzodiazepine addiction develops, people often take more or combine the medication with alcohol or other drugs to amplify the effects. They also might start engaging in high-risk behaviors and acting impulsively when they are using Benzodiazepines at higher doses than necessary for symptom relief.
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Changes In Social Interactions
As Benzodiazepine addiction develops, people may start interacting differently with the people in their lives. They may seem detached, apathetic, or restless. They may show less interest in activities and topics they once enjoyed, and it can be more difficult for them to feel emotional closeness. This can be frustrating and confusing to people in their lives. People with Benzodiazepine addiction might also start to isolate themselves and avoid social interactions completely.
Help Is Available
If you or someone you know is struggling with Benzodiazepine misuse or addiction, there are many effective treatment options.
Ashish Bhatt, MD, MRO
Doctor of Addiction Medicine
Learn about Dr. Ashish Bhatt
Dr. Bhatt has been Addiction Center's Medical Content Director for more than three years, providing his expertise to ensure quality and accuracy.
Doctor of Addiction Medicine
Expert in adult and child psychiatry
Over 20 years of professional experience