Lauren Geoffrion, M.D.

Benzodiazepines (benzos) are a type of central nervous system (CNS) depressant prescribed for anxiety, insomnia, as an anti-convulsant, and muscle relaxer.1 They also have the potential for dependence and misuse, especially in people who misuse other substances to enhance the effects.1, 3 When not used as prescribed or in combination with other substances, there can be risks associated with benzodiazepine misuse, including addiction. This article will explain what benzodiazepines are, their potential for misuse and addiction, withdrawal, and how to get treatment for benzo addiction. What Are Benzodiazepines?  [callout-complex title="Common Benzodiazepines" position="right"] Common short-acting benzodiazepines include the following:1 Restoril (temazepam) Versed (midazolam) Prosom (estazolam) Common long-acting benzodiazepines include the following:1 Xanax (alprazolam)–45 million prescriptions in 2017 Valium (diazepam)–12.6 million prescriptions in 2017 Ativan (lorazepam)–26.4 million prescriptions in 2017 Klonopin (clonazepam)–29.2 million prescriptions in 2017 Librium (chlordiazepoxide) [/callout-complex] Benzodiazepines belong to a category of drugs called CNS depressants. These types of substances decrease brain activity and are most commonly prescribed to treat anxiety and insomnia.1 They can also induce sedation and hypnosis, relax muscles, and reduce seizures.3 Other names for benzodiazepines include:1 Nerve pills. Tranks. Downers. There are several types of benzodiazepines, each classified by their duration of action, which ranges from 6 to 24 hours.1 Small modifications in the chemical structure of each benzodiazepine can also impact their pharmacologic effects.1 The effects of short-acting benzodiazepines are felt quickly but also wear off within a couple of hours. These are typically prescribed to manage insomnia at home.3 They can also be used for sedation, anxiety, or amnesia in an emergency or surgical settings.3 Long-acting benzodiazepines can last up to 24 hours and can be prescribed for insomnia with daytime anxiety.1, 3 Benzo Tolerance, Dependence, and Addiction Benzos are Schedule IV substances as part of the Controlled Substances Act, which means they have a lower potential for misuse and dependence.2, 3 With repeated use, your body begins to require a higher dose to achieve the same effects. This is known as tolerance. Tolerance develops because of how the body adapts to repeated substance use over time, to the point where a person needs increasing doses to feel the same desirable effects. Tolerance builds as the body becomes so used to a substance that it no longer responds to it the way it initially did, and as a result, the desired effects become blunted. An increase in tolerance often leads to escalating patterns of use, which can drive compulsive drug use and is a risk factor for addiction.10 Dependence is a physiological adaptation of the body to a substance, wherein the body becomes so used to the drug in the system that when the individual cuts back on their use or quits, withdrawal symptoms emerge. With significant levels of physiological dependence, a person may continue to compulsively drink or use drugs to avoid unwanted withdrawal symptoms.11 Addiction refers to the compulsive, uncontrollable use of a substance despite the harm that it causes. Addiction can include both physiological changes (such as tolerance and dependence) and several harmful behavioral changes, which can adversely impact an individual's life. Addiction development is accompanied by functional changes within the brain that can impact an individual's drive, motivation, thought processes, and behaviors so much that drug use becomes prioritized over all else. The development of addiction is influenced not only by repeated substance use itself, but also by genetic, psychosocial, and environmental factors.11 Addiction to benzodiazepines is also known as a hypnotic, sedative, or anxiolytic use disorder in the Diagnostic and Statistic Manual of Mental Health Disorders, 5th Edition (DSM-5).5 Addiction to benzodiazepines is the problematic use of such substances leading to clinically significant impairment and presenting at least 2 of the criteria listed in the DSM-5 for sedative, or anxiolytic use disorder. A few of these criteria include:5 Compulsively seeking higher doses of benzodiazepines. More time is spent using and acquiring benzos despite the consequences. Failure to fulfill obligations at work school or home because of benzo misuse. It is common for benzodiazepine misuse to occur alongside other drug use (polysubstance use).1 Opioids like heroin and alcohol are commonly used alongside benzos.1 The euphoric effects of benzos combined with their rapid onset are often a reason for misuse.1 [callout-complex title="Benzodiazepine Overdose" position="right"] Overdoses occur from taking large doses or, commonly, when combined with other drugs. Combining benzos with other substances like opioids or alcohol can cause damage to the brain, overdose, or even death.6 Taking stimulants or other drugs with benzodiazepines can be unpredictable.6 It can be challenging to recognize if the drugs are affecting you and making you more susceptible to overdose.6 Signs of a benzodiazepine overdose can include:3 Extreme drowsiness. Confusion. Impaired coordination. Decreased reflexes. Respiratory depression. Coma. Possible death. Overdose effects of combined use of benzodiazepines and opioids can include severe sedation, respiratory depression, coma, and death.3 If you suspect you or someone you’re with has overdosed, call 911 immediately. [/callout-complex] Benzo Withdrawal Withdrawal symptoms may be present when an individual who is dependent on benzodiazepines abruptly stops or abruptly cuts back on the dosage. Withdrawal from benzodiazepines may include uncomfortable withdrawal symptoms, which can depend on the dose, duration of use, and which drugs were used. They are also similar to the symptoms of alcohol withdrawal.8 Withdrawal symptoms may include:1 Anxiety. Insomnia. Dysphoria. Tremor. Seizures. Treating Benzodiazepine Addiction Treatment for benzodiazepine addiction often begins with detoxification or the clearing of the drug from your body. The Substance Abuse and Mental Health Services Administration recommends that benzodiazepine withdrawal always be done under medical supervision (in a hospital or treatment center) because of the potential for dangerous symptoms.8 Under supervision, medication can be given to minimize symptoms, and medical personnel is available in case of an emergency.8 Withdrawal symptoms may not appear immediately, so supervision may be required for 24 hours or more, or until symptoms clear.8 Once a person has undergone detoxification, ongoing treatment is encouraged to help overcome an addiction. Your addiction treatment team may utilize the following during rehab to help you stop using substances: Inpatient treatment may occur in a hospital or residential setting. A person enrolled in inpatient care lives at the facility for 24/7 treatment.9 Outpatient treatment varies in intensity and time commitment depending on your needs. A person may be seen once or twice a week or 5 days a week for several hours per day.9 Behavioral therapy is used in many treatment settings and comes in many different forms. Cognitive-behavioral therapy is a commonly used therapeutic intervention for substance use disorders.9 Medication may be used during detoxification and ongoing addiction treatment depending on the substances Medications to help a person who took long-acting benzos may be used depending on the circumstances.8 Each person struggling with addiction has a personal story and unique needs. Treatment is often individualized to meet your needs and give you the best chance at recovery. How to Find Benzo Detox or Rehab Near Me Getting started on the road to recovery may feel daunting, but help is available. American Addiction Centers (AAC) has top-rated treatment centers across the U.S. to help you or a loved one get started on the road to recovery. Contact one of our caring admissions navigators at [phone] to learn about treatment options, check your insurance, and start your new life. [sources] The U.S. Drug Enforcement Administration. (2019, December). Benzodiazepines. The U.S. Drug Enforcement Administration. (n.d.). Drug Scheduling. The U.S. Drug Enforcement Administration. (2020, April). Drug fact sheet: Benzodiazepines. Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality. American Psychological Association. (2015). Diagnostic and statistical manual of mental disorders, 5th Edition. Centers for Disease Control and Prevention. (2022, February 23). Polysubstance use facts. Hood, S.D., Norman, A., Hince, D.A., Melichar, J.K., & Hulse, G.K. (2012, November 5). Benzodiazepine dependence and its treatment with low dose flumazenil. British Pharmacological Society. 77(2), 285-294. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, no.45. HHS Publication No. (SMA) 15-4131. Rockville, MD. National Institute on Drug Abuse. (2019, January 17). Treatment Approaches for Drug Addiction DrugFacts. National Institute on Drug Abuse. (2022, March 22). Drugs and the Brain. National Institute on Drug Abuse. (2020, December 2). Is there a difference between physical dependence and addiction? [/sources] ...

Many people use alcohol to help them socialize or feel relaxed. But drinking too much in a short time period can lead to possibly deadly alcohol poisoning, or overdose. This article will help you better understand the risks of alcohol overdose, learn the signs and symptoms, and how you can help someone who is overdosing. What Is Alcohol Overdose? Alcohol overdose happens when there is so much alcohol in your bloodstream that it affects the part of your brain that controls basic life functions.1 During overdose, breathing, heart rate, body temperature, and other life functions can shut down.1 This can lead to brain damage and even death.1 Excessive alcohol use caused more than 380 deaths per day from 2015 to 2019.2 The 2018 National Health Interview Survey found that 25% of adults had at least 1 heavy drinking day in the previous year that put them at risk for alcohol overdose and its dangerous complications.3 What Is Excessive Drinking? Excessive drinking is engaging in binge or heavy drinking, drinking when under age 21, or drinking while pregnant.4 Binge drinking is drinking an amount of alcohol that raises your blood alcohol concentration (BAC) to 0.08% or higher:1,4 For women, 4 or more drinks in 2 hours. For men, 5 or more drinks in 2 hours. Heavy drinking means having:4 For women, 8 or more drinks per week. For men, 15 or more drinks per week. A standard drink is 1.5 ounces of liquor (for example: whiskey, gin, rum, vodka), 5 ounces of wine, 8 ounces of malt liquor, or 12 ounces of beer.1,4 What Causes Alcohol Overdose? Alcohol overdose is caused by drinking too much alcohol at a rate faster than your body can process (metabolize) it.1 Everyone’s body is different. Depending on certain factors, some people may be able to have a few drinks in an hour and be okay, while others may overdose on the same amount. But in general, the more you drink, the greater your risk of severe symptoms.1 Risk Factors for Alcohol Overdose Factors that increase your chances of overdosing on alcohol include:1,5 Taking alcohol with other drugs, especially opioids, benzodiazepines, sleep aids, and over-the-counter antihistamines (such as Benadryl). Binge or high-intensity drinking. Remember that binge drinking is 4 or more drinks in 2 hours for women and 5 drinks in 2 hours for men. High-intensity drinking is drinking 2 to 3 times that amount. Being a teen or in college. Having less food in your stomach. Drinking stronger drinks. Having low tolerance (meaning your body isn’t used to the presence of alcohol). Drinking more alcohol than usual in a given time. Alcohol Consumption Limits Blood alcohol content, or BAC, measures the percentage of alcohol in your bloodstream.1 Law enforcement officers use BAC to detect whether or not someone is unsafe to drive, but BAC does not necessarily otherwise tell you how impaired you are, especially if you have developed tolerance to alcohol’s effects.6 Even if you stop drinking when your BAC reaches 0.08%, your BAC can continue to rise as your body absorbs the remaining alcohol in your stomach and digestive tract.1 These are some common symptoms, levels of impairment, and risks for various blood alcohol concentration levels:1 Between 0.02 and .08%: At the lower end of this range, you may feel relaxed, a little warmer, and may make poor judgments. As you get closer to the legal limit of .08%, you may have blurry vision, lose your balance, slur your speech, and have slow reaction times. Between 0.08 and .20%: At .08%, it is considered illegal and unsafe to drive. As BAC increases, in addition to all of the above symptoms, you may also start to lose control over your balance and have trouble walking and talking. This may lead to falls and other injuries. Above 0.20%: Confusion, nausea, and vomiting are likely to occur. You are at risk for many life-threatening dangers, such as choking or aspirating on vomit, blackouts, increased heart rate, irregular breathing, coma, and death. It’s important to note that someone who regularly drinks heavily may have a high tolerance to the sedative and lethal effects of alcohol, and while the lethal BAC in a nontolerant person may be .40 to .50%, values exceeding these levels have been found in alcohol tolerant people arrested for drunk driving.7 Alcohol Overdose Complications Alcohol has effects throughout the entire body and can cause serious short- and long-term health problems. Possible complications of alcohol overdose include:1,5 Alcoholic hepatitis and other liver diseases. Dangerous changes in heart rhythm. Heart attack or stroke. Traumatic injuries, such as from falls or car crashes. Long-term brain damage, coma, or death. Blackouts or memory gaps, including long-term amnesia. Alcohol Overdose Symptoms Drinking alcohol for its relaxing and tension-easing effects can be a pleasant social pastime. But when you lose track of your drinking, it can lead to overdose. Alcohol overdose can be dangerous and even deadly.1 If you think someone has overdosed, call 911 for medical help and do not leave them alone. Signs and symptoms of alcohol overdose include:1 Confusion. Trouble staying awake, or passing out and not being able to wake up. Vomiting or choking. Seizures. Very slow breathing (less than 8 breaths per minute). Slow or irregular breathing (10 seconds or more between breaths). Slowed heart rate. Cold or clammy skin. How Can I Help Someone Having an Alcohol Overdose? Whether for yourself or a loved one, quickly getting medical help is the best thing to do when someone has overdosed. There is no way to know how severe their body will react, and what you do for them could be the difference between life and death. This is not the time to try “home remedies.” Contrary to popular belief, nothing can lower BAC except time; coffee, cold showers, “sleeping it off,” and chugging glasses of water will not help someone sober up any faster. In fact, by taking time to try home remedies, you could be risking their life.1 While you are waiting for medical help to arrive, after calling 911, some helpful things you can do are:1 Stay with them. If they are conscious, they might fall, walk in front of a car, or do other dangerous activities. If they are unconscious or hardly awake, they may choke on vomit or suffer other emergencies. Do not leave them alone. Have them sit up and lean forward, or lay on their side with an ear to the ground to prevent choking. Collect any information you can about the person’s medical information, allergies, medications they are taking, how much they drank, or if they took any other substances. Having this information can be very helpful for the emergency medical team. Give them water if they are conscious to prevent dehydration. How Is Alcohol Overdose Treated? Depending on the timing of help and severity of alcohol overdose, medical treatments can include:5,7 Gastric lavage (also known as stomach pumping). IV fluids to help with dehydration. IV or oral glucose. IV or oral Vitamin B1 (thiamine). Airway protection, which can include intubation (inserting a breathing tube). Preventing Alcohol Overdose The 140,000 deaths every year due to alcohol overdose and the additional complications suffered can be prevented by avoiding excessive drinking.5 You can help yourself and others avoid alcohol poisoning by:5 Limiting your own drinking and encourage others to as well. Responsible drinking is limited to 2 or fewer drinks in a day for men and 1 or less for women. Not drinking on an empty stomach. Avoiding drinking games that encourage rapid consumption of alcohol. Refusing to serve alcohol to minors or those who have already had too much. Not binge drinking. Educating yourself and others about the benefits of drinking less. Not using other substances while drinking. Being responsible and thoughtful about alcohol use helps you stay safe. It is important to remember that alcohol is a drug that can have serious side effects. Though it can be an enjoyable addition to social gatherings, careless treatment can quickly lead to tragic consequences. How to Find Treatment for Alcohol Misuse Chronic excessive consumption of alcohol is dangerous. Alcohol misuse can lead to addiction, overdose, or even death. If you or a loved one is struggling with alcohol use disorder, it is never too late to get help. American Addiction Centers (AAC) is a leading provider of alcohol detox and addiction treatment in the United States, with treatment centers across the nation. Call [phone] to explore your options and get the help you deserve. [vob-aktify-cta title="Does your insurance cover alcohol detox?" subtitle="Check your benefits online or text us for more information."] [accordion title="Detox at American Addiction Centers (AAC)"] Detox Centers: Laguna Treatment Hospital Adcare - Rhode Island Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks Immediate Service Areas: Aliso Viejo, CA Kingstown, RI Worcester, MA Lafayette, NJ Las Vegas, NV Grand Prairie, TX Etta, MS Hollywood, FL Riverview, FL [/accordion][accordion title="Treatment by location"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [/accordion][accordion title ="Insurance Articles"] Aetna Ambetter Blue Cross Blue Shield Bright Health Humana Kaiser Permanente Medicaid Medicare Tricare Without Insurance Veterans Insurance [/accordion][accordion title ="Treatment articles"] Detox services: Inpatient detox Outpatient detox Medical detox Rehab services: Rehab Inpatient rehab Outpatient rehab Same-day rehab State-funded rehab 30-60-90 day rehab Free rehab Choosing rehab Co-occurring Disorders Anxiety Depression PTSD Therapy Aftercare services: Aftercare Sober Living Support Groups Alcoholics Anonymous (AA) Narcotics Anonymous (NA) [/accordion][accordion title="Effects of Alcohol Withdrawal"] Alcohol Withdrawal Can You Die from Alcohol Withdrawal? Delirium Tremens (DTs)  [/accordion] [sources] National Institute on Alcohol Abuse and Alcoholism. (2021, May). Understanding the dangers of alcohol overdose. Centers for Disease Control and Prevention. (2022, July 6). Alcohol and public health. Centers for Disease Control and Prevention. (2018). Alcohol use. Centers for Disease Control and Prevention. (2019, December 30). What is excessive alcohol use? LaHood, A. J. & Kok, S. J. (2022, March 18). Ethanol toxicity. StatPearls Publishing. Lapham S. C. (2010). The limits of tolerance: convicted alcohol-impaired drivers share experiences driving under the influence. The Permanente journal, 14(2), 26–30. Hovda, K. E. & Jacobsen, D. (2016, April). Oxford textbook of critical care (2nd ed.): Management of alcohol poisoning. Oxford University Press. 1556–1559. [/sources] ...

From detox to long-term maintenance of recovery, medication can help you overcome alcohol addiction. During the initial treatment phase of detoxification, your care team may use a variety of supportive medicines to ease withdrawal symptoms and ensure your safety.1 But detox is often only the first stage of addiction treatment, and many people benefit from further treatment in their efforts for long-term recovery.2 The good news is that prescription medicines exist that can help make recovering from alcohol addiction a bit easier. Medicines for Alcohol Addiction After detox, there are many components of addiction treatment. While behavioral therapies and counseling are well-known, many people do not realize that there are FDA-approved medicines that can help reduce cravings and increase your motivation to avoid alcohol.2 These medicines are typically started after detox, and their goal is to help you accomplish long-term sobriety. While many people engage with alcohol addiction treatment through rehab or mental health providers, many primary care doctors can also prescribe each of the following medicines. Acamprosate (Campral) Acamprosate (brand name: Campral) can help reduce the long-term symptoms that make it hard to stop using alcohol.2 After detox, you may still have insomnia, anxiety, restlessness, and general uneasiness while your body continues to adjust to the continued absence of alcohol.2 While it can’t be started until 5 days after your last drink, acamprosate can help you get through this uneasy time.3 It can take up to 8 days to be fully effective in your body, so healthcare providers encourage taking it even if the first few days feel difficult.3 Studies show that acamprosate works best for people who are not currently drinking alcohol (abstinent) at the start of treatment and who are committed to continuing this abstinence.3 If that applies to you, acamprosate may be a good fit. Talk to your doctor about the reasons you drink and the symptoms you have while sober to get the right treatment for your situation. Disulfiram (Antabuse) Disulfiram (brand name: Antabuse) gives you an unpleasant physical reaction, such as nausea, flushing, and a racing heart if you drink alcohol while taking it.2 It can be tricky to form new habits in early recovery, but for some, feeling sick when you drink can be a powerful motivator to continue to not drink. In this way, it can work well for people who have a strong commitment to stopping drinking and are motivated by avoiding negative consequences. You can start taking disulfiram when you have a blood alcohol level of 0 or it’s been 12 hours after your last drink.3 Some people may have an allergy to disulfiram and it may not be appropriate for people with certain types of heart disease, so it’s important to talk to your doctor about your health history before you start taking it, as well as all your symptoms after you start taking it.3 Naltrexone Naltrexone blunts alcohol’s effects so that you don’t really get any pleasure from drinking.2 Naltrexone also helps reduce alcohol cravings by blocking its ability to activate the “reward” pathways in your brain.2 This can help you avoid relapse and refocus on other parts of your life that bring you pleasure. Naltrexone can be taken daily in pill form like the others, or it also comes in a monthly injection. This can make it more convenient while lowering the temptation to skip doses if you know you have an upcoming event.2 Naltrexone often has the greatest benefit if you stop drinking at least 4 days before starting the medicine.3 Finding Alcohol Addiction Treatment Taking medicine as a part of alcohol use disorder treatment can change addiction recovery from difficult to doable. As a leading provider of alcohol detox and rehab, American Addiction Centers (AAC) can help you start and continue your personal fight against alcohol addiction. Widespread across the country, there is likely an AAC treatment center near you that can offer what you need for recovery. Call [phone] to get started today. [sources] Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research based-guide (third edition). Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. (2015). Medication for the treatment of alcohol use disorder: A brief guide. HHS publication no. (SMA) 15-4907. Rockville, MD. [/sources] ...