Benzodiazepines are a prescription medication and are relatively common. They don’t cause euphoria like opioids and they aren’t ubiquitous like alcohol. Since they’re fast-acting, unlike SSRIs, you can take them only when you experience acute anxiety or can’t sleep. Benzos seem like a convenient and relatively harmless drug, yet it’s very hard to quit. What’s going on?
Dependence happens quickly. Dependence is the problem more often than addiction. In addiction, you crave the drug, look forward to the next use, and experience relief and euphoria when you use. Dependence simply means quitting is painful and you keep using to avoid withdrawal. While some people do get addicted to benzos, it’s mostly the dependence that keeps people using.
Physical dependence can develop in a matter of weeks, after which you may have to taper to quit safely. As usual, the higher the dose, the greater the dependence, but dependence occurs even at prescribed doses. That is, you don’t have to misuse benzos to develop a dependence quickly.
Withdrawal symptoms are unpleasant and dangerous. While withdrawal from most drugs is simply miserable, withdrawal from benzos is actually dangerous. Common withdrawal symptoms include anxiety or panic attacks, tremors, sweating, diarrhea, cognitive impairments, muscle cramps, emotional blunting, depersonalization, and depression. The most dangerous symptoms include suicidal thoughts, psychosis, and seizures. It’s impossible to avoid withdrawal completely. Even a slow taper will result in mild symptoms.
There was a reason for starting benzos in the first place. Most people start using benzos with a prescription. Xanax is one of the most commonly prescribed drugs worldwide. It’s typically prescribed for anxiety and insomnia. Many people are afraid that once they quit, the anxiety, panic attacks, or insomnia will come back. Often the first withdrawal symptom is rebound anxiety.
Ironically, it appears that benzos stop working for their intended purpose quickly, while the side effects gradually get worse. Benzos stop working for insomnia after about two weeks and they stop working for anxiety in about four months. At this point, people either take a higher dose, which works for a little while, or they maintain a dose that doesn’t work because they’re afraid of withdrawal.
It’s best to quit benzos slowly, and under medical supervision. This usually involves a taper, possibly using a different medication. Cognitive Behavioural Therapy has also been shown effective in moderating the severity of withdrawal. Therapy and social support are also necessary to address the original problems of anxiety and insomnia.