What Are Benzodiazepines? Uses, Risks, and How to Stop Safely

Benzodiazepines, usually shortened to "benzos," are prescription sedatives. Doctors use them for anxiety, panic attacks, insomnia, seizures, muscle spasms, and alcohol withdrawal. They work well for short stretches, and physical dependence can develop within weeks of regular use, which is part of why the FDA requires a boxed warning on every drug in the class.

What benzodiazepines are and how they work

Benzodiazepines are central nervous system depressants. They increase the activity of GABA, the brain's main calming neurotransmitter, which slows nerve signaling. That slowdown is what relieves anxiety, brings on sleep, relaxes muscles, and stops seizures. It is also what makes the drugs dangerous alongside other depressants like alcohol and opioids, because the effects stack.

They are controlled substances in the United States: accepted medical uses, with a recognized potential for misuse and dependence.

Common benzodiazepines

• Alprazolam (Xanax), mostly prescribed for anxiety and panic disorder. Sober Nation has a separate page on what Xanax is.
• Diazepam (Valium), used for anxiety, muscle spasms, seizures, and alcohol withdrawal.
• Lorazepam (Ativan), used for anxiety and before medical procedures.
• Clonazepam (Klonopin), used for panic disorder and some seizure disorders.

They differ mainly in how fast they start working and how long they last. Shorter-acting ones wear off sooner, and some people feel that as anxiety creeping back between doses.

What they are prescribed for

• Anxiety disorders and panic attacks
• Insomnia, usually for a short period
• Seizure disorders
• Muscle spasms
• Alcohol withdrawal, where they lower the risk of withdrawal seizures
• Sedation before surgery or a procedure

Risks: dependence, withdrawal, and overdose

In September 2020 the FDA updated the boxed warning for all benzodiazepines to cover abuse, misuse, addiction, physical dependence, and withdrawal reactions. Physical dependence can develop within weeks of regular use, even at the prescribed dose. That is not the same thing as addiction, but it does mean your body will react if the drug is cut back too fast.

The problems people most often run into:

• Tolerance, where the same dose does less over time.
• Withdrawal, which can include rebound anxiety, insomnia, tremor, sweating, and in severe cases seizures. The FDA's warning is blunt about it: stopping abruptly or reducing the dose too quickly can cause seizures that are life threatening.
• Overdose when combined with opioids or alcohol. Benzodiazepines alone rarely stop someone's breathing. Combined with an opioid, the FDA notes the result has included severe respiratory depression and death.
• Memory and coordination problems, and a higher risk of falls in older adults.

If you think someone has overdosed on benzodiazepines mixed with opioids or alcohol, call 911. Naloxone reverses the opioid part of a mixed overdose and will not hurt someone who has not taken opioids, so use it if you have it.

Do not stop benzodiazepines suddenly

This is the part people most often get wrong. If you have been taking a benzodiazepine daily for more than a few weeks, quitting cold turkey can trigger seizures. The safe way off is a gradual taper planned with a prescriber. For heavier or longer use, that often means a medically supervised detox. Sober Nation's guide to how to quit Xanax shows what a taper looks like in practice, and the page on drug and alcohol withdrawal explains why some substances need medical oversight and others do not.

Signs that use has become a problem

• Taking more than prescribed, or running out early
• Seeing more than one doctor to get prescriptions
• Feeling anxious or shaky between doses
• Mixing benzodiazepines with alcohol or opioids to feel more of an effect
• Trying to cut down and not managing to

If several of these sound familiar, the benzodiazepine self-assessment is a quick way to take stock. It is not a diagnosis, but it can help you decide whether to talk to someone.

Treatment for benzodiazepine dependence

Treatment usually starts with a slow taper, and sometimes a prescriber will switch you to a longer-acting benzodiazepine first to make the step-downs smoother. Counseling, most often cognitive behavioral therapy, works on the anxiety or insomnia that led to the prescription, so there is something in place when the medication is gone. Many people find they need help with both at the same time. NIDA's overview of prescription CNS depressants says the same thing in fewer words: anyone thinking about stopping should talk to a physician first.

You can search treatment centers by state in the Sober Nation directory. The signs of addiction by substance hub covers how a benzodiazepine problem looks different from other drugs.