Clinically reviewed by the licensed clinical team at Shepherd Recovery Centers. Content is for informational purposes only and does not constitute medical advice. Sources include the National Institute on Drug Abuse (NIDA), Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
What Are Benzodiazepines?
Benzodiazepines, commonly called benzos, are a class of prescription medications used to treat anxiety disorders, panic disorder, insomnia, seizures, and alcohol withdrawal. Common benzodiazepines include alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), and temazepam (Restoril). According to a study published in JAMA Psychiatry, approximately 30.6 million adults in the United States used benzodiazepines in a recent year, with 17.2% of those meeting criteria for misuse.
Benzodiazepines are involved in approximately 16% of opioid overdose deaths in the United States. Combined use of benzos and opioids dramatically increases the risk of fatal respiratory depression. (NIDA, 2021)
Benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA), the brain’s primary inhibitory neurotransmitter, producing sedation, anxiety relief, and muscle relaxation. These effects are therapeutic at prescribed doses. But benzodiazepines also carry a well-established potential for physical dependence and addiction, a risk that is often underestimated by both patients and prescribers.
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Why Benzodiazepine Dependence Is Uniquely Challenging
Benzo dependence stands apart from other forms of substance use disorder for one critical reason: the withdrawal syndrome can be medically dangerous, and in some cases, life-threatening. Abrupt discontinuation of benzodiazepines, particularly after heavy, prolonged use, can cause:
- Severe anxiety and panic attacks (often worse than the original anxiety being treated)
- Insomnia, tremors, and sweating
- Seizures, which can be fatal without medical supervision
- Psychosis and hallucinations in severe cases
- Rebound anxiety that can last weeks to months (protracted withdrawal)
The FDA’s 2020 black box warning update on all benzodiazepines acknowledges the risks of physical dependence, withdrawal, and addiction. This should not be a source of shame for patients. It reflects the inherent pharmacological properties of these medications, not a failure of character.
Signs of Benzodiazepine Use Disorder
- Taking benzos in larger amounts or for longer than prescribed
- Difficulty stopping or cutting down despite wanting to
- Significant time spent obtaining, using, or recovering from benzo use
- Continued use despite negative effects on memory, cognition, mood, or relationships
- Withdrawal symptoms when doses are missed or reduced
- Escalating doses to achieve the same level of relief (tolerance)
- Obtaining benzos from multiple sources or without a prescription
Co-Occurring Anxiety and Benzodiazepines
A significant clinical complexity in benzo addiction treatment is the frequent co-occurrence of the anxiety disorders for which benzos were originally prescribed. Clients often fear that stopping benzodiazepines will leave them without any protection against anxiety they experience as unmanageable. This fear is understandable and clinically valid.
At Shepherd, we address both the benzo use disorder and the underlying anxiety simultaneously. Our approach includes evidence-based non-benzo treatments for anxiety, particularly CBT, which is recognized by major clinical guidelines as the gold-standard long-term treatment for anxiety disorders, alongside careful, medically supervised tapering where appropriate.
Benzodiazepine Treatment at Shepherd Recovery Centers
Medical Evaluation at Intake
Given the serious risks of benzo withdrawal, a thorough medical evaluation at intake is essential. Our clinical team assesses current benzo use, duration and dose, history of seizures, and overall health status. For clients whose level of dependence requires medical detox before outpatient treatment, we will coordinate appropriate referrals and transition you into our program when it is clinically safe to do so.
Medically Supervised Tapering
Abrupt benzo cessation is unsafe for significantly dependent clients. Our clinical team works with prescribing physicians to develop a structured tapering protocol, typically using a longer-acting benzodiazepine equivalent to reduce the severity of withdrawal, guided by established clinical protocols from ASAM and the Ashton Manual.
Therapy for Anxiety and Addiction
CBT for anxiety is a core component of benzo treatment at Shepherd. Clients learn to tolerate anxiety through exposure-based techniques, cognitive restructuring, and interoceptive exposure, building confidence that anxiety, while uncomfortable, can be managed without medication.
Cognitive Behavioral Therapy is as effective as benzodiazepines for anxiety disorders in the short term, and more effective in preventing relapse long-term. (British Medical Journal, Meta-Analysis, 2019)
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If you or someone you love is struggling with addiction, Shepherd Recovery Centers is ready to help. Our licensed clinical team serves Missouri City, Fort Bend County, and the greater Houston area. We accept most major insurance plans and can verify your benefits within 24 hours. The first call is confidential and carries no obligation.