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Usage Trends

Benzodiazepines are very commonly prescribed, but they are supposed to be used only for brief periods of time. Benzodiazepine drugs have a number of genuine medical uses, but they are most frequently prescribed to relieve anxiety and fear. According to the American Psychiatric Association (APA), approximately "8 percent of all adults have suffered from a phobiaExtreme and often unexplainable fears of certain objects or situations., panic disorder or other anxiety disorder" during any given six-month period. "For millions of Americans, anxiety disorders are disruptive, debilitating and often the reason for loss of job and serious problems in family relationships."

Treating Anxiety

Anxiety disorders are sometimes controllable without drugs. Patients are often able to reduce their anxiety to manageable levels through weekly "talk therapy" sessions with trained psychotherapists. One type of psychotherapyThe treatment of emotional problems by a trained therapist using a variety of techniques to improve a patient's outlook on life., called cognitive-behavioral therapyA type of therapy that helps people recognize and change negative patterns of thinking and behavior. (CBT), has a very high success rate. Cognitive-behavioral therapy helps patients change their outlook on life and recast their negative feelings into positive ones.

In certain cases, however, therapy is not enough. Patients may require medication to control their symptoms. Psychiatrists often prescribe benzodiazepines to such patients. According to the APA, these drugs "relieve the fear, help end the physical symptoms such as pounding heart and shortness of breath, and give people a greater sense of control." Along with that greater sense of control comes the ability to recognize and "reduce the stress that can trigger anxiety."

Benzodiazepines are most commonly prescribed for women and elderly patients. Four out of five people who experience panic attacks are female. Elderly patients are commonly diagnosed with conditions such as insomnia and depressionA mood disorder that causes people to have feelings of hopelessness, loss of pleasure, self-blame, and sometimes suicidal thoughts.. These conditions respond well to treatment with certain benzodiazepines. But long-term use of these drugs among the elderly increases the likelihood of these patients developing a physical dependence on benzodiazepines.

In one study cited by Mental Health Weekly, 60 percent of older women taking benzodiazepines by prescription were on the drugs for more than four months. That time period is longer than recommended. In addition, the National Institute on Drug Abuse (NIDA) reported in its "Prescription Drugs: Abuse and Addiction" that "elderly persons who take benzodiazepines are at increased risk for falls that cause hip and thigh fractures, as well as for vehicle accidents."

Benzodiazepines are prescribed to treat anxiety as well as to relieve tension, agitation, insomnia, muscle spasms, and epileptic seizures. Photo by Erlie E. Pruitt Jr. Courtesy of Lance Logan Sims.

Part of the Multi-Drug Mix

Among drug abusers, benzodiazepines are hardly ever used alone. The White House's drug policy publication "Pulse Check" revealed that multi-drug use "increased steadily" between 1993 and 2003. About 80 percent of benzodiazepine abuse occurs in people who regularly abuse other drugs. This has led to "increased complications for drug treatment," noted the "Pulse Check" report, because "it is hard to determine what clients are using."

illicitUnlawful. drug users report that benzodiazepines increase and lengthen the highDrug-induced feelings ranging from excitement and joy to extreme grogginess. they get with other drugs. Heavy drinkers have reported that benzodiazepines enhance the effects of alcohol. These drugs can also ease the process of "coming down" from a stimulant high. So, many multi-drug abusers use it as part of their regular drug mix.

Abuse of benzodiazepines is especially high among heroin, cocaine, and methadone abusers. (A separate entry on each of these drugs is available in this encyclopedia.) According to S. Pirzada Sattar and Subhash Bhatia in an article for Current Psychiatry Online, nearly half of all intravenousInjected into a vein. (V) drug abusers also take benzodiazepines. However, "even patients who begin taking benzodiazepines for legitimate reasons may end up abusing them."

Who's Using Benzodiazepines?

Patterns of benzodiazepine use in America have been documented in two long-term surveys. One is the Monitoring the Future (MTF) study conducted by the University of Michigan (U of M) and sponsored by research grants from NIDA. The second is the National Survey on Drug Use and Health (NSDUH), previously called the National Household Survey on Drug Abuse or NHSDA. It is conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services.

The results of the 2004 MTF study were released to the public on December 21, 2004. Since 1991, U of M has tracked patterns of drug use and attitudes toward drugs among students in the eighth, tenth, and twelfth grades. (Prior to that, from 1975 to 1990, the MTF survey was limited to twelfth graders.) The 2004 MTF survey revealed that the use of tranquilizers and sedatives remained relatively "stable among all grades." About 2.5 percent of eighth graders, 5.1 percent of tenth graders, and 7.3 percent of high school seniors reported using drugs like Xanax between 2003 and 2004.

SAMHSA's 2003 NSDUH was broader than the MTF survey. The NSDUH traces drug use in the United States among people of all ages, not just among eighth, tenth, and twelfth graders. The NSDUH obtains information about nine different categories of illicit drug use. One of those categories includes the nonmedical use of prescription-type pain relievers, tranquilizers, stimulantsA substance that increases the activity of a living organism or one of its parts., and sedatives.

NSDUH reports combine the four prescription-type drug groups into a category referred to as "any psychotherapeutics" (SY-koh-ther-uh-PYOO-tiks). Numerous drugs are covered by this category. All of them are available through prescriptions and sometimes illegally "on the street." Over-the-counter drugs and legitimate uses of prescription drugs are not included in the NSDUH report. Respondents are asked to report only uses of drugs that were not prescribed for them or drugs they took only for the experience or feeling they caused.

The results show that a number of Americans became "new users" of psychotherapeutic drugs in 2002. Roughly 1.2 million people began using tranquilizers, and 225,000 began using sedatives. Among fifteen benzodiazepines, the nonmedical use of two specific drugs—alprazolam (Xanax) and lorazepam (Ativan)—rose the most between 2002 and 2003, from 3.5 percent to 4 percent of those surveyed. Use among twelve to seventeen year olds was unchanged, reflecting the same trend as the MTF survey. The biggest jump was seen in users who were slightly older, age eighteen to twenty-five. From 2002 to 2003, usage in that particular age group increased from 6.7 to 7.5 percent.

The short-acting benzodiazepines, such as Ativan, typically begin working in less than a half hour and are among the most commonly abused drugs. Scott Camazine/Photo Researchers, Inc.

In Canada, benzodiazepine use is tracked by the Centre for Addiction and Mental Health (CAMH). The CAMH publishes a series of leaflets on drugs under the title "Do You Know. … " The "Do You Know… Benzodiazepines" leaflet states that "approximately 10 percent of Canadians report using a benzodiazepine at least once a year, with one in ten of these people continuing use regularly for more than a year."