Benzodiazepine medications are traditionally prescribed for the treatment of anxiety disorders, such as generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD), but people may also find them useful for the treatment of other mental health conditions, as well as insomnia. These medications include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). While incredibly helpful at times, especially for people with the most severe symptoms, benzodiazepines can be highly addictive. Many people find the withdrawals from benzodiazepines much harder to deal with than those of opioids (including heroin).
In the past few decades, what we have been seeing, unfortunately, is a sharp rise in benzodiazepine abuse and addiction – and it is worth asking what factors could be leading to such a trend. Some of these factors also help to explain the increasing rates of other addictive substances, most notably, opioids, leading to a disheartening opioid crisis in the US (as well as in other countries, to a lesser degree). This is because opioids, like benzodiazepines, are also effective at alleviating anxiety.
First, however, I would like to clarify the distinction between dependence and addiction, as it is essential to keep this in mind in the following discussion. Physical dependence occurs when the body requires a certain dose of a drug to stave off withdrawal symptoms. In a state of dependence, the body adapts to the drug, and a higher dosage of the drug is needed to achieve the desired effects (known as tolerance). Physical dependence can happen with the chronic use of certain drugs, including prescription drugs like benzodiazepines (even when they are taken as instructed). Addiction, on the other hand, often features this physical dependence but it doesn’t always. Drug addiction refers distinctly to compulsive drug use despite harmful consequences (e.g. a failure to fulfil work, social, and family obligations), as well as an inability to stop using the drug.
When discussing the rise of benzodiazepine use, it’s crucial to note that patients who take prescribed benzodiazepines and who experience withdrawals from them are not necessarily addicted to them. But, in terms of patients taking them as prescribed, a high percentage developing a physical dependence (some estimates state that most of these patients will experience withdrawal symptoms). Most people taking prescription benzodiazepines may not be addicted; however, given the number of prescriptions, we should still be worried, as this indicates many patients will have to suffer through the effects of withdrawals.
Substance abuse, meanwhile, refers to taking more of a drug than intended, taking the drug for longer than intended, spending a significant amount of time obtaining and using the substance, and experiencing cravings or urges to use. Abuse often precedes addiction but you experience substance abuse without it developing into an addiction, in that there can still be control over one’s use and the abuse may not cause serious disruptions to one’s life.
The Rise of Anxiety Accompanies the Rise of Benzodiazepine Use
We can trace the rise of benzodiazepine use, abuse, dependency, and addiction alongside rising rates of anxiety in recent decades (take the UK and US as two examples), although some populations tend to be more likely to be affected – young adults, in particular, it seems. Based on increased feelings of anxiety and anxiety disorders, it’s no wonder, then, that rates of prescriptions for benzodiazepines have also skyrocketed in tandem. Yet, we have also witnessed increased usage of non-prescribed benzodiazepines, such as Xanax, with teenagers buying the drug on the dark web to self-medicate their anxiety.
We can thus explain the rise in benzodiazepine use, dependency, and addiction as partly coming down to increased anxiety, prescriptions, and illicit buying (made easier thanks to the dark web). Benzodiazepines have a high potential for abuse and addiction, which is related to their mechanisms of action (they lead to surges in the chemical dopamine in the brain). Dopamine is not ‘pleasure chemical’ as is often claimed – dopamine doesn’t cause pleasure but it does seem to be closely tied to reward, causing lasting changes in the brain’s reward system that makes us crave the dopamine-releasing benzodiazepines again. The brain’s reward system is well set up to direct us towards beneficial activities like eating and having sex but certain drugs and behaviours can also hijack this evolved system, leading to deleterious patterns of drug use.
When physicians and psychiatrists prescribe benzodiazepine drugs for periods of anxiety or anxiety disorders, it is often advised to use these anti-anxiety drugs for only a short period, so people can get over the most acute symptoms – this recommendation is based on the understanding of benzodiazepines’ nature to quickly lead to tolerance, which makes abuse more likely, as a user will need higher doses of the drug to get the same relief. This also has the potential to lead to addiction, whereby users continue to take the drug despite its negative effects. Benzodiazepine abuse and addiction are also common because these drugs can offer people very pleasant feelings of calm, relaxation, euphoria, and ease with sleep.
The Causes of Increasing Anxiety
The causes of anxiety are multifaceted, and while biological and genetic factors can help explain anxiety, we need to couple such factors with the kind of world we live, as well as be sure not to forget the psychological needs we have as humans. Researchers have associated increases in anxiety with changes like economic difficulties, climate change, and social media. All of these factors are, understandably, anxiety-inducing, and they shine a light on why recent decades have seen us becoming increasingly anxious.
But the author and journalist Johann Hari believes there are other causes of anxiety that we should pay attention to. He has argued that our psychological needs are increasingly coming into conflict with the environment we find ourselves in – Hari notes that these needs include the need to feel we belong, the need to feel that our lives have meaning and purpose, the need to interact with the natural world, the need to feel that people see us and value us, and the need to feel that we have a future makes sense. If the society we live in fails to properly meet these needs, Hari contends, then we will be prone to depression and anxiety, feelings that are our mind’s way of alerting us to a deep psychological problem that needs addressing.
In this way, anxiety is a natural response to the environment we live, and without a fundamental change in the environment, our only recourse for relief – or one of the most common and instinctive recourses – is benzodiazepine medication. Also, social isolation can exacerbate symptoms of anxiety, and due to the permeation and rise of loneliness in society, what we may be seeing is that already problematic anxiety is being worsened by already problematic feelings of isolation. And what is the reason for this kind of atomisation, with people feeling more and more disconnected from each other? Well, it would be lengthy to exhaustively describe all the factors, but one of the main ones worth mentioning includes, unquestionably, social media. The journalist George Monbiot has also propounded the view that neoliberal ideology, with its reverence of self-interested competitiveness and individualism, has made us atomised, much to our detriment.
A Note on Social Media
Outside of its effects on isolation, social media use contributes to anxiety in teenagers in other ways, and it then also offers opportunities for anxious teenagers to buy benzodiazepines from dealers, who use platforms like Instagram and Facebook to sell drugs like Xanax. In this way, social media has helped to contribute to one problem (anxiety) and then become a platform in which teenagers can seek a problematic solution (uncontrolled purchases of Xanax). There are deeper issues that need to be resolved in tackling younger people’s abuse of – and dependence on – benzodiazepines, as one of the reasons that many young people cite for using anti-anxiety drugs is as a way to cope with exam stress. As a society, we need to assiduously examine why exams have become so stressful for young people.
What Can Be Done to Tackle the Benzodiazepine Problem?
I hope that the common theme running through this piece has been the need to address the root causes of anxiety, rather than follow this trajectory of reliance on benzodiazepines. However, a sense of realism is also required in this discussion. All of the issues underlying rampant anxiety in society won’t be solved overnight. So what are people struggling with anxiety meant to do?
Well, first, clearly communicating the problem, its implications, causes, and solutions is paramount, as is communicating this persuasively to those who are best able to affect relevant change. This has to be a collective effort, with outcomes being uncertain, and likely to materialise in a positive direction slowly over time (unless we really do see some landmark policy and political changes that serve to massively reduce – or lift – anxiety).
Alongside this effort, we desperately need widespread adoption of alternative anxiety-reducing treatments. Coping with anxiety and fighting for a system that is conducive to good mental health is not a zero-sum game. Luckily, there are alternatives to benzodiazepines that are healthier and safer, while still being effective. These alternatives include a mindfulness meditation practice, regular exercise, certain dietary choices, and CBD (this compound is a popular choice for people who want anxiety relief because it has no or few psychoactive effects, and has been shown to be safe and non-addictive).
As well as finding healthy ways of coping with anxiety, individuals can also take steps to address the root causes of anxiety, in spite of the existing political, technological, and cultural forces that sow the seeds of anxiety in society. Reducing social media use, limiting news consumption, and prioritising social connection are a few examples of steps toward a direction of greater peace and calm.