Benzodiazepine use disorder
Alerts and Notices
Synopsis
Risk factors for abuse include other drug or alcohol dependence, chronic pain, personality disorder, depressive disorder, sleep disorder, and certain neuromuscular disorders.
Patients may stockpile prescription drugs, seek multiple prescriptions from multiple health care providers, acquire medications from other users, and exaggerate their symptoms to acquire larger quantities and higher doses of benzodiazepines.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies substance abuse from mild to severe. The criteria address signs of cravings, tolerance, loss of control, loss of interest in favorite activities, avoidance of responsibilities, and withdrawal symptoms upon abstinence.
Health care providers are advised against prescribing multiple benzodiazepines. When they are prescribed, it is advisable to use short-term prescriptions and to seek alternative therapies in older or high-risk patients. Long-term use of benzodiazepines has been shown to increase tolerance.
Adverse effects of benzodiazepine use include amnesia (memory loss), psychomotor impairment, ataxia, altered mental status, slurred speech, rebound anxiety, withdrawal symptoms, drowsiness, lethargy, disturbed concentration, feeling "hungover," uncoordinated muscular movement, and hypotonia. These effects increase the likelihood of impaired driving, falls, and fractures.
Benzodiazepine overdose or poisoning can occur when ingested in a high dose alone or in combination with ethanol or other drugs, particularly depressants. Toxicity can induce a state of excessive drowsiness, delirium, psychosis, seizures, stupor, or coma. Patients with a benzodiazepine use disorder are particularly prone to overdoses due to increased drug tolerance and often the use of escalating doses.
Related topic: Benzodiazepine withdrawal syndrome
Codes
ICD10CM:F13.10 – Sedative, hypnotic or anxiolytic abuse, uncomplicated
SNOMEDCT:
428406005 – Benzodiazepine misuse
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Major depressive disorder
- Generalized anxiety disorder
- Dysthymia
- Personality disorder
- Hypothyroidism
- Substance abuse (see, eg, alcohol use disorder, cannabis use disorder, opioid use disorder)
- Carbon monoxide poisoning
- Hepatic encephalopathy
- Sepsis – can present with altered mental status; will often have fever, leukocytosis, tachypnea, or tachycardia, none of which are necessarily seen with benzodiazepine use disorder
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/27/2019
Last Updated:03/27/2019
Last Updated:03/27/2019