Benzodiazepines and so-called Z-substances (benzodiazepine-like substances) are used to treat sleep disorders, anxiety and panic attacks or in cases of severe tension, epilepsy or convulsions. They are also used before operations. They are also known as "hypnotics" (sleeping pills), "tranquilizers" (sedatives) or "anxiolytics" (anxiety-relieving drugs). The individual drugs differ in terms of their duration of action.

Benzodiazepines and Z-substances are prescription drugs and should generally not be taken for longer than 4 to 6 weeks. In crisis situations, they can reliably alleviate symptoms such as anxiety, restlessness, inner tension and sleep disturbances until other psychotherapeutic or drug treatment approaches take effect. If taken regularly over a longer period of time, physical and psychological dependence can develop. If the problems persist over a longer period of time, the underlying causes should therefore be treated.

Benzodiazepines contain active substances which dock to receptors of nerve cells in the brain and thus act on the entire central nervous system. They reduce the transmission of stimuli and have a calming and anxiety-relieving effect, promote sleep, relax the muscles and relieve cramps. They also reduce the intensity of feelings, which - at higher dosages - isolates them from everyday events. In addition, benzodiazepines also affect memory, attention and movement coordination, which can lead to confusion, forgetfulness, slurred speech and gait problems. This can also severely impair fitness to drive. The rhythm and quality of sleep can also be disturbed by benzodiazepine use.

If taken regularly over a long period of time, there is a not inconsiderable risk of developing a dependency. This applies not only to high doses, but also to low doses. Therefore, benzodiazepines should only be used for short periods.
With regular use benzodiazepines may lose their potency, so the dose must be increased to achieve the same effect. In medical terminology this is called tolerance development. Such dose increases, or combinations of different benzodiazepines to maintain potency, increase the risk of dependence.

Two forms of benzodiazepine dependence can be distinguished: Low-dose dependence is often observed in older people who need a low dose of a benzodiazepine to sleep without increasing the dose as the dose progresses. Here the side effects are often relatively minor. In the rarer high-dose addiction, there is a tendency, through tolerance, to take higher and higher doses, with correspondingly more serious effects on well-being and functioning.

In the case of a dependence, withdrawal symptoms occur when the medication is suddenly discontinued - similar to an alcohol dependence. In addition, so-called rebound phenomena can occur even before the onset of withdrawal symptoms towards the end of an intake interval: This means that the same symptoms that were originally intended to be treated with the benzodiazepines occur suddenly and to a greater extent. This often prompts people to continue the medication seamlessly to avoid this unpleasant experience.

Long-term use can also lead to psychosocial problems and impaired performance through persistent drug-related side effects such as memory and attention deficit disorders, depressive moods, irritability, emotional disinterest, rapid exhaustion, drowsiness.

In general, the risk of accidents increases with the use of benzodiazepines - in traffic, at work or during leisure time.

Since the body breaks down the drugs more slowly with age, the duration of their effect is extended. The central nervous system of older people also reacts more sensitively to the damping and muscle-relaxing effect of the drugs. This leads to more frequent falls with fractures, confusion and forgetfulness. These side effects are often wrongly interpreted as signs of aging. Due to diseases, older people often take other medications as well. Such mixed use of benzodiazepines with other drugs can lead to serious health problems. Alcohol is also broken down more slowly in older people, which affects their responsiveness, cognitive abilities and balance.

By reducing or phasing out the medication, older people in particular can regain a higher quality of life in the event of overuse, as this can significantly improve their sensory perception, alertness, ability to process information, memory and thus their general well-being.

A particular risk is posed by so-called mixed use, i.e. the simultaneous use of benzodiazepines and other sedative substances such as alcohol or opioids. This can increase the attenuating effect of the individual substances, which can lead to drowsiness or even comatose states and a slowing of breathing - in the worst case, even respiratory arrest. Therefore benzodiazepines should not be taken together with alcohol or other sedative psychoactive substances!

In the case of dependence, control over the consumption is lost. Desire for the benzodiazepines is very strong and is often perceived as compulsion to maintain the effects or to avoid withdrawal symptoms. Tolerance may develop, i.e. the dose must be increased continuously to achieve the same effect. If the medication is discontinued, physical and psychological withdrawal symptoms occur, which can manifest themselves as anxiety, anxiety, sweating, trembling and headaches. In the case of dependence, thoughts often revolve around the use of benzodiazepines, while other interests and social contacts are neglected. Despite possible harmful or debilitating consequences, benzodiazepine use continues.

If medication is taken longer than necessary, in a higher dose than prescribed or without medical reason, this is called medication overuse or problematic use if psychological, physical or social impairments develop. Regular, long-term overuse can lead to dependency, i.e. loss of control over consumption. Withdrawal symptoms may occur and tolerance often develops. This means that the dose must be increased to achieve the same effect.

If you have the impression that you have developed a drug addiction and you suffer from the consequences and effects: Get support - you are not alone! A specialist can provide you with professional support on your way to more self-determination and quality of life. This does not necessarily require an inpatient stay in a clinic. A reduction in consumption or withdrawal can also be achieved within the framework of an outpatient program such as that offered by Arud. Frequently, short conversations with a doctor are already helpful in order to gain a new perspective and to motivate oneself for further steps.

Since the possible withdrawal symptoms when you stop taking benzodiazepines can be severe and vary greatly from person to person, you should first discuss a change in dose with a doctor.

In a detailed investigation, the first step is to find out whether there are any additional psychological or stress factors which may be underlying or contributing to benzodiazepine use. Appropriate treatment is then initiated for the underlying conditions and risk factors identified in order to achieve the greatest possible stability and thus to optimise the starting point for sustained benzodiazepine withdrawal.

The benzodiazepine withdrawal is carried out in small steps and at a pace that is acceptable to the individual patient, in order to prevent withdrawal symptoms from occurring and to allow the body and mind to stabilise sufficiently before each further reduction step. This process is very individual, tailored to the individual patient and can take weeks or months.

Many affected people often do not dare to seek help for years - out of shame and fear of being condemned. It is therefore important not to condemn or accuse affected persons. Honesty and compassion are helpful: If there are indications of a dependency, the person should be approached - in a compassionate and non-judgmental way. The affected person should feel that you care and support them in seeking professional help. However, the responsibility to get help and to make use of it lies with the person concerned.