What are they?
Benzodiazepines
The background to the benzo problem is given on another page. Here we give some basic information about the drugs. Benzodiazepines are some of the most widely prescribed drugs in the world and include Diazepam (Valium), Temazepam and Nitrazepam (Mogadon). To check if the drug that you are taking is a benzodiazepine or closely related drug, see drug identification.
Members of the benzodiazepine family are all related chemically and have similar effects on the nervous system. These include reduction of anxiety, sleepiness and muscle relaxation. One of the key differences between individual benzodiazepines is the duration of the intended effects. This is expressed as their half-life (the time for the blood concentration to fall by half). The shorter half-life drugs are favoured as “sleeping pills” so that you are not too drowsy when awake. The longer acting drugs are more often used as “tranquillisers”, because the effect is more evenly spread. Some of the benzodiazepines have other uses, and they are widely used in hospitals (e.g. pre-medication before operations).
Withdrawal symptoms tend to cause more problems with the shorter acting drugs, probably because the level in the bloodstream varies so much. With the longer acting drugs any withdrawal symptoms may occur several weeks after a reduction in dose. Two to three weeks is typical but longer periods are not uncommon. It is this surprising feature that may lead to users being caught in a cycle of continually increasing and decreasing their drug. After cutting their dose they may feel better for a day or two and think that they are on the right path. If they get a withdrawal reaction several weeks later they assume that it can’t possibly be the drug – there must be something wrong with themselves. Furthermore the drug seems to fix the problem. In reality all the drug may be doing is to reduce its own withdrawal symptoms (see dependence).
The benzodiazepines and similar drugs are sometimes termed “minor tranquillisers” as opposed to the “major tranquillisers” which are antipsychotic drugs. The term “minor” misleads some people (including some in the medical profession) into underestimating the power of these substances.
“The three Z’s”
Later drugs have been introduced which are often claimed to be free of the problems which the benzodiazepines have. The key drugs are Zolpidem, Zopiclone and Zaleplon (see drug identification). It is difficult to be certain how addictive they are but indications suggest that they should be treated at least as cautiously as benzodiazepines. Many more adverse reactions have been reported for Zopiclone, for example, than for the much older diazepam. It should be noted that the "three Z's" are taken up at some of the same, very specific, receptor sites in the brain used by the benzodiazepines. Their action is therefore similar. Prescribing advice (BNF) is that they should not be used long term.
Other drugs
A range of other drugs, besides the benzodiazepines, have been used as tranquillisers and sleeping pills. Most of these have suffered from problems with dependency, toxicity or both. The search for the holy grail of a truly harmless tranquilliser goes on, but some authorities feel that dependency may be an inherent feature of tranquillisers. See our notes on the background to the benzodiazepine problem.