People abuse benzodiazepines for a mix of reasons: to get high, to amplify the effects of other drugs, to self-medicate anxiety or insomnia, and because the drugs create a physical dependence that makes stopping extremely uncomfortable. About 4.6 million people aged 12 or older in the United States misused prescription tranquilizers or sedatives in 2024, roughly 1.6% of the population.
How Benzos Affect the Brain’s Reward System
Benzodiazepines work by amplifying the effect of GABA, the brain’s main calming chemical. They don’t produce GABA themselves. Instead, they latch onto GABA receptors and make those receptors more responsive, which is why they’re so effective at reducing anxiety, promoting sleep, and relaxing muscles. That calming flood is also what makes them appealing to misuse.
The reward pathway is more complex than with drugs like cocaine or amphetamines. Most addictive substances directly boost dopamine in the brain’s pleasure center. Benzodiazepines, oddly enough, don’t clearly raise dopamine levels with a single dose. Some studies have actually found they reduce dopamine in the short term. But they still trigger lasting changes in the brain’s reward circuitry, particularly by quieting inhibitory neurons in the ventral tegmental area, a region that acts as a gateway for dopamine signaling. Over time, this creates adaptations similar to those caused by other drugs of abuse, reinforcing the desire to keep using.
The Psychological Pull
For many people, the initial appeal is simply relief. Benzodiazepines dissolve anxiety, quiet racing thoughts, and produce a sense of calm that can feel profoundly rewarding if you’ve been living with untreated or undertreated anxiety, insomnia, or emotional distress. That experience of sudden relief is itself a powerful motivator to use the drug again.
But misuse often goes beyond anxiety relief. At higher doses, benzos produce feelings rated as “high,” “euphoria,” “good,” and “strong” in clinical studies. These euphoric effects are especially pronounced in people who already use other substances. Some users describe the feeling as a warm, heavy relaxation that blunts emotional pain along with physical tension. The line between “taking it for anxiety” and “taking it to feel good” can blur quickly, especially when someone starts increasing their dose beyond what was prescribed.
Combining Benzos With Other Drugs
A significant portion of benzo misuse happens alongside opioids or alcohol. Users have discovered that benzodiazepines amplify the subjective high from opioids, making the combined effect feel more intense and, in their description, more “heroin-like.” In controlled studies, adding a benzodiazepine to an opioid regimen significantly increased ratings of euphoria and drug strength, regardless of the opioid dose. Some people on maintenance therapy for opioid addiction actively seek out benzo prescriptions specifically to boost intoxication.
This combination is also the deadliest pattern of benzo misuse. Both drug classes suppress breathing, and together they multiply that risk. But from the user’s perspective, the combination produces a more complete high than either drug alone, which is why the pattern persists despite the danger.
How Tolerance Traps People
Benzodiazepines build tolerance remarkably fast. In animal studies, receptor binding in key brain regions dropped by roughly 50% within seven days of continuous use, with the sharpest decline happening between days four and seven. The brain literally reduces the number of available receptors, meaning the same dose produces less effect. Clinical guidelines recommend avoiding continuous use beyond four weeks, but long-term prescribing remains common.
Tolerance creates a straightforward trap: the dose that once worked no longer does. People increase their dose to recapture the original effect, which accelerates receptor changes, which demands a higher dose still. Someone who started with a legitimate prescription for panic attacks can find themselves taking two or three times the original amount within months, not to get high, but just to feel normal.
Withdrawal Makes Quitting Painful
Once dependence sets in, the withdrawal syndrome becomes its own powerful reason to keep using. Stopping or sharply reducing benzodiazepines after regular use produces a predictable set of symptoms: sleep disturbance, heightened anxiety and irritability, panic attacks, hand tremor, sweating, difficulty concentrating, nausea, palpitations, headache, and muscle pain and stiffness. In severe cases, particularly after high-dose use, withdrawal can cause seizures and psychotic reactions.
The cruelest feature of benzo withdrawal is that it often mimics and intensifies the very symptoms the drug was prescribed to treat. Someone who started taking a benzodiazepine for anxiety may experience withdrawal anxiety far worse than anything they felt before they began the medication. This rebound effect convinces many people that they can’t function without the drug, locking them into continued use even when they want to stop. The withdrawal timeline varies depending on the specific drug, but symptoms typically begin within one to four days of the last dose and can persist for weeks or, in some cases, months.
Where People Get Them
Benzodiazepines reach people through both medical and non-medical channels. The most common healthcare-related source is simply a person’s own doctor: about 11% of misusers in one study were using their own legitimate prescriptions in ways they weren’t intended. Others visit multiple doctors to collect multiple prescriptions, a practice known as doctor shopping, which yields the highest volume of diverted pills. Some obtain prescriptions from physicians who sell them illegally.
Outside the healthcare system, people get benzodiazepines from street dealers, by sharing or trading with friends, from family members, or through theft. The relative ease of obtaining these drugs, whether through a prescription pad or a text message, contributes to their widespread misuse. Unlike illicit drugs that require a specific supply chain, benzodiazepines sit in millions of medicine cabinets.
Who Is Most Affected
Benzo misuse spans age groups, but the patterns differ. Among young adults aged 18 to 25, past-year misuse of prescription tranquilizers or sedatives dropped from 2.7% in 2021 to 1.6% in 2024, a meaningful decline. Adults 26 and older held steady at 1.7%, representing about 3.8 million people. Adolescents aged 12 to 17 had the lowest rate at 0.7%, or about 172,000 individuals.
People with existing substance use disorders, particularly opioid use disorder, are disproportionately likely to misuse benzodiazepines. So are people with untreated or poorly managed anxiety disorders, insomnia, and mood disorders. The overlap between legitimate need and misuse potential is part of what makes benzodiazepines such a complicated class of drugs: they genuinely help millions of people, and they genuinely harm millions of others, sometimes the same people.