Benzo use in the Gay Community

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The Hidden Dangers of Long-Term Benzodiazepine Use: Why These Drugs Should Only Be a Short-Term Solution



Benzodiazepines (often called “benzos”)—including Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam)—are commonly prescribed for anxiety, insomnia, and panic attacks. Many of us in the gay community have experience with these medications, whether prescribed for short-term stress, to manage trauma, or even recreationally. But what happens when short-term use turns into long-term dependence? The answer is troubling—especially for older adults.

The American Geriatrics Society (AGS) strongly warns against long-term benzodiazepine use, and for good reason. These medications, while effective in the short run, can wreak havoc on mental and physical health when used for extended periods. Let's break down the risks and why it’s important to seek safer alternatives.

Short-Term Relief, Long-Term Harm

Benzos work by enhancing the effect of GABA, a neurotransmitter that slows down brain activity. This results in a calming, sedative effect. When used appropriately—such as for a panic attack or severe short-term anxiety—they can be a lifesaver. However, the longer you take them, the more your brain adapts, leading to tolerance, dependence, and potentially severe withdrawal symptoms.

The AGS, along with many other medical organizations, emphasizes that benzodiazepines should not be a long-term solution for anxiety or insomnia. Here’s why:

The Risks of Long-Term Benzodiazepine Use

  1. Memory Loss and Cognitive Decline
    Long-term benzo use has been linked to memory impairment, confusion, and an increased risk of dementia. Studies have found that chronic users, particularly older adults, are significantly more likely to experience cognitive decline.

  2. Increased Fall Risk and Fractures
    Benzos impair balance and coordination, making falls far more likely—especially in elderly patients. A hip fracture in an older adult can be life-threatening and drastically reduce quality of life.

  3. Dependence and Withdrawal
    Even when taken as prescribed, benzodiazepines can lead to physical dependence. Stopping suddenly can cause severe withdrawal symptoms, including seizures, rebound anxiety, insomnia, and even hallucinations. Withdrawal can last for weeks or even months in some cases.

  4. Increased Risk of Overdose (Especially When Combined with Alcohol or Other Substances)
    The combination of benzos with alcohol, opioids, or other depressants can be fatal. This is a major concern in our community, where nightlife and social drinking are common.

  5. Worsened Anxiety and Insomnia
    Ironically, long-term benzo use can make the very conditions they treat worse. Over time, they disrupt the brain’s natural ability to manage stress and sleep, leading to a cycle of dependence and worsening symptoms.

Who Is Most at Risk?

  • Older Adults: The AGS has explicitly listed benzodiazepines as “potentially inappropriate” for older adults due to their risks of falls, fractures, and cognitive decline.
  • People with a History of Substance Use: Those who have struggled with alcohol or drug dependency are at a higher risk of becoming dependent on benzodiazepines.
  • People with Anxiety and Insomnia: Long-term benzo use can create a cycle of increased anxiety and worsening sleep quality.

What Are the Alternatives?

If benzodiazepines shouldn’t be a long-term solution, what should we do instead? The good news is that there are safer, evidence-based options to manage anxiety and insomnia, including:

  • Cognitive Behavioral Therapy (CBT): Proven to be one of the most effective treatments for anxiety and sleep disorders.
  • SSRIs and SNRIs: These antidepressants are often safer long-term options for anxiety.
  • Lifestyle Changes: Regular exercise, mindfulness meditation, and proper sleep hygiene can make a huge difference.
  • Non-Benzodiazepine Sleep Aids: Medications like trazodone or melatonin can be safer alternatives.

Breaking Free from Benzos

If you or someone you know has been taking benzodiazepines long-term, don’t stop suddenly—withdrawal can be dangerous. Instead, work with a healthcare provider to slowly taper off the medication while exploring other treatment options.

At Tom of P-Town Health, we prioritize evidence-based care and want our community to stay informed. Benzodiazepines have their place, but they should be used wisely and sparingly. Long-term use can be harmful, and for our aging LGBTQ+ community, the risks are even greater.

If you have concerns about your medications or mental health, reach out for support. There are safer, healthier ways to manage anxiety and sleep without the long-term risks of benzodiazepines.

References:

  • American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
  • National Institute on Drug Abuse (NIDA)
  • Harvard Medical School: Benzodiazepines and Cognitive Decline
  • American Psychiatric Association: Guidelines on Anxiety Treatment

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