Lena Dunham revealed recently that she's been sober for six months after treating a substance abuse problem that began in a doctor’s office.
"I’ve been sober for six months," she told Shepard. "My particular passion was Klonopin," which is a type of benzodiazepine (also called benzos). "If I look back, there were a solid three years where I was, to put it lightly, misusing benzos, even though it was all quote unquote doctor prescribed," she said.
Dunham says that over the years, she started increasingly turning to the medication to manage the anxiety that would otherwise make it difficult to keep up her daily obligations.
She felt like she was required to show up for things she "didn't feel equipped" for. "But I know I need to do it, and when I take a Klonopin, I can do it," she explained.
Klonopin made Dunham "feel like the person I was supposed to be," she continued. "It was like suddenly I felt like the part of me that I knew was there was freed up to do her thing." Her doctor’s (or doctors’) willingness to prescribe the medication enabled Dunham to keep her worsening habit going, she says. "I didn’t have any trouble getting a doctor to tell me, ‘No you have serious anxiety issues, you should be taking this. This is how you should be existing.'"
After being diagnosed with an additional mental health condition and undergoing stressful medical ordeals to treat her endometriosis (including a total hysterectomy earlier this year), Dunham’s anxiety only grew. "I was diagnosed with pretty serious PTSD. I have a few sexual traumas in my past and then I had all these surgeries and then I had my hysterectomy after a period of really extreme pain," she told Shepard.
Eventually, she began experiencing symptoms of anxiety, including panic attacks, much more frequently. And as her anxiety ramped up, so did her prescribed dosage and the severity of her Klonopin misuse. "It stopped being, ‘I take one when I fly,’ to ‘I take one when I’m awake,'" she said.
Benzodiazepines are a class of sedatives that are the most commonly prescribed anti-anxiety medications in the U.S.—and they can definitely be habit-forming.
"They help people relax, and they’re good for immediately relieving anxiety," as well as anxiety-related insomnia, Steven Siegel, M.D., Ph.D., professor and chair of psychiatry and the behavioral sciences at the Keck School of Medicine of USC, tells SELF.
Clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax) are all benzodiazepines and induce their calming or sedating effect by increasing the levels of a neurotransmitter called GABA, according to the National Institute on Drug Abuse (NIDA). They may be prescribed as a first-line treatment for generalized anxiety disorder and a second-line treatment for panic disorder and social anxiety disorder, according to the National Institute of Mental Health (NIMH). Side effects may include drowsiness, lightheadedness, headache, irritability, constipation, and nausea. And when mixed with other drugs, particularly opioids or alcohol, the sedative effects can be dangerous and even life-threatening.
But they're really meant to be taken on a short-term or occasional basis. "They were designed to be taken as needed [or] used for days or weeks—not months, and definitely not years," Timothy Brennan, M.D., director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s Hospitals and director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine Mount Sinai, tells SELF.
When used this way, they can be an extremely effective component of an anxiety treatment plan, Dr. Siegel says. For instance, he says, a psychiatrist might give a patient suffering from severe PTSD-related panic attacks a prescription for 10 pills a month to be taken as needed. Or they might prescribe a few days’ worth to somebody who just had a death in the family and is experiencing severe insomnia, or to a person with a severe fear of flying.
The risk for misuse and abuse emerges when people start to use these drugs regularly for a long period of time.
Even though experts know these drugs should only be used in the short term, "people are staying on them for months or even years," Dr. Brennan says. People may become accustomed to immediately mitigating any feelings and symptoms of anxiety with a pill, he explains. And for somebody suffering from severe anxiety or panic attacks, the attraction of rapidly and reliably alleviating these symptoms is obvious. "It's understandable someone would want immediate relief," Dr. Brennan says. "If you take something that works in 15 minutes, like a benzo, you can imagine how challenging it [would be] for somebody to decide that a different drug like an SSRI"— which can take weeks or months to be noticeably effective—"might be better."
In addition to this psychological reliance, people can develop a tolerance to and chemical dependence on benzodiazepines. That means that your brain becomes accustomed to having the drug in your system and you gradually require more and more to experience the same effects, Dr. Siegel explains. "If you’re using them a lot and often, then you develop a brain chemistry where you cannot function without them," he says. "And when the substance wears off, you undergo a very recognizable withdrawal syndrome," Dr. Brennan adds. That might include symptoms like anxiety, insomnia, restlessness, agitation, and, most dangerously, seizures, he explains.
Treatment for benzodiazepine addiction involves gradually tapering off of the drug—and creating a treatment plan to more effectively manage the underlying anxiety issue.
"If you pull the drug away rapidly, you are instantly out of balance in a very dangerous way," Dr. Siegel says. In order to avoid those intense withdrawal symptoms, it’s crucial to quit benzos under the supervision of a psychiatrist who can help you taper down the dosage very slowly over a span of weeks or months, he adds. A psychiatrist can also help you "cross-taper," Dr. Brennan says, meaning they will slowly introduce a new drug, like an SSRI (selective serotonin reuptake inhibitors, which are commonly used to treat depression and anxiety disorders), while decreasing the dose of the benzo. And a therapist can help you developing coping skills to use to manage anxiety in the short term as well as over time.
It's also important to have supervision because long-term use of benzodiazepines use can actually increase a patient's baseline level of anxiety, sometimes referred to as "rebound" anxiety. "[The drugs] reset the barometer, so to speak, such that people’s anxiety somewhat worsens over the long term," Dr. Brennan says.
That makes treating the underlying anxiety with tools other than benzos all the more important. That might include different forms of therapy, different medications, or a combination of the two. Developing a benzo dependence can be a sign that the rest of a person's treatment plan is not working well enough, Dr. Brennan explains. "Many patients who abuse benzos do it because they feel their anxiety is not controlled."
The bottom line is that, if you feel your anxiety is still overwhelming even under the current set of tools you have to manage it, talk to your doctor, therapist, or psychiatrist—you have plenty of other options.