Ativan Addiction: Signs, Symptoms, and Treatment

What is Ativan?

Ativan is a brand name formulation of lorazepam, a prescription benzodiazepine that is FDA-approved in tablet form for the short-term management of anxiety disorders, and as an injectable solution as a pre-anesthetic sedative and treatment for status epilepticus.^1,2 In its various formulations, lorazepam may also be prescribed for certain off-label purposes such as to manage alcohol withdrawal or to treat panic disorders.¹

Like other benzodiazepines, lorazepam is a central nervous system (CNS) depressant, which means it works to calm an otherwise over-excited nervous system, producing drowsiness, sedation, and a calming effect.⁴

Lorazepam is listed as a Schedule IV substance under the Controlled Substances Act, which means that it has an accepted medical use and a relatively lower potential for abuse and dependence than drugs in Schedules I, II, and III.^1,5

In 2019, pharmacists in the United States filled an estimated 92 million benzodiazepine prescriptions—20% of which were scripts for lorazepam.⁶ And according to the U.S. Drug Enforcement Administration (DEA), lorazepam is one of the top 5 most prescribed, as well as the most frequently found, benzodiazepines on the illegal drugs market.⁷

While using lorazepam as prescribed—and for short periods of time—can be helpful and generally considered to be safe, there is potential for misuse, especially among individuals who take lorazepam for long periods of time (longer than 4 months), use it for its euphoric effects, or take it in combination with other substances such as alcohol, opioids, or other illicit drugs.^1,6,8

Is Ativan Addictive?

Yes, lorazepam can be a very addictive medication.¹ In 2020, 4.8 million individuals aged 12 and older misused lorazepam and other prescription benzodiazepines.⁹ That same year, the FDA added a boxed warning to Ativan and other benzodiazepine medications to highlight the risks of misuse, physical dependence, and addiction.⁶

Obviously not everyone who misuses lorazepam develops an addiction or a substance use disorder, which involves compulsive misuse of the drug despite negative consequences such as health problems or failure to meet responsibilities at work, school, or home.^4,10

Symptoms of Ativan Addiction

Only a qualified mental health or medical professional can diagnose an addiction to lorazepam. Clinicians use criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make a diagnosis of a substance use disorder involving lorazepam, which is known as a sedative, hypnotic, or anxiolytic use disorder.¹⁰

To receive a diagnosis, individuals need to meet at least 2 of the following diagnostic criteria within a 12-month period:¹⁰

• Taking lorazepam in larger amounts or for longer periods of time than originally intended.
• Being unable to cut down on lorazepam use despite expressing a desire to do so.
• Spending a lot of time trying to obtain, use, or recover from the effects of lorazepam use.
• Feeling cravings, or a strong desire to use lorazepam.
• Being unable to fulfill major obligations at work, home, or school because of lorazepam use.
• Continuing to use lorazepam despite having interpersonal or social problems that are likely due to drug use.
• Giving up important social, work, or recreational activities because of lorazepam use.
• Recurrent use of lorazepam in situations where it is dangerous to do so (such as driving or operating machinery).
• Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by lorazepam use.
• Tolerance, which, as mentioned above, means taking higher amounts or more frequent doses of lorazepam to feel the same effects.
• Withdrawal, which means experiencing unpleasant physical and mental symptoms when lorazepam use stops or is drastically reduced.

Ativan Overdose

While it is possible to overdose on lorazepam and other benzodiazepines alone, fatal toxicity is rare. Most benzodiazepine-related overdose deaths occur due to polysubstance use, especially the concomitant use of benzodiazepines with opioids, alcohol, or other CNS depressants.^1,8

According to estimates from the Centers for Disease Control and Prevention (CDC), in the first six months of 2020, 92.7% of benzodiazepine-involved deaths also involved opioids, and 66.7% involved illicitly manufactured fentanyls.⁸

Individuals who purchase Ativan and other benzodiazepines illicitly on the street may be ingesting opioids without even knowing it since counterfeit pills often contain harmful additions—like fentanyl—to make them more potent.^12,13

This combination can be fatal because both benzodiazepines and opioids can lead to pronounced sedation and dangerously slowed breathing.¹⁴

Symptoms of Ativan Overdose

Taken alone, benzodiazepine overdose can result in significant over-sedation and other symptoms that may include:²

• Extreme drowsiness
• Profound lethargy.
• Mental confusion.
• Slurred speech.

When combined with opioids, alcohol, or other CNS depressants, a lorazepam-involved overdose can be life-threatening. Signs of overdose may include:^1,2

• Profound sedation, sleepiness, and loss of consciousness.
• Poor or no muscle control.
• Slowed, shallow, or stopped breathing.
• Coma.
• Death.

Ativan Withdrawal

Individuals who misuse lorazepam at higher than recommended doses and/or over a prolonged period of time may be more likely to develop significant physical dependence and experience withdrawal symptoms when they drastically cut back or abruptly stop using the drug.¹

Lorazepam withdrawal symptoms may include:^2,10

• Sweating.
• Increased heart rate.
• Anxiety.
• Insomnia.
• Agitation.
• Restlessness.
• Confusion.
• Irritability.
• Hypersensitivity to light or noise.
• Hallucinations.
• Nausea and vomiting.
• Tremors.
• Seizures.

The DSM reports that with relatively short-acting benzodiazepines like lorazepam, withdrawal symptoms can start within 6-8 hours of the last dose. Symptoms may then peak in intensity around day 2 and noticeably improve by day 4 or 5.¹⁰ However, some individuals may experience relatively less intense, longer-term symptoms that persist for several months.¹⁰

The severity of symptoms can vary, impacted by several factors, including the duration and frequency of use, the dosage of lorazepam used, and an individual’s physical and mental health.¹⁰

Ativan Addiction Treatment

Ativan addiction treatment can include a variety of options. Treatment should be tailored to your unique situation and specific needs.¹⁶ As mentioned above, you should not attempt to detox from lorazepam or other benzodiazepines on your own.⁴ Medical detox can provide supervision and pharmacological support to keep you as safe and comfortable as you gradually withdraw from lorazepam.¹⁵ While detox can be an important first step in the recovery process that sets the stage for further treatment, it’s not a substitute for more comprehensive addiction treatment.¹⁸

After detox, you may transition to inpatient or outpatient treatment. Inpatient rehab requires you live onsite at a treatment facility and receive care, housing, and medical attention on a 24-hour basis. Inpatient treatment may be a good option for you if your addiction is severe, you have co-occurring disorders or physical health conditions, your housing situation is unsafe or unstable, or you lack a supportive network outside of rehab.¹⁸

Outpatient rehab means that you continue to live at home or in a sober living facility but attend treatment at an outpatient facility on a regular basis. Outpatient rehab may be well suited for you if your addiction is less severe, you have a stable home environment, supportive family and friends, and access to reliable transportation.¹⁸

Regardless of the setting, treatment can involve a combination of medication, which is primarily used to help with withdrawal, as well as behavioral therapy.⁴ Research indicates that benzodiazepine addiction can be treated with specific types of behavioral therapy, which may include:^4,17-19

• Cognitive-behavioral therapy (CBT). CBT helps you identify stressors and teaches you how to make more adaptive, healthy changes in your thinking, expectations, and behaviors.
• Contingency management (CM). CM involves providing tangible rewards when you meet specific behavioral targets in your recovery.
• Motivational interviewing (MI). MI helps you resolve any lingering ambivalence towards treatment to better engage you in your recovery efforts.
• Relapse prevention. Relapse prevention teaches you how to avoid triggers that might result in a return to substance use and focuses on you taking personal responsibility for your recovery.

Individuals who misuse benzos like Ativan often struggle with misuse of multiple substances, so treatment addresses the other substances use disorders as well.⁴

If you are concerned about your Ativan misuse or that of a loved one, or if you think you may have an addiction, you should know that treatment can help, and it can potentially prevent things from getting worse.

Don’t let the cost of treatment prevent you from getting the help you need.

If you have insurance, the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurers and group health plans to provide the same benefits for mental health care and substance use treatment and services that they do for medical and surgical care.²⁰

If you don’t have insurance, there are always ways to make things work. Some facilities offer free or low-cost care, sliding-scale fees based on your income, or payment assistance.²¹

Let American Addiction Centers help you navigate all of your options. Call us toll-free, 24/7. One of our compassionate Admissions Navigators will listen to your story, answer your questions, and help you find your path to recovery. Don’t wait; the decision to reach out can save your life. Call