Understanding Benzodiazepine Addiction and Co-Occurring Hoarding Disorder

Compulsive hoarding disorder, characterized by an intense fear of getting rid of things—regardless of their value—is often caused by severe anxiety. Prescription benzodiazepines, such as Xanax or Klonopin, are sometimes prescribed to manage that anxiety, but they only slow down the brain’s GABA neurotransmitter temporarily—and when the medication wears off, sufferers need more of the drug to achieve the same calming effect.

Those are the roots from which addiction can grow. But if we’re going to truly understand what it is that our loved ones suffer from, we need to acknowledge that, for many, addiction is a defense mechanism—a way to make it from one day to the next. Holding onto things with sentimental value could build a feeling of safety in someone’s life, especially if those things have some kind of relationship to someone they’ve lost. Or, perhaps they have intense anxiety around knowing what to keep and what to discard, and simply keeping everything is the only way they know how to manage that anxiety.

Likewise, there’s a perception that benzodiazepines simply induce a sense of calm in those who take them, but for many, especially those who live with the severest forms of anxiety, what they actually create is a sense of normalcy—of being able to go to the grocery store, pick their kids up from school, or make a hard phone call. In these situations, benzodiazepines make everyday tasks possible, which in turn makes them all too easy to rely on—and difficult to give up.

Relief from severe anxiety can feel so good—so euphoric—but addiction can quickly take hold if tolerance builds while anxiety levels remain the same. Even more problematically, benzodiazepines can worsen existing anxiety when abused, and that means that they can cause co-occurring disorders to develop tangentially with an addiction.

To help your loved one, you must first understand that they likely see each of the things they own as valuable, sentimental, or at least extremely unique—and therefore vital to retain. Meet them where they are—wherever that is. Because getting treatment for addiction would require your loved one to leave behind his or her possessions and risk losing them, this means that initially focusing on the hoarding is simultaneously the most important and, often, most difficult step—even though the underlying anxiety must be the root focus during treatment.

It can be difficult to know just what to say and do in order to get the importance of residential treatment across to your friend or family member, but there are definite do’s and don’ts as you encourage them to seek professional help:

• DO use similar language to that of your loved one when referring to his or her possessions; i.e. “things,” “stuff,” “collections,” etc. While you may not agree with these descriptions, it is important that your loved one feel as though you’re on their side, and that you aren’t attacking or judging them.

• DON’T use harsh or judgmental language in regards to your their hoarding, such as referring to it as “junk,” trash” or “worthless.” Those who hoard, including your loved one, are aware they do it—and are very likely to feel ashamed of it. Using degrading language will only exacerbate this and make it more difficult for them to open up about their addiction.

• DO discuss measures of safety, but be sure to do it calmly. Focusing on getting rid of items and how many there are is secondary to making sure that your loved one has clear paths to important areas; i.e. the front door, bathroom, fire escape window, etc.

• DON’T touch or move your loved one’s belongings without explicit permission. This is especially important leading up to the push for residential treatment, as it will require leaving possessions behind, and disrupting his or her home and things will be an immense source of anxiety and pain.