Key Takeaways
- Benzodiazepine use in Israel has historically spiked during times of war, and it’s likely rising again during the current Gaza and Iran conflicts.
- A 19-year study shows these medications are often used as a coping mechanism during national trauma but carry serious risks.
- Beyond relief, benzodiazepines may dull emotion, alter behavior, and increase the risk of aggression, dependence, and long-term psychological fragility.
As conflicts and crises intensify globally, their effects on mental health have become increasingly evident. A recent 19-year retrospective study from Israel reveals the significant rise in short-term anxiolytic medication use during times of national stress. Conducted by researchers at Maccabi Healthcare Services (MHS), the study offers rare insight into how public reliance on pharmacological interventions changes in response to conflict.
Study Background and Methodology
The study, titled “Coping with Conflict: Short-Term Anxiolytic Medication Use Amidst National Stress in Israel,” analyzed data from over 1.1 million adults enrolled in MHS between January 1, 2006, and July 31, 2024. It employed a retrospective cohort design and focused on both first-time and renewed benzodiazepine purchases.
Researchers utilized Cox proportional hazards models to determine the relationship between armed conflict and anxiolytic medication use, adjusting for age, sex, socioeconomic status, and psychiatric history. The study defined specific conflict periods, including:
- The Second Lebanon War (2006)
- Operation Cast Lead (2008)
- Operation Pillar of Defense (2012)
- Operation Protective Edge (2014)
- Operation Guardian of the Walls (2021)
- The October 7, 2023 conflict
Findings: Medication Use Surges During Armed Conflicts
Increased Use During Conflicts
The study found a 28% overall increase in first-time anxiolytic prescriptions during military operations (HR 1.28, 95% CI: 1.21–1.34). During the Second Lebanon War, the risk rose by 44%, while following the October 7, 2023, attacks, the hazard ratio reached 4.17—indicating a 317% spike.
Gender-Based Disparities
Women were disproportionately affected, showing a 26% increase in medication initiation during typical conflicts and an 81% spike post–October 7. These findings suggest that conflict-related mental health strategies must be responsive to gender-specific needs.
Regional Variation in Response
Geographically, northern Israeli residents were more affected during the Second Lebanon War (HR 1.39, 95% CI: 1.12–1.72), while southern residents saw increased use across multiple conflicts (HR 1.18, 95% CI: 1.05–1.33). Following the October 7 crisis, however, these regional disparities disappeared, pointing to a widespread national psychological toll.
Long-Term Trends and Social Implications
Beyond isolated conflicts, the study observed a gradual increase in anxiolytic prescriptions since 2006. This sustained growth hints at a broader societal shift: as community-based and interpersonal coping systems weaken under continuous stress, reliance on medication appears to be rising.
According to Dr. Tal Patalon, the study’s lead researcher, “This data illustrates how public reliance on pharmacological support surges in the face of trauma. It calls for strategic intervention—both immediate and preventive—to reduce long-term dependency on anxiolytics.”
Limitations and Considerations
While robust in scope, the study has limitations. It is observational and cannot prove causality. It also tracks dispensed—not consumed—medications and offers no information on clinical outcomes or adherence. Additionally, the study is a preprint and has not undergone peer review, making its conclusions provisional.
Clinical and Policy Implications
The study’s findings underline the need for both immediate and long-term mental health interventions during and after crises. While anxiolytics may offer rapid symptom relief, their long-term use raises concerns about dependence and withdrawal.
Healthcare systems must be prepared to offer:
- Trauma-informed therapy
- Community-based mental health support
- Public education to destigmatize treatment
- Gender-sensitive interventions
One psychiatric nurse in southern Israel noted, “After the attacks, I had patients coming in daily who hadn’t slept in weeks. They didn’t just need medication—they needed to talk, to process, to feel safe again.” Her account underscores that pharmacological support is just one facet of a larger mental health ecosystem.
Implications Amid the Gaza and Iran Conflicts
The study’s findings acquire even greater urgency in the context of the ongoing Gaza conflict and the expanding war with Iran. Although the study concluded with data from July 2024, the historical pattern it reveals—of dramatic increases in benzodiazepine use during times of national crisis—strongly suggests that a similar or even more intense spike is currently underway.
This raises critical public health and policy questions: Are we witnessing the pharmaceutical management of national trauma becoming a default response? Benzodiazepines are known to cause dependency, cognitive dulling, emotional blunting, and, in some cases, paradoxical effects such as increased aggression and anxiety. In a society already under immense pressure, could widespread use of these medications inadvertently exacerbate collective stress or even social volatility?
Equally concerning is the potential for inequity: not all populations have equal access to care or medications. Marginalized groups, including displaced residents, refugees, or those in conflict zones, may lack access to both pharmacological and psychological support, widening mental health disparities in already fragile systems.
As military conflict becomes a chronic condition in the region, the study invites a deeper examination of how we define resilience, and what kind of mental health infrastructure is needed not just to treat symptoms, but to strengthen psychological foundations across an entire population.
FAQs: Benzodiazepines, War, and Mental Health
What does the 19-year Israeli study show?
It found a clear pattern: benzodiazepine use spikes significantly during wars and national crises in Israel, suggesting people turn to medication to manage fear, anxiety, and trauma.
Which conflicts did the study analyze?
The Second Lebanon War (2006), Cast Lead (2008), Pillar of Defense (2012), Protective Edge (2014), Guardian of the Walls (2021), and October 7, 2023. The most dramatic spike came after the October 7 attacks.
Is there current data for the Gaza and Iran conflicts?
No. The study ended in mid-2024. However, based on past trends, it’s likely that benzodiazepine use is rising again now.
What medications are considered benzodiazepines?
Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Librium (chlordiazepoxide), Serax (oxazepam), Restoril (temazepam), and others.
What are these drugs prescribed for?
Anxiety, panic attacks, insomnia, muscle spasms, seizures, and alcohol withdrawal.
Why are they used more during wartime?
Fear, sleeplessness, hypervigilance, and psychological trauma increase during conflict. Benzodiazepines offer rapid relief, especially when mental health systems are overwhelmed.
Do they treat trauma?
No. They suppress symptoms like anxiety or panic but do not address the root trauma. Long-term healing requires therapy or structured support.
Can benzodiazepines change your personality?
Yes. Long-term or high-dose use can flatten emotions, cause memory issues, impair decision-making, and increase irritability or emotional disconnection.
Can they make people aggressive or violent?
In some cases, yes. Paradoxical reactions—such as aggression, hostility, and risk-taking—occur, especially in high doses or in people with certain psychiatric conditions.
Are they addictive?
Yes. They’re highly habit-forming. Physical and psychological dependence can develop in weeks, especially with daily use.
What happens if someone stops suddenly?
Withdrawal can cause severe symptoms: rebound anxiety, insomnia, tremors, hallucinations, seizures, or even death. They must be tapered under medical supervision.
What are the common side effects?
Drowsiness, confusion, slowed reflexes, memory problems, depression, sexual dysfunction, and poor coordination. They increase fall risk in older adults.
How do they affect mental resilience?
They may weaken it. If overused, they can block emotional processing and delay recovery. People may rely on the drug instead of learning to manage anxiety or trauma.
Are there safer alternatives during war or crisis?
Yes. Short-term therapy, stress inoculation, mindfulness, peer support, and trauma-focused CBT can all help. SSRIs or sleep aids may be safer for long-term use.
Does everyone react the same way?
No. Some feel calm and function better. Others feel sedated, dull, detached, or unwell. Sensitivity varies by genetics, mental health history, and dosage.
Can these drugs impair functioning in daily life?
Yes. They may affect work, parenting, driving, and communication. In high-stress settings like wartime, this can impact both individual and community safety.
Do they work immediately?
Yes, most benzodiazepines act quickly—within 15–30 minutes—making them appealing during acute anxiety or panic episodes.
Are there gender differences in use?
The study showed women were more likely to be prescribed benzodiazepines during and after conflict, especially after the October 7, 2023, attacks.
Does region matter in Israel?
Historically, residents in northern and southern Israel were more affected by nearby conflicts. But the October 2023 spike was nationwide.
Can benzodiazepines cause long-term harm?
Yes. Cognitive decline, emotional blunting, sleep disruption, and risk of chronic anxiety or depression may result from long-term use.
What should people do instead of relying solely on these drugs?
Seek out mental health support, talk to a doctor, ask for therapy referrals, and use medication only short term if prescribed.
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Final Thoughts
If there’s one takeaway from this research, it’s that resilience cannot be outsourced to a pill. Benzodiazepines may quiet the nervous system, but they don’t rebuild what war and fear dismantle—trust, routine, connection.
In times like these, public health responses must be bold and multidimensional. But on an individual level, perhaps the most radical act is this: resist the urge to numb everything. Feel what you’re feeling. Talk to someone who listens. Go for a walk without your phone. Take the anxiety seriously, but not silently. Because while medication may be part of the answer, it should never become the whole conversation.
References
Patalon, T., Saciuk, Y., Yonatan, Y., Hoshen, M., Trotzky, D., Pachys, G., Fischel, T., Nitzan, D., & Gazit, S. (2024). Coping with conflict: Short-term anxiolytic medication use amidst national stress in Israel. https://doi.org/10.1101/2024.10.04.24314902
