A common topic in online anxiety disorders communities is the question of whether or not Xanax is addictive. Xanax is one of several medications known as benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate.
Why This is Important
The issue of benzodiazepine addiction is important to me mainly because of the stories I hear from people with anxiety disorders. I frequently hear from people who were forced to stop taking benzodiazepines even when the medications have been a successful treatment for them. Usually a person faces this situation when a doctor retires or leaves an HMO, or the person moves. Also important to me are the people who have tried medication after medication without success, but their doctors have not suggested benzodiazepines because of the addiction issue.
So Are They or Aren't They?
In answering the question of benzodiazepine addiction, I am going to share with you what I have read on the subject. You may choose to agree with me or not. I recommend reading the same material and even researching further before forming your own opinion. I have read material on both sides of this issue, and the views presented below make the most sense to me.
I am indebted to William D. Kernodle's Panic Disorder: The Medical Point of View, the first book I read that explained the difference between addiction and dependency. If you want to understand (or begin to understand) the biology of panic disorder as well as the function of medications, then do read this book.
The Definitions
The term addiction is often equated with abuse; however, addiction and abuse are not the same. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages.
When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines.
The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too.
A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person's body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued onlywith the supervision of a qualified physician.
People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence.
If You're Taking a Benzodiazepine
- Be sure you are seeing a psychiatrist who specializes in anxiety disorders and who is aware of current research on benzodiazepines.
- Do not discontinue benzodiazepines without telling your prescribing physician. If you've been taking them for a few months or so (and choose to stop them), you should taper off them, and your physician should be helping you do so.
- Read as much as possible about this subject. You never know when you'll need to get a new doctor who might not be familiar with current research.
- Be concerned if you've been raising your dosage over time. There may be some adjustment when you first start benzodiazepines. And there might be some adjustment later. However, if you are increasing it regularly, then there might be a problem (and your doctor should know better than to raise the dosage continually).
Research Worth Reading
| "In patients without histories of substance abuse ... benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper Jr A (1995). Addiction to benzodiazepines -- how common? Arch Fam Med 4(11): 964-70). "Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach M, et. al. (1995). Clinical aspects of chronic use of alprazolam and lorazepam. Am J Psychiatry 152(8): 1161-70). "The vast majority of the use of benzodiazepines is appropriate." (Woods JH, Winger G (1995). Current benzodiazepine issues. Psychopharmacology 118(2): 107-15). "With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit ... There is no epidemic of misuse." (American Psychiatric Association May 1990. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse). |
