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Benzodiazepines: Addiction and Dependence

What's the Difference?

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Updated April 28, 2014

Benzodiazepines are a class of medications commonly prescribed for the treatment of anxiety and panic attacks associated with panic disorder. There is little dispute that benzodiazepines can be physically and psychologically addicting. What is up for debate, however, is the extent of the problem among users who take these medications solely for therapeutic purposes in the treatment of anxiety.

To get a clearer picture of the dependency risks associated with benzodiazepine use, it is important to make the distinction between drug dependence and drug addiction. Is physical dependence on a benzodiazepine the same as addiction? If withdrawal symptoms occur upon discontinuation of a benzodiazepine, does this mean addiction has occurred?

Dependence

Physical dependence to a drug can be identified by withdrawal symptoms if the drug is abruptly stopped or decreased. While physical dependence may be a component of addiction, it is not, in and of itself, addiction. In fact, physical dependence is a consequence of many medications. For example, certain blood pressure medications can cause physical dependence. Yet, these medications do not lead to addiction.

Physical dependence may be an expected outcome of long-term therapeutic use of benzodiazepines. Such dependence may cause withdrawal symptoms if the medication is stopped abruptly or decreased too fast. These symptoms may include:

  • anxiety
  • diarrhea/stomach upset
  • insomnia
  • muscle cramps
  • headache
  • decreased concentration
  • rapid breathing
  • tremors
  • seizures

If an individual is physically dependent on a benzodiazepine, withdrawal complications can be avoided by slowly decreasing the dosage of the medication over a period of time.

Addiction

Drug addiction is a brain disease identified by components of physical and psychological dependence. Detoxification can result in the end of physical dependence, but the psychological component maintains a steadfast hold on the addict. It is this component that makes maintaining sobriety so difficult for sufferers. There is no cure for addiction and maintaining sobriety is usually an ongoing quest for those afflicted.

Drug addiction results in drug-seeking behaviors and continued use despite negative consequences. Drug-seeking behaviors with benzodiazepine may include getting the drug from more than one provider or illegally obtaining the drug without a doctor’s prescription.

Addiction to benzodiazepines or other drugs can result in negative consequences in many life functions. These consequences may include loss of work productivity, family or relationship problems or legal issues. Drug addiction results in continued use of the drug despite the negative consequences.

According to the American Society of Addiction Medicine, drug addiction differs from drug dependence. Not all people with physical dependence to a drug will go on to develop addiction. It is believed that certain individuals are predisposed or vulnerable to addiction based on biological, psychological and social influences.

Signs of drug addiction may include:

  • drug-seeking behaviors (obtaining the drug from multiple doctors, illegally obtaining the drug)
  • cravings for the drug
  • preoccupation with obtaining the drug
  • misusing the drug for intoxication or pleasure
  • dependence and withdrawal upon stopping the drug
  • interference with normal life functions (decreased work productivity, decreased motivation)
  • relationship problems
  • legal issues
  • continued use despite negative consequences

Pseudo-addiction

Drug-seeking behavior is a usual component of addiction. But, this type of behavior may also be the result of genuine symptoms that have not been adequately treated. For example, a person who has symptoms of anxiety and panic may engage in drug-seeking behavior to get his or her symptoms under control. This is not a true addiction because the individual is not seeking the drug for pleasure purposes and does not exhibit drug-seeking behaviors once panic symptoms are adequately treated.

Long-Term Benzodiazepine Use

Many people who are prescribed long-term benzodiazepine therapy for anxiety associated with panic disorder or another anxiety disorder worry about becoming “addicted.” Some doctors may withhold benzodiazepine treatment because of the same issue. Many studies have suggested that long-term benzodiazepine use is effective and safe and does not lead to addiction for most people being treated for anxiety. But, for some people, benzodiazepine use may lead to addiction. This risk appears greater in those with a history of alcohol or other drug addiction or those actively abusing alcohol or other drugs.

It is important to remember that benzodiazepines are generally safe and effective when used as directed. Tolerance and dependence may result, and may even be expected, with long-term use. But, this is not the same thing as addiction. If you think you have an addiction problem, help is available. Talk to your doctor or other healthcare provider about treatment options.

Sources:

Lessenger, James E., MD and Feinberg, Steven D., MD, MPH. “Abuse of Prescription and Over-the-Counter Medications.” J Am Board Fam Med. Jan 2008. 1983; 286: 1876-7.

Longo, Lance P., MD and Johnson, Brian, MD. “Addiction: Part I. Benzodiazepines--Side Effects, Abuse Risk and Alternatives.” American Academy of Family Physicians. 01 Apr 2000. 2121-2131.

National Institute of Mental Health. “Medications”. Jan 2007.

Pomerantz, Jay M., MD. “Risk Versus Benefit of Benzodiazepines.” Psychiatric Times. 01 August 2007. Vol. 24, No. 7.

US Drug Enforcement Administration. ”Benzodiazepines.” 25 Nov 2008.

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