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Benzodiazepines: Abuse, Tolerance, Dependence, Addiction

What Are the Risks?

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Updated July 22, 2009

Benzodiazepines are a class of medications commonly prescribed for the treatment of anxiety and panic attacks associated with panic disorder. This class of medications may be used alone or in combination with other medications such as SSRIs. Because benzodiazepines stimulate the brain’s reward or pleasure centers, they have the potential for abuse and are, therefore, classified as Schedule IV controlled substances.

For many people taking a benzodiazepine to treat panic disorder, there is a fear of becoming “addicted.” But, most studies show that under these circumstances, addiction is not a common occurrence. Tolerance and physical dependence can occur with benzodiazepine use, but this is not addiction. Abuse is not a necessary component of tolerance and physical dependence. Let’s take a closer look at what these terms really mean.

Abuse

Drug abuse is commonly defined as using a drug for a non-therapeutic effect. Usually, an individual who is abusing a benzodiazepine is using excessive doses of the medication to produce a sense of euphoria or to get a “high.” Long-term drug abuse can lead to tolerance, dependence, and for some, addiction.

Tolerance

Tolerance can result from using a drug over an extended period of time, even while using only the prescribed dosage. The result of tolerance is that the drug does not produce the desired effect or the effect is diminished. Tolerance to a benzodiazepine may mean increasing the dose of the medication to produce the desired therapeutic outcome.

Dependence

Physical dependence to a drug often includes tolerance and can be identified by withdrawal symptoms if the drug is abruptly stopped or decreased. Benzodiazepine withdrawal symptoms due to physical dependence 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, it is usually necessary to decrease the dosage slowly to avoid withdrawal complications.

It is important to note that while physical dependence may be a component of addiction, it is not, in and of itself, addiction.

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.

According to the American Society of Addiction Medicine, drug addiction differs from drug dependence and drug tolerance. Not all people who develop tolerance or 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.

Drug addiction is a disease that 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.

It is important to remember that benzodiazepines are generally safe and effective when used as directed. Tolerance and dependence may result with long-term use. But, this is not the same thing as addiction. If you are concerned about addiction to benzodiazepines, you should talk to your doctor or other health care provider.

Sources:

American Academy of Pain Medicine. 2001. “Definitions Related to the Use of Opioids for the Treatment of Pain.” 30 Nov 2008.

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 on Drug Abuse. 15 Sept 2008. “InfoFacts: Understanding Drug Abuse and Addiction.” 05 Dec 2008.

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