Benzodiazepines: The Need-to-Know Series (“Addicted?!”)

“No doubt about it, those little yellow pills made life a whole lot easier. But gulping one down as soon as I got out of bed got me to thinkin’…”

We began our benzodiazepine need-to-know series yesterday. Must-read foundational learning in Part 1, so click here and you’re on it.

My initial plan was to chat discontinuation and withdrawal today. But I decided it made more sense to drop in a piece on dependence first. Good idea?

Let’s get after it…

Benzo Dependence

Benzodiazepine (benzo) dependence is deceptive and dangerous business. Research has found that some 40% of those qualifying for a diagnosis of benzo dependence have no clue they have a problem. On the other side of the coin, 11% found not be dependent believe they are.

Benzo dependence can be physical, psychological, or both. A physical dependence is grounded in tolerance and the presentation of withdrawal symptoms upon a decrease in dosage or cessation. Physical dependence typically stems from long-term prescribed use. Abuse is rarely involved.

A psychological dependence is about craving. But the craving doesn’t present in an effort to relieve withdrawal symptoms. No, it’s about experiencing the pleasures of the drug. Abuse is likely a factor.


In coming to understand benzo tolerance, it’s important to keep in mind their assorted actions – anticonvulsant, muscle-relaxant, anxiolytic (anti-anxiety), and sleep-inducing.

Tolerance to the anticonvulsant and muscle-relaxing effects of benzos occurs within a few weeks of onset of use. Tolerance develops rapidly to the sleep-inducing effects of benzos; however, it takes several months to develop tolerance to the anxiolytic effects.

Interestingly enough, there’s great debate as to whether or not benzos retain their anxiolytic properties after four months. In fact, there’s evidence suggesting long-term use of benzos may actually worsen anxiety. And that may lead to dosage escalation.

Of course, there are some in the research world who believe benzos are effective in neutralizing anxiety over the long-haul. But then others say the action is strictly a matter of preventing rebound anxiety withdrawal effects.

“Could I be the next benzo addict?”

Could be. There are risk factors regarding who may become benzo dependent…

  • Use beyond four weeks
  • Use of high doses
  • Use of benzos with higher potency (e.g.: alprazolam (Xanax)) or shorter action (e.g.: triazolam (Halcion))
  • A leaning toward a substance dependent personality
  • Past or present substance abuse or dependence disorders
  • Concomitant use of antidepressants

“What are the signs and symptoms of benzo dependence?”

The most obvious signs and symptoms of trouble are…

Feeling unable to cope without the drug, unsuccessful attempts to cut down or discontinue use, tolerance, and withdrawal symptoms when decreasing dosage or upon cessation.

One may also experience anxiety, depressed mood, depersonalization, derealization, sleep disturbance, hypersensitivity to touch and pain, tremor, shakiness, muscular aches, pains, twitches, and headache.

Suicidal and self-injurious ideation and behavior have been reported – especially in adolescents.

Let’s take a look at The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) criteria for benzo dependence. At least three of the following are present, and have been for at least one month. If less than a month, they appeared repeatedly during a 12-month period…

  • Behavioral, cognitive, and physiological phenomena that are associated with the repeated use and that typically include a strong desire to take the drug.
  • Difficulty controlling use.
  • Continued use despite harmful consequences.
  • Preference given to drug use rather than to other activities and obligations.
  • Increased tolerance to effects of the drug and sometimes a physical withdrawal state.

One final note. Long-term benzo use and dependence are serious problems for the elderly. Failure to address either can lead to dangerous medical complications.

Tomorrow: Discontinuation, Withdrawal, and Opinion!

Okay, tomorrow – for sure – we’ll handle benzo discontinuation and withdrawal. But don’t you think it made sense to do the dependence piece first?

I’ll also give you my professional and personal opinion regarding benzo use.

So that will do it for today. Look forward to chatting with you on the morrow…

image credit Emma Holister