Benzodiazepines: The need to know series | Dependence

by | Jun 2, 2011

what are benzodiazepines

No doubt about it, those pills can make life a whole lot easier. But is it too good to be true? If you’re gulping one down as soon as you get out of bed, and several throughout the day, it’s time to do some soul-searching.

In fact, there’s evidence suggesting long-term use of benzos may actually worsen anxiety. And that may lead to dosage escalation.

The entire series was reviewed and updated 4.12.23.

We began our three-part benzodiazepine need to know series with a detailed review of what they are, how they work, and their adverse effects.

It’s must-read foundational information, so be sure to give it a go.

My initial plan was to end the series here with a discussion of discontinuation and withdrawal. But I decided it made more sense to drop in a piece on dependence first.

Let’s get after it…

Benzodiazepine dependence

Benzodiazepine (benzo) dependence is deceptive and dangerous business. Research has found that some 40% of those who are dependent upon benzos have no clue they have a problem.

On the other side of the coin, 11% of those who aren’t 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.

Benzodiazepine tolerance

In coming to understand benzo tolerance, it’s important to keep their assorted actions in mind. They include anticonvulsant, muscle-relaxant, anxiolytic, and sleep-inducing.

benzodiazepine dependence

“Tolerance, dependence – all I know is I’m struggling. And I’m not used to that.”

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 dose escalation.

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

Am I benzodiazepine dependent

Could be. There are risk factors regarding who’s likely to 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
  • Concomitant use of antidepressants

Signs and symptoms of benzodiazepine 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.
  • Experiencing 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, especially in adolescents

To make sure we have our bases covered, let’s take a look at The International Classification of Diseases, Tenth Revision (ICD-10) criteria for benzo dependence.

At least three of the following have to be present for at least one month. If less than a month, they’ve appeared repeatedly during a twelve-month period…

  • Behavioral, cognitive, and physiological phenomena that are associated with 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.

That’ll do it

The benzodiazepine story goes on and on, doesn’t it? Yes, those pills seem to be able to make life a whole lot easier, but I’m thinking it’s just too good to be true.

Okay, that takes care of part two of our series, leaving one more piece to go. Finish up by reading about benzodiazepine withdrawal.

And as long as you’re doing some reading, check out those Chipur mood and anxiety info and inspi titles.

Bill White does not intend to replace the care of a licensed medical or mental health professional. The material is provided for informational purposes only. Always talk with your medical and/or mental health provider before making decisions.

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