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Benzodiazepine Use, Abuse, and Dependence

Charles P. O'Brien, MD, PhD

Published: February 15, 2005

Article Abstract

Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have somepotential for abuse and may cause dependence or addiction. It is important to distinguish between addictionto and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepinesusually have other substance abuse problems. Benzodiazepines are usually a secondary drug ofabuse—used mainly to augment the high received from another drug or to offset the adverse effects ofother drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence,a predictable and natural adaptation of a body system long accustomed to the presence of adrug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence,which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication,may be controlled and ended through dose tapering, medication switching, and/or medicationaugmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatmentmay be necessary for some patients; this continuation of treatment should not be considered abuse oraddiction.

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