Physiological Dependence and Addiction
Chronic prescription and use of benzodiazepines or Z-drugs can lead to physiological dependence. As noted in a study in 1990, “Depending on the outcome criteria used, anywhere from 58% to 100% of patients were judged to have experienced a withdrawal reaction”.[1] Benzodiazepine physiological dependence is well-documented, and each benzodiazepine label (intended for physicians) and medication guide (intended for patients) contains a warning about addiction and/or physical dependence.
However, this concern is often not noted to the patient and is sometimes downplayed by the prescriber, and not all patients thoroughly read the medication guide. Although often used interchangeably, note that the terms “addiction” and “physiological dependence” refer to different phenomena. When referring to benzodiazepines, there is a bigger difference between physiological dependence and addiction than with most other classes of drugs. Please see “The Language of Harmful Use” on the Dependence page for a discussion of this difference, and the Terminology page for a description of each of these terms, as well as “abuse” and “kindling” as they apply to benzodiazepines and Z-drugs.
A patient can become physiologically dependent on benzodiazepines after using this class of drugs for as little as 2 weeks[2], and there are many reports of this happening in less than 2 weeks. The risk of dependence increases with use chronicity. The symptoms of benzodiazepine dependence are highly varied, and therefore are often not recognized by prescribers who lack training specific to benzodiazepine dependence. The associated withdrawal syndrome, which may include tolerance withdrawal, can be quite difficult and protracted.
With benzodiazepines and Z-drugs, the results of physiological dependency can lead to worsening symptoms. As leading benzodiazepine neuropharmacologist Dr. Malcom H. Lader stated in 2002,[3]
“The main characteristic of these dependent people was that when they tried to stop they didn’t just get their old symptoms back, they didn’t just get their old symptoms back in an exaggerated form, they developed new symptoms which they had not experienced before.”
