The use of tranquilizers in the treatment of mixed drug abuse

If the abuse potential of tranquilizers, and particularly benzodiazepines, is examined by their administration as a therapeutic agent to persons dependent on alcohol, alcohol and drugs, or drugs alone, these substances are found to be potentially dependence producing with similar mechanisms to those of other hypnotics and sedatives. However, their abuse potential varies from one substance to another, and on the whole is relatively small. At all events, with constant medical supervision, patients who were previously dependent on a drug of barbiturate type do not independently increase their intake so as to become dependent on the tranquilizers. These experiments on persons with an inherent susceptibility to dependency show that tranquilizers must represent only a very small risk to the general population. The view that benzodiazepines are not potentially dependence producing has no more scientific foundation than the exaggerated fears of this potential. Important is that the uncontrolled supply of highly potent tranquilizers, and above all those with a strong sedative component, leads to dependence in a considerable percentage of cases in the treatment of mixed abuse. No conclusions in absolute terms on the risk presented by tranquilizers (and above all benzodiazepines) may be drawn from observations made in the uncontrolled administration of these substances in case of polytoxicomania. It follows that tranquilizers, which, as far as their therapeutic effect is concerned, are a valuable aid in the treatment of drug abuse, can be safely given when there is constant medical supervision combined with psychotherapy. The basic principle to be followed in the use of tranquilizers for the treatment of drug-dependent persons, is, therefore, their periodic administration in limited doses with constant medical supervision. In principle, however, because of the abuse potential which is nevertheless present, the same mode of administration is also to be recommended for other patient groups. Uncontrolled long-term administration is to be rejected in all circumstances, and supply should be strictly on prescription only in order to prevent uncontrolled acquisition. The various experiments carried out by us on the administration of benzodiazepines to patients with simple or mixed drug dependence show that the habit forming potential of benzodiazepines must, on the whole, be considered as being relatively small; at all events, this group of substances is the least hazardous of all known sedatives. This is of considerable importance, since the neuroleptics and antidepressants (which in themselves present no risk of abuse) are generally poorly tolerated and refused by patients with an inherent tendency towards drug dependence.