Recognition and management of benzodiazepine dependence

Primary care physicians prescribe the majority of benzodiazepines and thus may see most patients who are dependent on these drugs. The diagnosis of benzodiazepine misuse is based on the history, the physical examination and drug use patterns. The treatment of benzodiazepine misuse can be a challenging process that requires the physician's patience, caution and sound clinical judgment. Patients who misuse benzodiazepines may have coexisting psychiatric problems that require treatment, such as depression or panic disorder. Family physicians can manage these patients but should be prepared to refer them for hospitalization when habituation and withdrawal reactions are complicated by medical instability, noncompliance or clinical deterioration.