Benzodiazepines: tolerance, dependence, abuse, and addiction

Many recent studies have clearly documented the development of tolerance, dependence, and addiction to benzodiazepines. In spite of these studies and reviews of the literature, confusion remains regarding the risk and benefits of the use of benzodiazepines in medical practice. The source of the confusion arises in part from the lack of clarity in the definitions of tolerance, dependence, and addiction. The distinctions among these important terms are frequently obscured in research studies and, especially, in clinical practice. In addition, the practice of separating medical from nonmedical populations in reports of benzodiazepine dependence is misleading. The overlap between medical and nonmedical benzodiazepine users is large, so that many of these individuals fall into both categories. These and other points should be considered as serious questions to the safety and freedom from dependence and addiction in any drug-using population.