Preference for alprazolam as opposed to diazepam in benzodiazepine-dependent psychiatric inpatients

Fourteen inpatients with long-term benzodiazepine (BDZ)-dependency were gradually withdrawn from their medication. During a four-day study period patients received 5 mg diazepam t.d.s. Under double-blind conditions the 5 mg diazepam was replaced twice, by either 0.5 mg or 0.37 mg alprazolam. When the hypothetically realistic alprazolam to diazepam equivalent ratio of 1:10 with regard to hypnosedative and anxiolytic properties was used, alprazolam was clearly preferred to diazepam in three sensitive tests. When alprazolam and diazepam were tested using the altered equivalent ratio of 1:14, "liking" and "seeking potentials" revealed no significant differences. However, also under these test conditions alprazolam tended to be preferred in a drug choice test. It is concluded that alprazolam appears to implicate somewhat higher reinforcing properties, possibly leading to a higher abuse liability in BDZ-dependent patients as compared to diazepam.