Benzodiazepine abuse and dependence: misconceptions and facts

Benzodiazepines can be prescribed for a number of medical conditions. Many physicians are reluctant to prescribe benzodiazepines out of fear of producing dependence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treatment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are prescribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational users of benzodiazepines are young men. Documentation of indication for use, collection of drug-abuse history, close monitoring, and drug holidays can improve the management of this class of medication.