The nosology of abuse and dependence

Physicians who prescribe benzodiazepines often are asked by their patients if these drugs might be addicting or have potential for abuse. Clarifying these concepts is difficult because of numerous "gray areas" of drug use and confusion over medical criteria for such terms as "addiction", "dependence", and "tolerance". Many of the efforts to clarify the terminology regarding substance habituation, abuse, and addiction have resulted in additional confusion. They have resulted in overlapping definitions of abuse and dependence, the injection of moral judgments into scientific terms, and difficulty separating the diagnoses of the physical dependence (caused by prolonged use of a wide variety of drugs, many of which are never abused) from that of physical dependence secondary to an abusive pattern of use. This article will trace the history of the various definitions currently in use, and will suggest newer terminology to replace misleading or erroneous terms.