Psychological and physical dependence can develop within a few weeks or months of regular or repeated use.
Psychological dependence is less of a problem. Many users report a sort of physiological “craving” for the drugs (to relieve the withdrawal symptoms of tolerance or interdose usually), but at the same time feel revolted by them and angry that they have to take them to avoid withdrawal symptoms.
Therapeutic dose dependence
People who have become dependent on therapeutic doses of benzodiazepines usually have several of the following characteristics.
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- They have taken benzodiazepines in prescribed “therapeutic” (sometimes ‘low’ or moderate, comparatively) doses for months or years.
- They have gradually come to “require” (a physical or physiological dependence) benzodiazepines to carry out normal, day-to-day activities
- They have continued to take benzodiazepines although the original indication for prescription has disappeared (many times, they are advised to continue by their prescriber).
- They have difficulty in stopping the drug or reducing dosage, because of withdrawal symptoms.
- If on short-acting benzodiazepines they develop anxiety symptoms between doses or get a sort of physical “craving” for the next dose (see Interdose withdrawal)
- They become anxious if the next prescription is not readily available; they may carry their tablets around with them and may take an extra dose before an anticipated stressful event or a night in a strange bed.
- They may have anxiety symptoms, panics, agoraphobia, insomnia, depression and increasing physical symptoms despite continuing to take benzodiazepines.
The number of people worldwide who are taking prescribed BZs is tremendous. For example, in 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. About 2 percent of the adult population of the US (around 4 million people) appear to have used prescribed BZ hypnotics or tranquilizers regularly for 5 to 10 years or more. Similar figures apply in the UK, over most of Europe, and in some Asian countries. A high proportion of these long-term users must be, to some degree, dependent. Exactly how many are dependent is not clear. However, many studies have shown that 50-100 percent of long-term users have difficulty in stopping benzodiazepines because of withdrawal symptoms.
Prescribed high dose dependence
A minority of patients who start on prescribed benzodiazepines begin to “require” larger and larger doses (tolerance withdrawal) – either increased by their prescriber or by the patient themselves (see ‘pseudoaddiction‘).