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Re: Trashing Benzos - Re: addiction. Mr. Scott

Posted by Alan on February 15, 2002, at 23:22:03

In reply to Trashing Benzos, posted by Mr. Scott on February 15, 2002, at 19:38:39

> Certain elements about benzos scare me because I like to be in control, but someone who sees the whole picture would surely see that Effexor and Paxil are just as bad if not worse in all respects. You can't go on a trip and forget to take your Effexor just like you can't forget to take your Klonopin. Someone please correct me, but what is the difference? Just because Monkeys and Rats don't self administor Effexor when locked in a cage? Maybe it's because the Rats and Monkeys are smarter than we are. Because the label calls them "discontinuation symptoms" instead of "withdrawal Symptoms".
> Scott

The demonisation of this entire class of medications is also motivated by other factors - mainly the misunderstanding of undereducated docs that don't understand your first paragraph (above) which is really the issue about the medical distinction between "addiction" and "medical dependence".

When one loosely tosses out the term "addictive" they are ignoring the medical communities' definitions for PRESCRIBED MEDICATIONS for valid reasons.

The term used when someone is on long term treatment for a medication is MEDICALLY DEPENDENT. And yes, there is a huge distinction.
The continual refusal to accept this may inhibit someone from seeking treatment for unneccessary fear of "addiction."

"Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View."

Addiction vs. Dependency:
Benzodiazepines & Anxiety Disorders

Xanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate.

"Needing medication for many years -- even over a lifetime -- to function normally is not drug abuse or drug addiction but rather medical dependence." -- William D. Kernodle, Panic Disorder: The Medical Point of View

Why This is Important

"In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines -- How Common?" Archives of Family Medicine 4.11 (1995): 964-970).

"Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170).

"The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115).

"With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990).

William D. Kernodle's Panic Disorder: The Medical Point of View....If you want to truly understand (or begin to understand) the biology of panic disorder as well as the function of medications, then do read this book.

The Definitions:

The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages.

When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines.

The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too.

A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person's body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician.

People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence."





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