Hypnotic Dependence and Withdrawal

The use of hypnotic drugs has always been an important topic given the enormous commercial success of these drugs since their launch and the potential risk of significant side effects, with negative impacts on patients. Dependence syndrome or substance use disorder is relatively common among users of hypnotic drugs, especially benzodiazepines and Z-drugs, the classes associated with this condition. The harmful effects of benzodiazepines and Z-drugs have been widely documented in the literature and in clinical practice and have sparked debate about the adequate prescription of these substances by physicians and their proper use by the general population. So far there are no guidelines for the treatment of hypnotic dependence, but consensual recommendations exist that should guide patient management. The treatment, which must be individualized, involves gradual discontinuation of the hypnotic drug, the use of other drugs to treat withdrawal symptoms, and a psychotherapeutic approach. Cognitive behavioral therapy and motivational interviewing are widely used techniques, with a higher level of evidence recommending the former. Care should also be taken in the follow-up after drug discontinuation in order to minimize the risk of relapse or return to inappropriate hypnotic use.