Benzodiazepine Addiction: A Difficult Story

Benzodiazepines (BZD) are low toxicity drugs that act on acceptor sites on GABA receptors. Their therapeutic index is very broad, meaning that doses causing a fatal poisining are much higher than theapeutic doses and cannot induce death unless combined with other treaments, by example some antidepressants. However, these drugs exert undesirable effects at therapeutic doses, in particular in the elderly population. The consumption of benzodiazepines exposes a number of well-identified risks, such as memory and behavioral problems. These risks are increased in the elderly. The use of benzodiazepines exposes individuals to a risk of abuse inducing psychological and physical dependence, with a withdrawal syndrome when discontinuation of the treatment. It took many years to highlight this phenomenon of dependence, insofar as the BZD seemed to be a revolution in the treatment of anxious pathologies. They were considered as the pill of happiness. Little by little, after many more or less controlled studies carried out by independent researchers, despite the pressure of the pharmaceutical industry, the proof of the dependence imposed itself. Withdrawal syndromes have become common place after discontinuation of planned or unplanned treatment. The clinical signs of this withdrawal are now well known and are an integral part of the DSM. Dependence must be recognized as a major risk for treatments lasting more than a month, this is what should guide the prescription or not of a BZD. If dependence is established for patients treated long term, it will be difficult to wean these patients other than by hospitalization.