Treatment of Benzodiazepine Dependence

Traditionally, various terms have been used to define substance use-related disorders. These include addiction, misuse (in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM-IV] 1), harmful use (in the International Classification of Diseases, 10th Revision [ICD-10] 2), and dependence. 3 Long-term intake of a drug can induce tolerance of the drug's effects (i. e., increased amounts are needed to achieve intoxication, or the person experiences diminished effects with continued use4) and physical dependence. Addiction is defined by compulsive drug-seeking behavior or an intense desire to take a drug despite severe medical or social consequences. The DSM-IV and ICD-10 define misuse and harmful use, respectively, on the basis of various somatic or psychological consequences of substance use and define dependence on the basis of a cluster of somatic, psychological, and behavioral symptoms. According to the ICD-10, dependence is diagnosed if 3 or more of the following criteria were met in the previous year: a strong desire or compulsion to take the drug, difficulties in controlling drug use, withdrawal symptoms, evidence of tolerance, neglect of alternative pleasures or interests, and persistent drug use despite harmful consequences. The latest edition of the DSM (DSM-5) 4 has abandoned the categorical distinction between abuse and dependence in favor of a dimensional approach, specifying 11 criteria for substanceuse disorders, which range from mild (in patients meeting 2 or 3 criteria) to severe (in patients meeting 6 or more criteria). Key elements of substance-use disorders are dose increases, tolerance of and craving for the drug's effects, and loss of control. These diagnostic criteria and definitions are used for all classes of abused drugs, including prescription drugs such as benzodiazepines. However, the criteria may be less appropriate - or even problematic - in the case of mentally ill patients who use or are dependent on prescription drugs than in the case of mentally healthy persons who take drugs primarily for recreational purposes.