Dependency
Labels
People may be horrified at being labeled “addicts” because they have been taking a drug prescribed by their doctor. Other terms such as “habituation” have been used. The World Health Organisation has suggested that “drug dependency” should be the expression of choice. All of these terms are an attempt to describe a situation where a person feels compelled to continue taking a substance for whatever reason.
Reasons for dependency
Dependency may occur because a person craves the effects that a drug produces (either good feelings or the suppression of discomfort). It may also occur because a person has experienced withdrawal symptoms and wants to avoid them. The first case is sometimes called psychological dependence and the second physical dependence. There has been a tendency in some quarters to overplay the role of psychological dependence with respect to benzodiazepines and to underplay the physical effects. There is evidence that the majority of people will become dependent on these drugs after one or two years. Most people don’t actually like taking benzodiazepines but they do want to avoid withdrawal symptoms. These symptoms may also fool them into believing that they actually need to take the drug in order to keep them well.
Drug tolerance
A key feature of addictive substances is the need to keep increasing the dose to achieve the desired effects. The user becomes conditioned to the drug as his or her body becomes tolerant to it. It can be all too easy to get into a spiral where the dose is increased until some practical or physical limit is reached. At such high doses the withdrawal effects are much stronger and it is much harder to come off. The benzodiazepines certainly show these effects although luckily most people do not have access to an unlimited supply. Nevertheless, even on a constant dose, the intended effects of the drug decline with time and some “withdrawal” symptoms may be experienced.
After taking an addictive drug regularly for some time the body makes physical changes to accommodate it and re-establish “normal” conditions. This is what leads both to tolerance and to withdrawal symptoms. When the drug is suddenly withdrawn the body cannot instantly re-adapt. Withdrawal symptoms can be quickly suppressed by taking an appropriate dose of the drug. This is how physical dependence works.
“Psychological dependence”
Psychological dependence is harder to define. The user may crave the beneficial effects of the drug, may dread living without it, may find it difficult to change the habit or may be under social pressure to take it. There may be psychological factors in physical dependence and physical factors in psychological dependence so the terms are not especially helpful. Rebound effects do not clearly fall into either camp. A person takes benzodiazepines originally to help with some problem e.g. anxiety or insomnia. The drugs temporarily suppress these problems but do not cure them. Sometimes withdrawal symptoms can mimic the original symptoms that were the reason for the original prescription and can lead to the notion by the person and the professional that the benzos were ‘masking’ the original symptoms. This can then lead to the prescribing of more/ other drugs which can interfere with the withdrawal process. Try to hang onto the fact that it really is benzo withdrawal that is making you feel the way you do. Even people who were given the pills for a physical reason (eg: backache) start to experience feelings of panic and anxiety for the first time in their lives, when on and coming off benzodiazepines.
What to do about it
So there are many possible reasons for a person becoming dependent. That dependency can be broken however by understanding how the process works and by getting support.
DO:
- Take control
- Get fully informed about your drug and about withdrawal
- Use others to support and advise you
- Take your time
DON'T:
- Go 'cold turkey' and stop suddenly
- Allow yourself to be pushed into actions which seem unwise to you