Talk:Benzodiazepine dependence

Criticism

Hey folks just added a nuetrality dispute to this page because it reads more like a boogyman article against the legitamate use of these drugs...the title is misleading. While most of the content is spot on to the article title, it then meanders on to topics such as legal status and all of the many crazy criminal activities which may or may not have occured with the assistance of these drugs (citations needed). I would suggest breaking this article up into two articles: (1) a "just the facts" article on dependence, both physical and mental, and (2) an article regarding the boogy-man stuff which is obviously valid although I'm not sure how valid without citations, etc.

--MikeW —Preceding unsigned comment added by 209.183.32.44 (talk) 18:13, 27 December 2008 (UTC)

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I agree with your points. The legal status is not really relevant to dependence and there was undue weight given to the legal status of benzodiazepines, so I shortened it way down in size. I trimmed out all of the noncited data and also data related to non-english, non-european countries out of the legal status section. I had moved that big legal status from the main benzodiazepine article because the main benzodiazepine article got too big. I didn't actually write up the legal status stuff. The drug related crime was all credibly cited from the peer reviewed literature so I don't think that there was a lack of citations. Though I think that drug related crime from benzodiazepines is more related to their intoxicating, amnesia and "feelings of invincibility" when they are abused moreso than as a result of dependence. Abuse often occurs outside of dependence/addiction eg abusing once a week or once a month etc. I moved the crime data to the more relevant article drug related crime, check it out it is all cited. I removed the dispute banner as I think that I have addressed all of your concerns.--Literaturegeek | T@1k? 22:02, 27 December 2008 (UTC)

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Cool, I ran a a diff and it looks awesome. I still think the legal status stuff should be moved entirely to another page as I don't think it's relevant to the specific topic of dependency... Maybe just add a link in the "See Also" section to another page with information on the legal status? --MikeW

Hi Mike, I moved it back to the article where it originated from, the benzodiazepine article. The benzodiazepine article is more of a general article which covers all important subject matters relevant to benzodiazepines. You are right dependence, a physical or psychological medical disorder is not relevant to a drugs legal status. Have a good day.--Literaturegeek | T@1k? 15:34, 28 December 2008 (UTC)

2014 and I still agree with the initial criticism. This is an opinion piece and little else. A lot of the "science" is dated and hardly balanced. Even the words "addiction" and "dependence" are equated...would you say a person is "addicted" to antihypertensive meds? Addiction classically implies drug-seeking behavior, etc.-not found in dependence-dependence simple means that the drug must be withdrawn by taper if the person is discomforted by a decreased dose. There is really a lot of misinformation in this article-I suggest another set of eyes to clean it up. Dehughes (talk) 14:22, 20 May 2014 (UTC)

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2019 and it's a controversial mess. It's too massive for me to edit and I'm new, but here's my input. There’s a difference between being addicted to a prescription drug and being dependent on it and this article fails to make the distinction. Inter-dosing or abrupt withdrawal can result in seizures and death, but there's no mention of death! Please add.

Remove repetitive comments about alcohol, other drugs, the implication that everyone who is dependent is drug seeking or abusing it, and CBT. Post-acute Withdrawal Syndrome (PAWS) which lasts for years, is only vaguely mentioned. The list of withdrawal symptoms makes it sound like a cake walk. The mention of Flumazenil (used to treat benzo OD cases) should be removed. They only studied substance abusers with seizure disorder.

The whole article is very one-sided. "Numbers of benzodiazepine prescriptions have been declining, due primarily to concerns of dependence." False. Recent news stories from Huff Post, Washington Post, LA Times, etc... indicate benzo prescriptions are on the rise and we're facing an epidemic.. Add info about link between benzos and Alzheimer's. --NoBreederRat (talk) 10:30, 13 September 2019 (UTC)

References

Complete OR and contradiction

Regarding only the mental/physical effects section - and only a bit of it, at that - I'm a bit confused as to why there is a sentence referring to "the author" without a citation or even name/organization anywhere near it. Also, saying that all psychiatric problems stem from a "poisoned brain" (exact quote, mind you) if you are taking benzodiazepines is a giant leap at best and certainly not NPOV. Professor Ashton mysteriously appears later on in the section with no explanation as to who s/he is and their affiliation, and it goes on to say that s/he was denied funding for further studies... on what, exactly? Who IS Professor Ashton? Why is absolutely none of their work cited in this entire article? I'm guessing vanity edit, considering the amount of misspellings contained. That section repeats itself and contradicts itself at the same time, which is rather impressive. It also reeks of an antipsychiatry POV for a good half of it. "Poisoned brain" is not a medical condition nor is it appropriate for an encyclopedia article. I'm really not sure where to start rewriting parts of it, so I tagged generously and I'll let people with more expert knowledge on the matter clean it up as necessary if they would like to. as it is, it's unreadable and sounds like something you would read in a high school P.E. paper. The rest of this article is really very well written and cited which is why it was confusing to reach this part. This is my rationale, if anyone disagrees with it, well, that's what the talk page is for - discussion :) I'd be happy to hear who Professor Ashton is, why her/his research grants being denied is relevant to benzodiazepine dependence, and what condition "poisoned brain" falls under.go slowly (talk) 19:45, 28 December 2008 (UTC)

The citation was at the end of the sentence of that paragraph. I deleted the authors views of benzodiazepines having no place in the treatment of anxiety as the article is on dependence and the long term effects of benzodiazepines not anxiety disorder. I also deleted it to make the article more neutral. No where, anywhere in the article or in the peer reviewed citation did it say all psychiatric symptoms are due to alcohol or benzodiazepines. Infact the summary in the wiki article says quite the opposite. See bracketed comments

alcohol or benzodiazepine dependence often (not always) act to keep the anxiety disorders going and often progressively making them worse.

It was noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs and what one person can tolerate without ill health (highlighted text clearly states that some people who take benzodiazepines do so without any adverse effects on their health) another will suffer very ill health and that even moderate drinking can cause rebound anxiety syndromes and sleep disorders.

Professor Ashton is a professsor of psychiatry and psychopharmacology and has studied benzodiazepines for most of her career at Newcastle University, School of Neurosciences. Poisoned brain was a taken out of a citation so was not original research but I have deleted it for neutrality purposes as you suggested. The research grants declined are listed in one of the citations. It is not known for sure why her research grants were declined. You have to remember that this article is on benzodiazepine dependence, so naturally you will not read about the therapeutic applications in this article and the article is going to focus more on the adverse consequences or possible consequences of chronic benzodiazepine use, misuse and dependence. This is the same for any article on dependence. An article on alcohol dependence, opiate dependence, nicotine dependence is not going to go into details about the therapeutic and wonders of opiates say for pain management or alcohol used sensibly in a social setting or whatever. It is naturally going to talk about tolerance, dependence, long term effects and negative side of the drug. It is not a matter of being antipsychiatry. With that said you have raised some valid points and I have already made some deletions. I will see if I can clean the article up. Also this article is only a few days old with stuff cut and pasted from other articles to shorten them.--Literaturegeek | T@1k? 20:41, 28 December 2008 (UTC)

I tidied the article up a bit and made the refs more clear, in a more clear order. I removed the tags as I don't think that they are needed anymore. Professor Ashton has published more papers on benzodiazepines than almost anyone else. If you read medical literature on benzodiazepines her research is more often than not cited in medical papers.--Literaturegeek | T@1k? 23:46, 28 December 2008 (UTC)

Cancer

Benzodiazapines can cause cancer so why was the cancer section deleted? --TreasureXNY (talk) 17:07, 7 February 2009 (UTC)

The section was deleted because there were no reliable sources that support benzodiazepine carcinogenicity. Feel free to provide references to support your claim so a section can be written on this specific long term effect. Thanks. Letsgoridebikes (talk) 20:39, 7 February 2009 (UTC)

The single reference that even came close to providing some link between BZs and cancer is the following: "Kripke, Daniel F (2008). "Evidence That New Hypnotics Cause Cancer" (PDF). Department of Psychiatry, UCSD. University of California." I feel it is irresponsible to make such an extraordinary claim based off a single, non peer-reviewed source. I took a quick look through the article's bibliography, and could not find any articles that clearly supported the claim that BZs cause cancer, although the paper may be a useful starting point. That's why I've listed it here. When dealing with matter like this, it is important to remember that the burden of evidence rests with the addition of material, not its removal.Letsgoridebikes (talk) 20:53, 7 February 2009 (UTC)

Organic brain syndrome study

I corrected the citation of this study. It were 194 patients treated for long time benzodiazepine abuse in this institution. In 30% of them an organic brain syndrome was found. 70% of them were also alcohol dependent or dependent on other drugs. Somatic symptoms, anxiety and depression were the reasons while they started benzodiazepines, not symptoms of the organic brain syndrome. In my opinion this is a weak primary source, because it describes a collective with 70% polydrug dependent and alcoholic patients, so any observed pathology cannot be connected to any secured causality in this case. 30% incidence of organic brain syndrome is not uncommon in patient collectives treated for alcoholism alone. So the study has little value for assessment of the sequelae of benzodiazepine abuse. By no means can this study be generalized as effect of benzodiazepine abuse. Propose to delete. 70.137.165.53 (talk) 23:30, 6 April 2009 (UTC)

Since this article is not on alcoholism and alcohol appears to be clouding significantly the interpretation of the results how about moving as it is to a more relevant article like organic brain syndrome?--Literaturegeek | T@1k? 07:11, 7 April 2009 (UTC)

I am afraid the article provides little insight beyond the fact that patients treated in an institution for alcoholism and polydrug abuse commonly show signs of organic brain syndrome. This is not surprising at all. It is one of those weak primary sources with little scientific substance. 70.137.165.53 (talk) 10:42, 7 April 2009 (UTC)

I have deleted it per this discussion.--Literaturegeek | T@1k? 21:19, 7 April 2009 (UTC)

WP:MEDMOS

This appears to be a disease or condition. Wondering if it could be organized per WP:MEDMOS?Doc James (talk · contribs · email) 19:44, 29 May 2010 (UTC)

Yes it should be made compliant with MEDMOS as best possible. I might not be able to get free time until Tuesday evening to work on this though.--Literaturegeek | T@1k? 01:34, 30 May 2010 (UTC)

Definition

Looking over this article, it seems the official definition of benzodiazepine dependence and "withdrawal symptoms" (relapsing of the symptoms that the med is there to cure temporarily) equals my use of asthma meds, and that of millions of other people on the planet who have a lifelong dependence upon asthma meds because the underlying condition cannot be treated. Thus, the article falls short upon explaining why, exactly, long benzodiazepine use is considered a kind of abuse that must be treated, whereas the very same symptoms for asthma meds are not considered an inherent need to intervene.

Plus, I'm currently talking to a person who had herself clinically tested for 50+ other meds to replace her benzodiazepine use, and none other than benzodiazepines could do anything about her underlying panic disorder, which is why she is as dependent upon benzodiazepine as I am about my asthma meds. And still they keep trying to legally incapacitate her for her use of the med, even though no other side effects beside "withdrawal symptoms" can be found, all because the ICD definition pretty much fits the use of astha meds with millions of people all over the planet. --80.187.113.170 (talk) 22:54, 10 July 2015 (UTC)

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potential typo

"the development of tolerance occurs as a result of neuroadaptations, which result in decreased GABA inhibition and increased excitability of the glutamate system"

This contains a typo, which profoundly reverses the meaning. It should say "which result in decreased GABA activity" or "which result in increased GABA inhibition"; it should NOT say, "which result in decreased GABA inhibition".

It's considered fairly fundamental understanding of benzodiazepines that it is a GABAergic agonist. Tolerance to it reduces GABAergic activity (e.g. through downregulation of GABAR) and may increase excitability of the glutamate system. Thoreaulylazy (talk) 06:07, 2 February 2020 (UTC)

Dependence is NOT addiction

The section of this article which attempts to diagnose 'dependence' is actually diagnosing addiction, and contradicts the earlier part of the article which clearly differentiates between the two. The vast majority of benzo-dependent persons display no drug-seeking behavior and have become dependent simply by rigidly adhering to their psychiatrists' bad advice. This is a grievous and inexcusable flaw that renders the entire article worthless. 2601:940:C100:3130:AC4B:DDC4:6C02:69B5 (talk) 13:27, 20 August 2022 (UTC)

I agree the vast majority of people dependent on benzos do not have drug seeking behaviour. I think you mean physical dependence is not addiction. There is a term psychological dependence which can overlap, at least in part, with addiction.--Literaturegeek | T@1k? 19:38, 20 August 2022 (UTC)

Re: I think you mean physical dependence is not addiction. There is a term psychological dependence which can overlap, at least in part, with addiction.

Psychological dependence and addiction are separate disorders because their modes of reinforcement are entirely opposite. Psychological dependence is mediated entirely by negative reinforcement (i.e., the withdrawal state upon cessation of chronic use; the motivation to remove the "bad stimulus" that is withdrawal increases the likelihood that drug use will be reinstated). On the contrary, addiction is entirely positive reinforcement (i.e., the rewarding effects of a drug) that manifests as compulsive engagement with particular rewarding stimuli.

Psychological and physical dependence syndromes are titled as such to simply reflect the category of withdrawal symptoms they induce; physical dependence results in somatic withdrawal symptoms, whereas psychological dependence results in withdrawal symptoms that are cognitive in nature (e.g., emotional-motivational).

Addiction and dependence glossary
addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal – symptoms that occur upon cessation of repeated drug use physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome) reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach sensitization – an amplified response to a stimulus resulting from repeated exposure to it substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Professional Crastination (talk) 15:04, 17 July 2024 (UTC)