Benzodiazapine risks

Although the title of April’s cover story (“Benzodiazepines: A versatile clinical tool,” Current Psychiatry, April 2012, p. 54-63; http://bit.ly/MrIAab) seems to encourage the use of benzodiazepines, the authors state benzodiazepines are second-or third-line treatments for most conditions, particularly for chronic problems.
As an addiction medicine physician, I see well-intentioned doctors prescribing benzodiazepines to patients with chronic ailments. I would like to emphasize the addictive nature of benzodiazepines. “When used appropriately” is contradictory if benzodiazepines are used daily. Tolerance manifests as an exacerbation of the original symptoms, usually leading to a dosage increase. Every day, I see patients in a state of chronic withdrawal manifested in unpleasant ways because they took benzodiazepines “exactly as prescribed, 3 times per day for 4 years.”
Alprazolam is the bane of an addiction medicine practice because it crosses the blood-brain barrier immediately and is relatively short acting. This is a recipe for almost certain addiction, and there are better medications. I regularly transition patients from addictive substances, including benzodiazepines, and no matter what condition I am treating—panic attacks, obsessive-compulsive disorder, depression, generalized anxiety, social anxiety, posttraumatic stress disorder, or situational anxiety—I can almost always control the patient’s symptoms using non-addictive medications.
If benzodiazepines are used for almost anything other than a short-lived condition, we are doing a tremendous disservice to our patients and exhibiting the “just give them a pill and get to the next patient” mentality we are accused of.
Terrance Reeves, MD, ABAM
Medical Director
South Walton Medical Center
Miramar Beach, FL

From Current Psychiatry July, 2012, click here.

Editor's note: I see a lot of my clients who are on Alprazolam (Xanax) and taking it on a regular basis. I try to educate them about the nature of the drug and how it can be used as a tool in managing their symptoms. Taking it on a regular basis for any period of time is usually not a good idea and requires a detailed discussion with the prescribing physician. If psychotherapy has not been recommended for symtpom management along with the Alprazolam, the patient can become easily addicted. Dr. Reeves concerns stated above are correct and need to be heeded.