Dependence

Two days ago, on July 9, Richard Lewis published on Mad in America a post in which he draws attention to the prolific worldwide prescribing of benzodiazepines, and the problems that this creates. The article includes a music video of a song which Richard has written and performs. The song is called Benzo Blue, and it “highlights the struggles of the millions of worldwide victims/survivors of prescribed benzodiazepine drugs such as Xanax, Ativan, Klonopin, and Valium.” ...

I recently read an article by Fredric Neuman, MD, Director of the Anxiety and Phobia Center at White Plains Hospital, NY. The article is titled The Use of the Minor Tranquilizers: Xanax, Ativan, Klonopin, and Valium, and was published in June 2012 by Psychology Today. Thanks to Medicalskeptic for the link. Dr. Neuman opens by telling us that benzodiazepines are “…very commonly prescribed for any sort of discomfort.” ...

Important updates on this subject can be found at the posts listed at the bottom of the post. . . . . . . . . . . . . . . . . I've recently come across an article by Matt Samet called Social Vacuum. It's dated March 2013, and was published on Robert Whitaker's website Mad in America. Matt had been taking a benzodiazepine for some time, and while on a tapering withdrawal, he experienced some distressing symptoms, including some acute social discomfort. (For a full account of benzo withdrawal – click here.) ...

This post was edited and updated on June 29 2014, to include additional thoughts. . . . . . . . . . . . . . . . . A Rational Policy on Drugs and Alcohol In my last post I argued against government prohibitions against drugs and alcohol. My position is that substances such as cocaine, heroin, methamphetamines, etc., should be legal in the same way that alcohol and tobacco are today. I believe, however, that the distribution and marketing of these substances should be brought under direct government control. All of the commonly abused addictive substances are dangerous, and they have taken - and continue to take - an enormous toll on society. This cost includes lives, health, lost opportunities, money and general suffering and anguish. But it’s difficult to put old heads on young shoulders, and it seems that each generation - indeed each individual - has to learn these lessons anew. I don’t believe we can ever eradicate substance abuse entirely. ...

In my previous post on this subject, I discussed addiction to alcohol and other drugs. I made the point that addiction to these substances is not an illness, but rather an extremely strong habit. Treatment Programs The notion that alcoholism is a disease gained popularity in the 50’s and 60’s. At about the same time, employers were beginning the practice of offering medical insurance to their staff, and insurance companies routinely included 30 days of treatment per year for alcoholism and/or drug addiction. At the time, there were very few treatment units for these problems, and little use was made of the drug and alcohol provisions in the insurance policies. ...

The APA’s DSM lists two broad categories of diagnoses in this area: dependence and abuse. So we have alcohol dependence and alcohol abuse; amphetamines dependence and amphetamines abuse; cocaine dependence and cocaine abuse. And so on. Dependence is defined by the presence of three or more of the following criteria: tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect markedly diminished effect with continued use of the same amount of the substance withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance … the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms the substance is often taken in larger amounts or over a longer period than was intended there is a persistent desire or unsuccessful efforts to cut down or control substance use a great deal of time is spent in activities necessary to obtain the substance… use the substance … or recovery from its effects important social, occupational, or recreational activities are given up or reduced because of substance use the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance … Abuse is defined as one or more of the following: recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home … recurrent substance use in situations in which it is physically hazardous … recurrent substance-related legal problems … continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effect of the substance … Let’s consider alcohol dependence, which to all intents and purposes is what most people would refer to as alcoholism. A person who drinks, say, half a bottle of whisky every day, who never appears particularly drunk, who becomes extremely sick if he stops drinking, who has made numerous unsuccessful efforts to quit, who has incurred some liver damage, and whose social life has been severely curtailed because of drinking, would normally be called an alcoholic. Some people prefer the term addicted and would describe him as addicted to alcohol. DSM would say that he has a mental disorder called alcohol dependence. The problem with all three terminologies is that they encourage us to blur the distinction between a description and an explanation. This distinction is the central theme of this blog. ...