Definition and Diagnosis
This disorder involves a problematic pattern of use of benzodiazepines or other sedative-hypnotic-anxiolytic agents, leading to impaired control, tolerance, and a withdrawal syndrome that can include serious complications such as seizures if not managed appropriately.
Epidemiology
Misuse most often arises in the context of long-term prescribed use for anxiety or insomnia, though non-medical use also occurs, sometimes in combination with opioids or alcohol, which increases overdose risk.
Risk Factors
Risk factors include long duration of prescribed use, higher prescribed doses, history of other substance use disorders, co-occurring anxiety or insomnia, and concurrent use of opioids or alcohol.
Symptoms and Subtypes
Features include difficulty reducing or stopping use, tolerance, and withdrawal symptoms such as rebound anxiety, insomnia, tremor, autonomic instability, and, in severe cases, seizures or delirium, particularly after abrupt discontinuation of high doses.
Diagnosis
Diagnosis follows DSM-5-TR criteria for sedative, hypnotic, or anxiolytic use disorder, with careful history-taking around dose, duration, and pattern of use, since dependence can occur even with medically supervised long-term use.
Treatment
Gradual, supervised dose tapering is the cornerstone of treatment to minimize withdrawal risk, often over weeks to months. Adjunctive psychotherapy, particularly CBT for the underlying anxiety or insomnia, supports longer-term discontinuation.
Prognosis
Gradual tapering under medical supervision is generally well tolerated, though abrupt cessation of long-term high-dose use can be medically dangerous. Long-term outcomes are favorable when tapering is combined with treatment of the underlying condition.
Reference
New Oxford Textbook of Psychiatry (2nd ed.).