BENZODIAZEPINE ADDICTION -
AN INTRODUCTION
Dr Reg Peart
VOT Newsletter, 1995
Although the word dependence is more generally accepted scientifically, I, like some medical institutions and journals, prefer the word addiction because it more accurately reflects the nature of benzodiazepine problems, and because the word dependence (neutral or nebulous) can and is used to minimise the problems and sweep them under the carpet. In essence I use both words in a synonymous sense.
There are four overwhelming facts to bear in mind when discussing addiction:
That ALL mind altering drugs, prescribed or otherwise, have the potential for addiction: it is only a question of degree.
That the individual sensitivity to these drugs is extremely wide. This is not stressed enough or insufficient account is taken of this by the medical profession or the drug companies. This aspect has been known and accepted by support groups for over 50 years, i.e. the primary consideration is the effect of the drug on the individual. Other aspects like how much, how often, where, why and when are secondary.
That the cause of drug addiction is the interaction between the body and a drug is obvious but needs stating. Hence the probability of becoming addicted is largely independent of such factors as race, colour, creed, intelligence, physical stature, social stature, profession, gender or sexual orientation etc. Hence factors relating to pre-morbidity, underlying illness etc., personality defects or disorders are largely irrelevant. I'll come back to the latter point.
Conversely, the pattern in the decline of the addict in physical, mental, emotional, sociological and spiritual terms is overwhelmingly similar in a general sense. Of course there are specific differences due to different drugs and especially their accessibility or availability.
Professor Krivanek, the Director of the Clinical Drug Dept at Macquarie University, Sydney, Australia, put things in perspective: the only difference between a drug addict and the rest of society is the drug.
There are many myths about addiction and I would like to quote Dr. Phelps, who is the Clinical Professor at the Medical School of the University of Washington and is a self declared recovering addict. These myths are:
Addicts are criminals.
Only illegal drugs are addictive.
Problems, pressure or stress can turn somebody into an addict.
Addiction is immoral and addicts have weak characters.
Addiction is a psychological problem - belief in this leads to treatment of peripheral symptoms which doesn't work and both patients and doctors come to believe the trouble must be in the patient’s mind.
There are different kinds of addiction - this leads to doctors differentiating between physical and psychological addiction and insisting that there are addictive personalities which lead to addiction. In fact, addiction causes an addictive personality (if there is such a thing). As is frequently the case for benzo problems the medical profession puts the cart before the horse. I wonder why they do not suggest that the diabetic personality causes diabetes, or the hypoglycaemic personality causes low blood sugar problems.
I do not believe the medical profession has more than its fair share of members with personality disorders, defects or problems. There are other reasons why it is high in the league of addiction with 5% - 6% of its members addicted to either prescribed drugs, alcohol or hard drugs. Indeed some sections of the medical profession have higher rates e.g. 10% - 12% for anaesthetists in the USA (Aust. Journal of Addiction).
In recent years the World Health Organisation (WHO) has declared:
33 benzodiazepines as drugs of addiction.
That benzo addiction is the second largest addiction after alcohol in the western world.
That the definition of addiction is independent of the drug used.
That this addiction (or dependence) syndrome includes seven key elements:
A subjective awareness of compulsion to use a drug(s) usually during attempts to stop or moderate drug use.
A desire to stop use in the face of continued use.
A relatively stereotype drug taking habit i.e. a narrowing in the repertoire of drug taking behaviour.
Evidence of neuroadaption (tolerance and withdrawals).
Use of the drug to relieve or avoid withdrawal symptoms.
The reliance of drug-seeking behaviour relative to other important priorities.
Rapid reinstatement of the symptoms after a period of abstinence.
It is not tenable to consider physical and psychological dependence as independent aspects (dualism of the brain and mind is an outdated 19th century concept). Psychological addiction must be considered in the context of the psychological changes produced by the drug.
That the result of addiction is a complex web of physical, mental and social problems: all must be considered in any assessment or diagnosis of addiction and that in general there is a chain of causation (from the physical to the mental to the sociological).
This article is an extract from the talk given by Dr. Peart at the Bristol Conference. Dr Reg Peart is National Co-ordinator of VOT, Victims of Tranquillisers.
AIMS OF VOT
MISSION STATEMENT
To PROMOTE the awareness of side effects and adverse reactions caused by tranquillisers and other psychoactive drugs
To PROVIDE help, support and information to those who have suffered medical and legal problems resulting from these drugs
VOT was founded in the spring of 1993. The primary aim of VOT was to act as a lobby pressure group to fight the injustice surrounding withdrawal of funding of the benzodiazepine litigation and subsequent dismissal of Legal Aid Certificates by the Legal Aid Board. However, VOT now sees itself as a medico-legal support group as well as a pressure lobby group due to the demands of claimants who were originally suing the benzodiazepine manufacturers with the support of legal aid and who are now continuing claims as Litigants In Person.
VOT also acts in a secondary role as a support group for people struggling with withdrawal as a result of reduction of drug dosage and those suffering protracted withdrawal after successful discontinuation of drugs.
VOT aims are:
To educate about addiction
To lobby parliament for recognition of the potential of medically prescribed drugs to cause irreparable harm to the mental, physical and social well beings of the individual
To seek justice for those individuals whose lives have been ruined by benzodiazepines
To support individuals trying to reduce dosage or to take legal action
To contact groups overseas
To keep abreast of research
To up-date and inform an already over-worked medical profession of potential and actual drug problems
To provide contacts for isolated members
To contact other action groups for prescribed drugs and other medical problems e.g. Thalidomide, Septrin and ECT
VOT
Victims of Tranquillisers
Flat 9, Vale Lodge, Vale Road,
Bournemouth, BH1 3SY,
England, United Kingdom
Telephone / Fax : 01202-311689
National Coordinator:
Dr RF Peart, BSc, PhD
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