Introduction

Many benzo injured patients are met with unintentional misunderstanding when discussing their difficulties while taking and withdrawing from prescribed benzodiazepines.

When it comes to benzos and withdrawal, the terms addiction, dependence, and tolerance are commonly used - and widely misunderstood.

It is important to understand the difference between these terms:

Tolerance is when your dose stops working. Once you have reached tolerance, your options become limited; either increase your dosage to prevent withdrawal or begin tapering.
Dependence is when a person stops using a drug and their body goes into withdrawal. The withdrawal symptoms that emerge are not ones that individuals can control. This person is now dependent on this medication and cannot just stop taking it.
Addiction is a disease that refers to compulsive drug use and behavior despite harmful consequences. Addiction is the psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.

Let’s look at these terms in more detail.

Tolerance

Tolerance occurs when the receptors in your brain adapt to the drug dose you’re on and you may find you need to increase your dose to achieve the same effect.

In other words, your prescribed dose is no longer creating the same pharmaceutical effects it once did. Although patients continue to take their medications as prescribed, tolerance to the drug prevents it from working as it used to.

Tolerance is almost always associated with some degree of dependence when it comes to benzos.

Dependence

In medical terms, dependence specifically refers to a physical condition in which the body has adapted to the presence of a drug. Dependence to a benzodiazepine is a chemically created bond between your brain and the medication, making you reliant on the substance. It happens to all human brains exposed to drugs such as benzos and it is not the same as addiction.

Physical dependence refers to the need to continue taking the drug in order to avoid experiencing unpleasant and painful symptoms.

Mental dependence is when use of the drug is a conditioned response to an event or feeling, in other words, a trigger. Triggers could be certain people, places, events or anything a person associates with using a particular substance. If mental dependence is also present, then addiction may be too.

People who have become physically dependent on prescribed therapeutic doses of benzodiazepines rarely have an actual addiction.

If anyone with a physical drug dependence stops taking that drug suddenly, that person will experience predictable and measurable symptoms, known as a withdrawal syndrome. Essentially the brain does not know how to function without it and this can result in the presentation of the many bizarre and distressing symptoms that patients can experience.

Addiction

Addiction is a disease. It refers to compulsive drug use despite harmful consequences. The person may be experiencing issues meeting work, social, or family obligations which may indicate a problem. Dependence is often a part of addiction. The difference with addiction, is that it is a disease, unlike tolerance or dependence.

If someone continues to use substances that produce negative consequence in their lives, they may have an addiction problem or a substance abuse disorder.

Here is a short definition of Addiction from the ASAM (American Society of Addiction Medicine):

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

Most patients taking their benzos ‘as prescribed’ do not fit the criteria for addiction at all.

Summary

Tolerance is when your dose stops working. Once you have reached tolerance, your options become limited; either increase your dosage to prevent withdrawal or begin tapering to properly withdraw from benzodiazepines. Quitting taking benzodiazepines suddenly, or Cold Turkey, is not a viable option for patients, as this can be fatal.

Dependence is when a person stops using a drug and their body goes into withdrawal. The physical and mental symptoms that emerge are not ones that individuals can control. Physical dependency refers to the need to continue taking the drug in order to avoid experiencing unpleasant and painful symptoms.

Addiction is a disease, it refers to compulsive drug use despite harmful consequences and is very often associated with psychological dependence e.g the emotionally difficult battle within a person to avoid taking a substance.

It is important to note that physical dependence upon a psychotropic medication like a benzodiazepine does not share the same addictive cravings, but rather a need for the brain to be delicately tapered off these medications, slowly and safely to prevent harm and minimise withdrawal symptoms.

Unfortunately, many medical facilities and general public alike refer to benzo withdrawal as an addiction and this is utterly inaccurate. The inability to simply stop taking a benzodiazepine without symptoms does not constitute addiction. It is in fact a sign that the patient now has a physical dependence on the drug. It is possible to be dependent and have a high tolerance without being addicted.

Final Words From Benzo Warrior

Anyone taking these medications is at risk of dependence, tolerance and addiction, even when taken exactly ‘as prescribed’. Prescribing guidelines state they should not be used continuously for longer than 2-4 weeks.

Many of the side effects of benzodiazepine tolerance, dependence and withdrawal mimic other disorders. Some patients go on to find themselves being diagnosed with all manner of chronic health conditions only to later find out that their medications were the cause.

If you are on these medications please do not stop abruptly (cold turkey) as the risks include seizures, psychosis and death. The best place to start is the Ashton Manual for safe tapering guidelines.

If you are in need of support as you withdraw and heal from these medications please join us in the private Benzo Warrior Community on Facebook.

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