When considering the problem of addiction, the focus shifts from the Ativan drug to the patient taking it. Benzodiazepine addiction in recent years has attracted increased attention, as a result of which there have been scientific works, which raise the issue of the possibility of abuse and dependence in the long-term use of benzodiazepines.
Many of these studies have shown that the true physical dependence on benzodiazepines when used in therapeutic doses develops rare; especially with duration of intake fewer than 3 months and that, the current habit of benzodiazepines occurs usually in a limited number of patients:
- with personality disorders,
- in abusers of other psychoactive drugs.
In other words, the behavior of the “truly addicted” is very different from the behavior of an ordinary person taking benzodiazepines from the pharmacies.
There are five mechanisms that explain the development of some withdrawal syndrome in patients:
- patients irrationally believe in the power of drugs, and therefore, have more severe withdrawal symptoms,
- any bodily symptoms during the reduction of the drug is a measure (fault) for the abolition of the drug,
- the withdrawal of the drug causes fears, and they contribute to the appearance of somatic anxiety symptoms that are associated with withdrawal symptoms; patients are not able to distinguish symptoms of anxiety from withdrawal symptoms; this fact can be a primary defect in the development of a prolonged withdrawal syndrome,
- benzodiazepines are presented to a patient as the only possible way to control vegetative arousal, while other strategies for coping with stress are absent,
- patients are distinguished by a special personality structure, more focused than normal, on bodily symptoms.
When prescribing benzodiazepines (and its cancellation), the following tactics should be followed:
- careful selection of the patients, taking into account the clinical-psychopathological state, age, personality characteristics, propensity to dependency,
- if possible, maintain low or medium doses of the drug or use different doses, and also conduct fractional short courses of therapy,
- the drug should be withdrawn within 1 to 2 months with the obligatory simultaneous addition of other therapeutic strategies: placebo, psychotherapy, etc.,
- taking into account the cross tolerance of benzodiazepines, it is possible to replace one drug with another using the equivalent dose method (short-lived for long-lived benzodiazepine),
- it is important to adhere to a reasonable rate of dose reduction: approximately 25% per quarter of the withdrawal period (for example, if the withdrawal period is 4 weeks, then the dose should be reduced at a rate of 25% per week).
Therapy with benzodiazepines may be prolonged for years in elderly patients, patients with chronic diseases, patients in whom the use of benzodiazepines in unstable and fractional doses leads not only to the reduction of symptoms but also to the improvement of functioning and the “quality of life”.