Talk Cancer

Question:

- Hide quoted text — Show quoted text – Addiction vs. Dependency: Benzodiazepines & Anxiety Disorders Xanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate. "Needing medication for many years — even over a lifetime — to function normally is not drug abuse or drug addiction but rather medical dependence." — William D. Kernodle, Panic Disorder: The Medical Point of View RESEARCH "In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines — How Common?" Archives of Family Medicine 4.11 (1995): 964-970). "Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170). "The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115). "With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990). The Definitions The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages. When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines. The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too. A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person’s body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician. People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence. The rest of the article is at http://panicdisorder.about.com/health/panicdisorder/library/weekly/aa031 997.htm Before you buy. This article itself, and these definitions are also obsolete.  Noone in the field of addiction equates addiction with dependence (physical or otherwise) anymore.

And nobody claimed this in Julie’s text. Although I appreciate every effort to define the difference between addiction & dependence I can’t find anything in Julie’s quote that contradicts what you say below. You basically say the same thing…. Philip – Hide quoted text — Show quoted text –  Addiction is defined as a pathological overinvolvement with a drug characterised by compulsive drug-seeking and compulsive drug taking, even after withdrawal.  Dependence is DEFINED by the onset of a market WITHDRAWAL SYNDROME when the drug is terminated. Fortunately, dependence is easy to treat. You quit the drug and dependence goes away after withdrawal (maybe 2 weeks). Sadly, addiction does not go away — relapse rates for addictive drugs like cocaine are 75% a year after withdrawal is over — this is one of the strongest reasons to believe they are unrelated. Second, drugs that produce strong dependence are not necessarily the most addictive, that is, there is no strong relationship between the size of withdrawal and size of addiction.  Alcohol and barbiturates produce, by far, the strongest withdrawal and dependence but are only mildly addictive.  On the other hand, cocaine and amphetamine produce only mild withdrawal and dependence but are strongly addictive. Benzodiazepines are not (by any one who has any idea what they are talking about which usually does not include the prescribing doctor unless he is a psychiatrist) addictive. They do produce a MILD dependence and a MILD withdrawal which may make them somewhat habit forming.  The benzos were developed from the drug Miltown which produced a more significant dependence; it was developed from the barbiturates which produce a very strong dependence (again: no addiction).  That is, these drugs represent about 50 years of drug perfecting which has been aimed specifically at reducing this side effect. Historically, there is a lot of confusion about this issue because dependence, withdrawal, and addiction were believed to be the same thing for many decades… this is because the models were based on classical studies of the opiates heroin and morphine for which there is a good correspondence among the phenomena (morphine dependence was widespread after the civil war, and heroin addiction developed soon after Bayer introduced Heroin as a zero side effect version of morphine — it wasn’t).  However, stimulant addiction, which became prevalent in the 60’s has completely abolished this view of addiction, akthough it persists in the popular press and in medical training. The basic story boils down to whether addicts take drugs to avoid the unpleasant consequences of withdrawal (this is the negative reinforcement or dependence view) or for the feeling of a drug high (euphoria — the positive reinforcement view). The bulk of evidence now suggests that the addictive properties of drugs are associated with the ability of a drug to produce a high.  For this reason, very closely related drugs may or may not be addictive. For example, the mechanism of action between vicodin and heroin is the same, but heroin can act much more quickly in the brain and is addictive, whereas vicodin can only produce dependence.  Indeed, the only difference between morphine and heroin is the ability to get in the brain more quickly (indeed, heroin is converted to morphine once it gets in the brain), but heroin is MUCH more addictve. I would suggest you dig out a copy of a RECENT text on addiction… you will find the focus on drug-reinforcing properties and no interest in the ability to produce dependence…. Also the claim that people who are addicted to other drugs will become addicted to benzos is not based on any credible evidence. moreover, there is considerable evidence that there is a genetic propensity for addiction – that is, regardless of use, only certain people ar susceptible to addiction – even to the most addictive drugs. This is not well understood, but is easy to see even in animal studies. So it is misleading to even say that a drug will be habit-forming, even if it was likely to be a habit-forming drug in the susceptible individual. Back to  benzos they do not really have pronounced reinforcing properties… but they can produce a mild dependence, whose withdrawal consists of a more exaggerated anxiety than one would experience even if you never started taking them. So for this reason, they can be hard to get off of. But you won’t find anyone in a "benzo house’ who sold their family earnings, gave up their children, job, and home, and caught AIDS getting the drug — that is addiction… the kind of dependence benzos produce is similar to that produced by long term aspirin use (withdrawal = headaches) and less than that produced by nosedrops (withdrawal = severe congestion). Later, S (a pharmacologist)

Response:

this statement is a complete crock. how you can claim that a controlled substance is not addictive is amazingly negligent for a pharmacologist. i guess you agreed with the tobacco companies too when they use to claim nicotine was not addictive either? please…

You’re must be some kind of a genius. Substances are controlled for legal reasons, not because they have been scientifically proven to be addictive.  Marijuana, which is schedule 1 (no medical use), is not addictive (although it can produce mild dependence and there are a few examples of people who have become addicted, this is certainly not the norm). Nicotine, which is not scheduled, is definitely addictive. Your own statement makes it clear you understand there is no definite relationship between being controlled and addiction (or did you forget that nicotine is not controlled?).  The list of non-addictive substances that are controlled is quite long.  Many have good reasons for being controlled (e.g. LSD, I mean do you want LSD to be over the counter even though it isn’t addictive… the reason it is controlled tightly is because it is mind-alterting, somewhat dangerous, and has no valid medical use). Substances are controlled for various reasons, e.g., (1) abuse potential, which includes the propensity for addiction and dependence (2) no medical use, (3) dangerous, (4) historical reasons.  The Historical reasons, are generally the least scientific (these are the reasons marijuana and heroin are schedule 1=no medical use).   Now, you should also consider that drugs that are controlled here are not controlled in other countries, and those with no medical use may have medical use in other countries. That is the concept of drug abuse is cultural. for example, some codeine preparations are over the counter in Canada, even though US policy is that the drug has high abuse potential (it doesn’t, you will not find a codeine addict anywhere, and recent studies of chronic pain and cancer patients have shown they do not become addicted to it or go own to become addicted to other drugs).  And Heroin is widely medically used in other countries (in England especially) but its medical use is forbidden here. The problem is heroin fills a nice gap in potency between morphine and the MUCH more powerful (with much worse side effects) approved drug fentanyl.  For years, doctors with cancer patients have lobbied to be allowed to use heroin, but for historical reasons they are not allowed to. The historical reason is that heroin was perfectly legal for 30 years and many people became addicted to it, and in the course of a trade war with China over opium imports, the US Government outlawed it forever. So do not expect US drug laws to make sense.  To some extent, they make sense, in that they restrict dangerous substances. But most were written before drug abuse, dependence, and addiction were even understood conceptually. Even today, our understanding of what produces addiction is relatively poor. Unfortunately, the DEA talks (and Barry McAffrey) talks out of its ass as it it knows what addiction is and what produces it.  Indeed, the government seems to understand that its laws need major overhaul, but they will not be overhauled until there is a good understanding of addiction, which there isn’t. So why fix something broke with something else that will be broke.  However, the interference with doctors that the DEA has made is unreasonable and intolerable. Doctors are being held hostage to the remnants of the Reagan drug-war, even though they have nothing to do with the problem — doctors who prescribe, for example, pain medicine, or benzos, do not make addicts, and do not smuggle drugs in from Colombia, and have no reason to be being tracked by the DEA.  THis situation will not last forever, however, in particular, cancer and chronic pain doctors have become fervent in defending their right to take care of their patients without the interfernece of the DEA. Back to the original topic… Moreover, the fact is drug companies have worked hard to remove the properites of drugs that produce dependence and addiction, and by and large have succeeded.  if you understand the rational design that has been the development of benzos (and antidepressents) in fact this (and a reduction in overdose potential) has been one of the main focuses in improvement.  Sure, these drugs still produce some dependence, but not addiction. Later, S (I apologize for posting anonymously but I cannot stand getting endless spam)

Response:

But you won’t find anyone in a "benzo house’ who sold their family earnings, gave up their children, job, and home, and caught AIDS getting the drug — that is addiction..

That is an excellent point — Steve

Response:

this statement is a complete crock. how you can claim that a controlled substance is not addictive is amazingly negligent for a pharmacologist. i guess you agreed with the tobacco companies too when they use to claim nicotine was not addictive either? please…

Response:

this statement is a complete crock. how you can claim that a controlled substance is not addictive is amazingly negligent for a pharmacologist. i guess you agreed with the tobacco companies too when they use to claim nicotine was not addictive either? please…

The authorities often quoted here by the anti benzo clique, folk like noted Canadian addiction expert Dr. Ray Baker [1] and Prof of Psychopharmacology Dr Crystal Heather Ashton, who they claim is the world leading benzo expert and supposedly ran the worlds first benzo detox clinic, also make the distinction between benzos only causing dependence and not addiction. Unfortunately, these are facts they conveniently overlook when they regularly make their benzos are addictive claims here. Ian [1] Dr Baker, quoted by leading anti benzo campaigner David Woolfe: ::Physical dependence is simply a neurobiological phenomenon due to ::continued exposure to a drug. It happens to all human brains exposed ::to drugs such as benzodiazepines and opioids. It is not addiction.

Response:

Julima – Thanks for posting these. We need balanced information like this from time to time to dispell the myths about benzos. — Steve

Response:

Julima – Thanks for posting these. We need balanced information like this from time to time to dispell the myths about benzos. — Steve

Thank you Steve. THis is important to put up front again.!!!! Before you buy.

Response:

– Hide quoted text — Show quoted text – Addiction vs. Dependency: Benzodiazepines & Anxiety Disorders Xanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate. "Needing medication for many years — even over a lifetime — to function normally is not drug abuse or drug addiction but rather medical dependence." — William D. Kernodle, Panic Disorder: The Medical Point of View RESEARCH "In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines — How Common?" Archives of Family Medicine 4.11 (1995): 964-970). "Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170). "The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115). "With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990). The Definitions The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages. When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines. The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too. A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person’s body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician. People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence. The rest of the article is at http://panicdisorder.about.com/health/panicdisorder/library/weekly/aa031 997.htm Before you buy.

This article itself, and these definitions are also obsolete.  Noone in the field of addiction equates addiction with dependence (physical or otherwise) anymore.  Addiction is defined as a pathological overinvolvement with a drug characterised by compulsive drug-seeking and compulsive drug taking, even after withdrawal.  Dependence is DEFINED by the onset of a market WITHDRAWAL SYNDROME when the drug is terminated. Fortunately, dependence is easy to treat. You quit the drug and dependence goes away after withdrawal (maybe 2 weeks). Sadly, addiction does not go away — relapse rates for addictive drugs like cocaine are 75% a year after withdrawal is over — this is one of the strongest reasons to believe they are unrelated. Second, drugs that produce strong dependence are not necessarily the most addictive, that is, there is no strong relationship between the size of withdrawal and size of addiction.  Alcohol and barbiturates produce, by far, the strongest withdrawal and dependence but are only mildly addictive.  On the other hand, cocaine and amphetamine produce only mild withdrawal and dependence but are strongly addictive. Benzodiazepines are not (by any one who has any idea what they are talking about which usually does not include the prescribing doctor unless he is a psychiatrist) addictive. They do produce a MILD dependence and a MILD withdrawal which may make them somewhat habit forming.  The benzos were developed from the drug Miltown which produced a more significant dependence; it was developed from the barbiturates which produce a very strong dependence (again: no addiction).  That is, these drugs represent about 50 years of drug perfecting which has been aimed specifically at reducing this side effect. Historically, there is a lot of confusion about this issue because dependence, withdrawal, and addiction were believed to be the same thing for many decades… this is because the models were based on classical studies of the opiates heroin and morphine for which there is a good correspondence among the phenomena (morphine dependence was widespread after the civil war, and heroin addiction developed soon after Bayer introduced Heroin as a zero side effect version of morphine — it wasn’t).  However, stimulant addiction, which became prevalent in the 60’s has completely abolished this view of addiction, akthough it persists in the popular press and in medical training. The basic story boils down to whether addicts take drugs to avoid the unpleasant consequences of withdrawal (this is the negative reinforcement or dependence view) or for the feeling of a drug high (euphoria — the positive reinforcement view). The bulk of evidence now suggests that the addictive properties of drugs are associated with the ability of a drug to produce a high.  For this reason, very closely related drugs may or may not be addictive. For example, the mechanism of action between vicodin and heroin is the same, but heroin can act much more quickly in the brain and is addictive, whereas vicodin can only produce dependence.  Indeed, the only difference between morphine and heroin is the ability to get in the brain more quickly (indeed, heroin is converted to morphine once it gets in the brain), but heroin is MUCH more addictve. I would suggest you dig out a copy of a RECENT text on addiction… you will find the focus on drug-reinforcing properties and no interest in the ability to produce dependence…. Also the claim that people who are addicted to other drugs will become addicted to benzos is not based on any credible evidence.   moreover, there is considerable evidence that there is a genetic propensity for addiction – that is, regardless of use, only certain people ar susceptible to addiction – even to the most addictive drugs. This is not well understood, but is easy to see even in animal studies. So it is misleading to even say that a drug will be habit-forming, even if it was likely to be a habit-forming drug in the susceptible individual. Back to  benzos they do not really have pronounced reinforcing properties… but they can produce a mild dependence, whose withdrawal consists of a more exaggerated anxiety than one would experience even if you never started taking them. So for this reason, they can be hard to get off of. But you won’t find anyone in a "benzo house’ who sold their family earnings, gave up their children, job, and home, and caught AIDS getting the drug — that is addiction… the kind of dependence benzos produce is similar to that produced by long term aspirin use (withdrawal = headaches) and less than that produced by nosedrops (withdrawal = severe congestion). Later, S (a pharmacologist)

Response:

Addiction vs. Dependency: Benzodiazepines & Anxiety Disorders Xanax is one of several benzodiazepines. The alleged addictiveness of Xanax and other benzodiazepines is a hot topic among people with anxiety disorders and the professionals who treat us. The issue is often discussed on online support groups, sometimes resulting in heated debate. "Needing medication for many years — even over a lifetime — to function normally is not drug abuse or drug addiction but rather medical dependence." — William D. Kernodle, Panic Disorder: The Medical Point of View RESEARCH "In patients without histories of substance abuse, who are prescribed benzodiazepines under medical supervision . . . benzodiazepines almost never induce behavior that satisfies any reasonable definition of addiction" (Piper, Jr., A. "Addiction to Benzodiazepines — How Common?" Archives of Family Medicine 4.11 (1995): 964-970). "Long-term users of alprazolam/lorazepam . . . used a constant or decreasing dose of medication . . . Persistant use of alprazolam/lorazepam for therapeutic purposes did not represent abuse or addiction as the terms are usually understood" (Romach, M., et. al. "Clinical Aspects of Chronic Use of Alprazolam and Lorazepam." American Journal of Psychiatry 152.8 (1995): 1161-1170). "The vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs" (Woods, J.H. and G. Winger. "Current Benzodiazepine Issues." Psychopharmacology 118.2 (1995): 107-115). "With panic/agoraphobia patients there is no evidence of abuse. Chronic use is justified in these patients; risk must be weighed against benefit, dependence against relief . . . Potential abusers are those with personality disorders, dysphoria (mood disturbance) and current or previous substance abuse . . . there is no epidemic of misuse. Abuse seems to be limited to substance abusers . . . chronic use is justified in chronic anxiety patients. Chronic use does not usually lead to abuse" (American Psychiatric Association. Benzodiazepine Task Force on Use, Dependence, Toxicity and Abuse. May 1990). The Definitions The term addiction is often equated with abuse. Addiction is generally marked by tolerance and/or psychological dependence. With tolerance, a person needs to increase the dosage of a medication over time in order to receive the same therapeutic benefits. Studies show that the majority of people with anxiety disorders do not increase their benzodiazepine dosages over time; in fact, most lower their dosages. When we think of addiction we are often thinking of psychological dependence. With psychological dependence, a person continues to take a medication no matter what the consequences. The person will also seek out the medication no matter what the consequences. Again, as with tolerance, most studies show that people with anxiety disorders do not become psychologically dependent on benzodiazepines. The exceptions to the studies mentioned above are people who have a history of addiction to other drugs. People with such a history are possibly at risk for becoming addicted to benzodiazepines, too. A condition which does occur with long-term, regular use of benzodiazepines is physical dependence. After using benzodiazepines regularly for a few months (and the time varies for each individual), a person’s body will usually adapt to the drug. If the medication is stopped abruptly, the person will experience withdrawal symptoms. These symptoms may be lessened (or even eliminated) by slowly tapering off the medication, if one chooses to stop taking it. Benzodiazepines should be discontinued only with the supervision of a qualified physician. People who are on medication for an illness for a long time are not addicted to the medication; they are medically dependent on it. They need to keep taking the medication in order to keep the symptoms of the illness away. The majority of anxiety disorders patients who take benzodiazepines over the long term fall into the category of medical dependence. The rest of the article is at http://panicdisorder.about.com/health/panicdisorder/library/weekly/aa031 997.htm Before you buy.

Response: