Originally Posted by LittleZion
It's because some benzos (Xanax) are addictive -- that's why psychiatrists (who know what they'rd doing) are hesitant to prescribe them, especially in someone who might get hooked.
There is some debate but here's a few (there are many more) journal reviews/articles that would likely not agree with the use of "addiction" wrt benzos in anxiety patients. This includes one review (see second abstract) representing the opinion of "a representative panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depressive disorders."
J Clin Psychiatry. 2005;66 Suppl 2:28-33.
Benzodiazepine use, abuse, and dependence.
Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication, may be controlled and ended through dose tapering, medication switching, and/or medication augmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.
The full article can be found at:
http://www.psychiatrist.com/supplenet/v ... 6s0205.pdf
J Clin Psychopharmacol. 1999 Dec;19(6 Suppl 2):23S-29S.
International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders.
Uhlenhuth EH, Balter MB, Ban TA, Yang K.
Despite decades of relevant basic and clinical research, active debate continues about the appropriate extent and duration of benzodiazepine use in the treatment of anxiety and related disorders. The primary basis of the controversy seems to be concern among clinicians, regulators, and the public about the dependence potential and the abuse liability of benzodiazepines. This article reports systematically elicited judgments on these issues by a representative panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depressive disorders, a panel which was constituted by a multistage process of peer nomination. The criterion for inclusion at each stage was the nomination by at least two peers as one of the "professionally most respected physicians of the world with extensive experience and knowledge in the pharmacotherapy of anxiety and depressive disorders." Sixty-six respondents (90%) completed a comprehensive questionnaire covering a wide range of topics relevant to the therapeutic use of benzodiazepines and other medications that might be used for the same purposes. Overall, the expert panel judged that benzodiazepines pose a higher risk of dependence and abuse than most potential substitutes but a lower risk than older sedatives and recognized drugs of abuse. There was little consensus about the relative risk of dependence and abuse among the benzodiazepines. Differences between benzodiazepines with shorter and longer half-lives in inducing withdrawal symptoms are much less clear during tapered than during abrupt discontinuation. There was little agreement about the most important factors contributing to withdrawal symptoms and failure to discontinue benzodiazepines. The pharmacologic properties of the medication may be the most important contributors to withdrawal symptoms. In contrast, the clinical characteristics of the patient may be the most important contributors to failure to discontinue medication. The experts' judgment seems to support the widespread use of benzodiazepines for the treatment of bona fide anxiety disorders, even over long periods. The experts generally viewed dependence and abuse liability as clinical issues amenable to appropriate management, as for other adverse events related to therapy. However, more definitive clinical research on the remaining controversial issues is urgently needed to promote optimal patient care.
J Psychiatr Res. 1990;24 Suppl 2:81-90.
A practical approach to benzodiazepine discontinuation.
Non-medical use of benzodiazepines is rare among patients with anxiety disorders. Numerous studies have found that non-medical use, or abuse, of benzodiazepines occurs usually among patients with histories of alcohol and drug abuse--those who use those drugs to get "high". This article distinguishes between medical and non-medical use of benzodiazepines in clinical practice, and offers practical approaches to discontinuation of benzodiazepine treatment for both medical and non-medical users of those medicines. The major barrier to clear thinking about the abuse of benzodiazepines is the confusion of "addiction" and "withdrawal". Addiction means high, unstable dosing outside medical and social boundaries for "recreational" purposes, loss of control over use, and continued use despite clear evidence of harm. Alcoholism and heroin addiction are typical examples of addiction (Kalant, 1989). In contrast, withdrawal is a pharmacological consequence of discontinuation of a substance on which a person has become dependent. Many drug-addicted people have only minor withdrawal symptoms when they stop drug use. Many medical patients, with no evidence of addiction, have withdrawal symptoms when they stop treatment, especially when they stop abruptly (e.g. surgical patients using narcotic analgesics and epileptics using benzodiazepines or barbiturates in their treatment). Addiction to benzodiazepines, in the sense of loss of control over use and continued despite harm, is virtually limited to people with pre-existing drug or alcohol abuse, while withdrawal symptoms after prolonged daily use are common among medical users of benzodiazepines. The serious nature of both drug abuse and anxiety disorders is not emphasized sufficiently during medical school or in the professional literature. The distress and disability from which both groups of patients and their families suffer is profound. Fortunately, both drug abuse and anxiety patients receive tremendous benefit from successful treatments, both pharmacological and nonpharmacological (DuPont, 1986a; DuPont, 1984). This article discusses the use of benzodiazepines in two distinct populations--drug abusers and patients with anxiety disorders--and helps clinicians distinguish between the use of benzodiazepines in the two groups. The central distinction made in this article is reflected in the common use of the words "drugs" and "medicines". The former term often denotes non-medical substance use, while the latter term refers to traditional pharmacotherapy.