Phenomenology and Variations in
Presentations
Long-term use of benzodiazepines can result in
physical de-pendence in nondrug-dependent medical patients. Withdrawal symptoms
“or” return of symptoms suppressed by the benzodi-azepines may make
discontinuation difficult.
Some patients who are physically dependent on or
unable to discontinue a medication do not necessarily have a substance-use
disorder. Physical dependence results from neuroadaptive changes resulting from
long-term exposure to a medication. In-ability to discontinue the medication
may simply mean that pa-tients are unwilling to tolerate the severity of
postwithdrawal symptoms that develop. In the absence of medication-produced
dysfunction, the continuation of the medication may be an appro-priate choice.
Patients who do not have a substance-use disorder take medications in the
quantity prescribed. They follow their physicians’ recommendations, and they do
not mix them with drugs of abuse.
Abusers of alcohol and other drugs rarely present
for primary treatment of sedative–hypnotic dependency. From the drug-abusing
patient’s point of view, sedative–hypnotic use is an effort to self-medicate
anxiety or insomnia, which is often the result of alcohol or stimulant abuse.
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