Benzodiazepine dependence

Meet the patient

A 71-year-old retired teacher has taken temazepam 20 mg every night since her husband died in 2014. She has never taken more than prescribed, never asked for an early script, and never thought of herself as having a drug problem.^[1][9]

She has fallen twice this year. Her daughter says she repeats herself. Her new GP has written "stop temazepam" on the discharge summary.^[9][10][11]

Both things are true at once: she is physiologically dependent, and she has done nothing wrong. Getting that sentence right is the whole topic — because the plan that follows it is completely different from the plan that follows "she is addicted".^[1][8][14]

Fellowship candidates must hold two truths simultaneously: short-term, indication-limited use can be legitimate and life-saving (severe acute anxiety, alcohol withdrawal protocols, procedural sedation), while chronic unsupervised use drives falls, cognitive harm, dependence and overdose synergy with other depressants.^[1][8][16]

References18ShowHide

1. [1]Soyka M. Treatment of Benzodiazepine Dependence N Engl J Med, 2017.PMID 28614686
2. [2]Brett J, Murnion B. Management of benzodiazepine misuse and dependence Aust Prescr, 2015.PMID 26648651
3. [3]Ashton H. The diagnosis and management of benzodiazepine dependence Curr Opin Psychiatry, 2005.PMID 16639148
4. [4]Voshaar RC, Couvée JE, van Balkom AJ, et al. Strategies for discontinuing long-term benzodiazepine use: meta-analysis Br J Psychiatry, 2006.PMID 16946355
5. [5]Darker CD, Sweeney BP, Barry JM, et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence Cochrane Database Syst Rev, 2015.PMID 26106751
6. [6]Baandrup L, Ebdrup BH, Rasmussen JØ, et al. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users Cochrane Database Syst Rev, 2018.PMID 29543325
7. [7]Lader M, Kyriacou A. Withdrawing Benzodiazepines in Patients With Anxiety Disorders Curr Psychiatry Rep, 2016.PMID 26733324
8. [8]Lader M. Benzodiazepine harm: how can it be reduced? Br J Clin Pharmacol, 2014.PMID 22882333
9. [9]Markota M, Rummans TA, Bostwick JM, et al. Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies Mayo Clin Proc, 2016.PMID 27814838
10. [10]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
11. [11]Barker MJ, Greenwood KM, Jackson M, et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis CNS Drugs, 2004.PMID 14731058
12. [12]Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline Can Fam Physician, 2018.PMID 29760253
13. [13]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
14. [14]Brunner E, Chen CA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits J Gen Intern Med, 2025.PMID 40526204
15. [15]Fluyau D, Revadigar N, Manobianco BE. Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation Ther Adv Psychopharmacol, 2018.PMID 29713452
16. [16]Guina J, Merrill B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives J Clin Med, 2018.PMID 29385731
17. [17]Billioti de Gage S, Bégaud B, Bazin F, et al. Benzodiazepine use and risk of dementia: prospective population based study BMJ, 2012.PMID 23045258
18. [18]Ashton H. Benzodiazepine withdrawal: an unfinished story Br Med J (Clin Res Ed), 1984.PMID 6143582