Addictive behaviors and benzodiazepines: 1. Abuse liability and physical dependence.
A review of scientific and clinical evidence indicates: (1) benzodiazepines have an abuse liability and can cause physical dependence, (2) abuse liability is of a lower order of magnitude than that associated with common intoxicants such as barbiturates, opioids or stimulants, (3) sustained, exclusive use of benzodiazepines for inducing intoxication occurs but, it is infrequent, (4) benzodiazepines tend to be secondary drugs to a preferred primary intoxicant; in experimental paradigms normals prefer placebo to benzodiazepines, (5) susceptibility to physical dependence varies widely as low doses are sufficient to produce it in some but very high multiples are not sufficient to produce it in many others, (6) factors predisposing to physical dependence are: total lifetime dose, previous exposure to drugs cross-tolerant, such as alcohol or barbiturates, concomitant severe medical/psychiatric problems, and severe persisting stress. Individual susceptibility to abuse and to become dependent on benzodiazepines should be investigated much more vigorously than it has heretofore.