Physical Dependence

Physical dependence is a phenomenon that can develop as early as a few days of regular benzodiazepine prescription. Physical dependence is the reason benzodiazepine withdrawal symptoms manifest. Estimates show that between 20-100% of prescribed long term (more than 2-4 week) benzodiazepine patients have difficulty stopping because of withdrawal symptoms. The presence of physical dependence does not indicate addiction. 

What Does Physical Dependence Mean?

Developing a physical or physiological dependence to benzodiazepines means that persistent change in GABA receptor conformation has occurred due to repeated prescribed dosing of benzodiazepines. More simply, the body now relies on a benzodiazepine to prevent withdrawal symptoms. Physical dependence is a normal and predictable outcome and one that should be expected after chronic exposure to many commonly prescribed tolerance-forming medications, not just benzodiazepines.

How is Physical Dependence Different Than Addiction?

It is common for people to conflate  physical dependence and addiction, believing they are synonymous. 

According to the FDA: 

Physical dependence is not synonymous with addiction; a patient may be physically dependent on a drug without having an addiction to the drug. Tolerance, physical dependence, and withdrawal are all expected biological phenomena that are the consequences of chronic treatment with certain drugs. These phenomena by themselves do not indicate a state of addiction. 

Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence.

This helps clarify that while sometimes with addiction physical dependence is present, the presence of physical dependence alone does not indicate an addiction.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

“Dependence” has been easily confused with the term “addiction” when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction.

Conflating addiction with physical dependence is very dangerous to prescribed benzodiazepine patients as the treatments for physical dependence and addiction are very different and conflicting. While patients experiencing addiction often require access to their drug of choice limited, prescribed physically dependent patients best chance of avoiding a lengthy protracted withdrawal syndrome requires reliable access to their prescription in order to safely taper over many months to years.

Further Reading: 

Addiction vs Physical Dependence 

Benzodiazepine Related Problems: It’s Almost Never Addiction

Dependence is Separate from Addiction

Words Can Hurt Those on Benzodiazepines 

Don’t Harm Them Twice: When the Language Surrounding Benzodiazepines Adds Insult to Injury (Part 1)