Benzodiazepines are widely prescribed, with four of them—alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan)—listed among the top 100 most commonly prescribed medications.2 Benzodiazepines generally produce almost immediate effects, and thus may be prescribed for short-term, intermittent, “as-needed” use.
Because of these concerns, it may not be in the best interest of patients who have both panic disorder and a current substance abuse problem to use the BZs for their anxiety. Studies indicate that between 35 and 45 percent of patients are able to withdraw from the BZs without difficulty. These are symptoms of withdrawal, rebound, and relapse, which can sometimes occur simultaneously. Physical dependence means that when a person stops taking a drug or reduces the dose quickly, he or she will experience symptoms of withdrawal.In such patients, alternatives to benzodiazepines may be preferable and may include antidepressants, anticonvulsants, buspirone, antihypertensive agents and the newer neuroleptic medications.Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse.Generics are available for many, which helps reduce cost. These may continue during the first few weeks, but tend to clear up, especially if you increase the dose gradually. Some people experience low moods, irritability or agitation.Rarely, a patient will experience disinhibition: they lose control of some of their impulses and do things they wouldn't ordinarily do, like increased arguing, driving the car recklessly or shoplifting. A patient taking a BZ should drink very little alcohol and should refrain from drinking within hours of driving a car. Although it is rare for a person with an anxiety disorder to abuse a benzodiazepine, patients with a history of substance abuse report a more euphoric effect from the BZs than do control subjects.