Tolerance and dependence

There is a tolerance to benzodiazepines and cross-tolerance between them and other depressants. The speed of tolerance to benzodiazepine depends on the dosage. The emergence of withdrawal syndrome associated with the rejection of benzodiazepines, is rarely observed, because large doses are necessary for its appearance. When abstinence syndrome is still observed, it is similar to the symptoms in case of refusal from alcohol and barbiturates, but not so serious. Most benzodiazepines are long-acting drugs with a half-life of more than one day, and active metabolites are present in the blood even longer. Thus, withdrawal symptoms can appear after a few days and can last for about a month. The main symptoms are reciprocal insomnia, anxiety, tremors, increased salivation and even such serious consequences as the occurrence of convulsions. One of the problems in assessing withdrawal symptoms is the difference between the symptoms caused by the refusal of the drug and the symptoms for which the drug was used to suppress. For example, the extensive controversy over the drug Valium unfolds thanks to an autobiographical book and the film “I dance as fast as I can,” written by Barbara Gordon in 1979. Gordon was a successful professional dancer and maintained her condition on the advice of a doctor with very high doses of the drug. When she decided to refuse it, her doctor simply advised her to stop taking the drug, instead of helping her to refuse it. This, of course, was the wrong decision. Gordon clearly describes the symptoms of her refusal of the drug:
“… From early in the morning I began to feel an imminent sense of anxiety. But it was different from my usual fits of rage. I felt as if short bursts of electricity, like pins and knitting needles passing through my body. My breath was becoming frequent, and I was beginning to cover sweat … My scalp was starting to burn, as if there were burning hot coals under it. Then I started to experience ridiculous little twitches, spasms, my leg was twitching, my arm; soon a strong shiver turned into convulsions. “

She could not leave the house, much less work. Her relationship with her beloved man and her friends was disrupted. As a result, she went to the hospital for several months. However, her symptoms continue to this day. The novel is an exciting description of the disease of anxiety, although it contains a not quite typical description of withdrawal syndrome after taking a benzodiazepine like Valium. As noted, although there are persistent symptoms of refusal of the drug, it is rather difficult to distinguish the long-term symptoms caused by the rejection of the drug from the repetition of the previous symptoms of anxiety. The experience of Barbara Gordon can illustrate the case when the combination of symptoms manifested itself only when the drug that masked them was released from the body.

The possibility of abuse of benzodiazepines is much less than other depressants. Laboratory animals showed a positive attitude toward benzodiazepines, learning to press the lever to receive an injection promotion, but, as experiments have shown, benzodiazepines are an incentive of moderate strength and are less preferable than barbiturates. Studies have also been conducted on “self-assigning” (see Chapter 5) benzodiazepines among people who have experienced sedative abuse. In secret studies, scientists have shown that people will prefer benzodiazepines to a simple harmless tablet, but benzodiazepines, like in the case of animals, will give up to barbiturate preferences. When comparing different benzodiazepines, it turns out that preference is given to strong, fast-acting drugs, such as Valium, over less powerful compounds with a slower dissolution time, such as, for example, oxazepam.

Tolerance, dependence and abuse are also associated with benzodiazepines, but the problems they cause are usually easier than in other depressants. However, over time, new problems associated with the use of benzodiazepines emerge.

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