Psychiatry and Clinical Psychopharmacology

Substance abuse and dependence A case report of benzodiazepine dependence

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S112-S112
Read: 355 Published: 20 March 2021

Since their introduction in 1950s, benzodiazepines appear to be used for the treatment of anxiety disorders while it is recommended that they should not be prescribed as the first line treatment. The wide use of benzodiazepines could be explained, at least in part, by their good clinical efficacy in terms of reduction or control of anxiety-related symptoms and in terms of decreased risk of suicide because of their low toxicity. However, there is strong evidence suggesting that benzodiazepines could have a dependence potential, that chronic use is associated with adverse effects and that withdrawal might produce a definite abstinence syndrome. In this case we present a 33 year-old man, who admitted to the outpatient clinic because of clonazepam dependency. He had been working as a medical doctor and had used clonazepam for 9 years regularly (up to 4 mg per day). After recovering from Pott disease 12 years ago, he was recommended to use clonazepam for chronic back pain. Increased self-esteem, euphoria and lack of dizziness were the main motivators for the patient for continuous use. Although he was recommended to decrease the dosage, he did not quit or taper the drug. His maximum abstinence period was 10 days. Patient stated that he was using the drug to “improve his performance”. He reported taking clonazepam before important social and occupational activities. He believed that it was impossible to express himself or to talk to his supervisor without taking this medication. The former psychiatrist had planned a gradual tapering of clonazepam but the patient found that schedule difficult to continue. He was euthymic, expressed anxiety about doing his daily activities without clonazepam and risk of insomnia. He did not have any other substance abuse or dependency or other psychiatric disorders, and was followed and treated with a tapering protocol. The first step was to fix the dose of clonazepam at certain times, as decided by the patient (2 mg at morning and 2 mg at noon). With this step, increase of drug dosages to improve performance was prevented. Patient started to notice that social performance was better without taking an extra dose of clonazepam. After 2 months, clonazepam was tapered down gradually (0.25 mg per month). Anxiety to reduce the drug and distractibility were significant at the beginning, but decreased within a few months. Treatment of psychological dependency is important and must be the first target before tapering. In addition to this, low dose tapering and psychotherapeutic relationship based on empathy have a key role in treatment process.

EISSN 2475-0581