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

J. Doe

[Editor’s note: The author has chosen to remain anonymous because they are currently in the midst of psychiatric drug/benzo withdrawal and wish to wait until they’re healed before they make the decision about whether or not to emerge publicly with their real name.]

Language is important. And when language dictates specific treatment protocols, it should be used with extreme scrutiny. Using the wrong words can put vulnerable people at risk—not only to their sense of self-worth, their sense of self-knowledge, and they way they are treated, but also to their health.

The psychiatric profession and the pharmaceutical industry have a long history of romanticizing language. When the word “withdrawal” was thought to evoke negative feelings in relation to psychiatric drugs, psychiatry and pharma euphemistically substituted the term “discontinuation syndrome” to lower any apprehensions in patients about taking them (or perhaps they meant “discontinuation” in the global sense—as in “discontinue your life,” “discontinue functioning,” “discontinue brain use”). When Valium got a bad rap under the label “tranquilizer,” the term “anxiolytics” was introduced to describe a newer crop of benzodiazepine tranquilizers—Xanax, Ativan, Klonopin, etc—that were more potent but carried smaller dosage labels, deceiving patients into thinking that they were taking a minimal amount when they were actually taking a dose as much as 20 times more potent than an equivalent dose of Valium (1mg of clonazepam, or Klonopin, for example, is equivalent to approximately 20mg of diazepam, or Valium).

Anyone who has been made iatrogenically dependent on benzodiazepines without informed consent knows the feeling of deception by a formerly trusted practitioner, not to mention how devastating it is to discover that one cannot stop the drug without tapering very slowly, sometimes over years’ duration, to avoid suffering severe and disabling symptoms.

Add to that the experience of being labeled and treated as an “addict,” or as someone who has a “substance use disorder”—sometimes by the very people who did this to you—and the blow is even more bitter, while the outcomes can be dire. People who blindly follow an ignorant clinician’s advice and treat their benzodiazepine dependency like an addiction—by rapidly tapering or admitting themselves to a facility for detox—may find themselves in an incapacitating and even life-threatening situation that can persist for years.

Appealing for the proper use of terminology here—“dependence” instead of “addiction”—is in no way calling for addicts to be stigmatized or treated poorly or for people who are made iatrogenically dependent to be treated superior. Instead, it’s calling for a clear distinction between the two terms that is already made (if not always understood or followed) in most respected specialties of medicine, ensuring that individuals who have iatrogenic physical dependence are treated appropriately. In the case of benzodiazepine dependence, mistreatment—treating it the way one would treat an addiction—can result in potentially fatal seizures, psychosis, or suicide as well as years of infirmity due to protracted withdrawal syndromes. The stakes of using the appropriate terminology in this case couldn’t be higher: in medicine, diagnosis terminology defines protocol and treatment and therefore ultimately determines the outcome for the patient.


Frequently referred to as the DSM, or “psychiatry’s bible,” the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association provides criteria to be used by clinicians as they evaluate and diagnose various so-called mental health conditions. The current version, the DSM-5, includes a new chapter on “Substance-Related and Addictive Disorders” that focuses on “substance-use disorders” (SUDs) and “substance-induced disorders,” offering revised criteria for categorizing a variety of disorders and suggesting a range of severity within each diagnostic category.

Before exploring the current DSM-5 terminology, however, let’s go back and look at the previous edition, the DSM-IV, because the terminology used in that version continues to cause confusion. The DSM-IV divided substance-use disorders into two types: “substance abuse” and “substance dependence.” At a glance this terminology may seem appropriate—one might assume that “substance abuse” refers to the abuse of a drug and “substance dependence” refers to mere physical dependence (in medicine,“dependence” is typically used to describe the body’s adaptation to a consumed substance without necessarily implying abusive behavior). But that’s not what the terminology meant in the DSM-IV. In the DSM-IV, the label “substance abuse” was used to describe an earlier or less-severe form of addiction, while “substance dependence” was given to a more-severe manifestation of the disorder. Baffled yet? Many clinicians certainly were.

The editorial below from the American Journal of Psychiatry sheds some light on the DSM-IV’s choice of terminology. Apparently the committee for the DSM-IV had opted for the term “dependence” in place of the word “addiction” in part because “addiction” was thought by some to sound pejorative. The authors of this editorial, arguing for revised terminology, point out that the term “dependence” as used in the DSM-IV only served to confuse clinicians, with the result that patients suffered:

There was good agreement among [DSM-IV] committee members as to the definition of addiction, but there was disagreement as to the label that should be used. The proponents of the term “addiction” believed that this word would convey the appropriate meaning of the compulsive drug-taking condition and would distinguish it from “physical” dependence,” which is normal and can occur in anyone who takes medications that affect the CNS. Those who favored the term “dependence” felt that this was a more neutral term that could easily apply to all drugs, including alcohol and nicotine. The committee members argued that the word “addiction’” was a pejorative term that would add to the stigmatization of people with substance use disorders. A vote was taken at one of the last meetings of the committee, and the word “dependence” won over “addiction” by a single vote.



And so, it was decided to merge the DSM-IV’s terminology of “substance abuse” and “substance dependence” into one entity called “substance-use disorders” (SUD) in the DSM-5.

In outlining their revisions to the DSM-5, the American Psychiatric Association did issue a clarification acknowledging that addiction and physical dependence are not synonymous: “The diagnosis of dependence caused much confusion. Most people link dependence with ‘addiction’ when in fact dependence can be a normal body response to a substance.” But their clarification does little good if medical providers remain addled by the previous DSM-IV terminology and are unable to differentiate addiction/abuse from iatrogenic dependence. Such lingering confusion could lead to people being wrongly diagnosed and treated under the diagnosis of “substance abuse disorder” (SUD) when they are merely physically dependent. The reason this is inevitable is because there is no separate and distinct diagnosis for iatrogenic physical dependence alone.

The following image shows a comparison between the diagnostic criteria used in the DSM-IV and the DSM-5: (Image Source)


In practice, patients who present with tolerance and withdrawal only, even though they meet two of the symptom criteria above, are not meant to be diagnosed as having “SUD-Mild” if they are taking the drug under medical supervision.

Since there is no separate or distinct diagnosis for this condition, patients may still find themselves misdiagnosed with SUD (addiction) according to the DSM-5 criteria. For example, interdose withdrawal—withdrawal between doses due to a drug’s short half-life—might be mistaken for “craving.” And if you look at the criteria for therapeutic dose dependence in The Ashton Manual, many patients who are iatrogenically dependent could easily meet the “repeated attempts to quit” criterion if, say, their attempts to quit cold-turkey, or to taper too quickly, produce intolerable withdrawal symptoms. As for “using larger amounts,” many people prescribed a benzo end up having their dose increased over time by their prescriber due to tolerance, while “physical/psychological problems related to use” are seen with tolerance as well, even when a benzo is used only as a doctor prescribes.

So what should people who present with only tolerance and withdrawal (after taking a prescribed benzo) be diagnosed with, according to the DSM-5? Are there really no options for diagnosing iatrogenic benzodiazepine dependence that don’t include substance-use criteria? Take a look at the image below, which is a listing of all available DSM-5 diagnoses with corresponding ICD codes for sedative, hypnotic, anxiolytic use:

DSM5 diagnoses

Underlined in yellow are the substance-induced disorders, indicating a number of “disorders” that are not accompanied by a “use disorder” (that is, a substance-use disorder). These include withdrawal as well as intoxication and other substance/medication-induced “mental disorders” (e.g., sleep disorders, neurocognitive disorders, sexual dysfunction, anxiety disorder, or depressive disorder). Would any of those fit the bill?

Let’s think this through. Any psychopharmaceutical intervention with benzodiazepines that lasts more than the recommended two to four weeks, resulting in dependence, tolerance, withdrawal, or toxicity, seems to become a self-fulfilling prophecy. In other words, if people take benzos long-term as directed and go on to inevitably develop physical dependence, which then causes symptoms such as neurocognitive dysfunction or depression, they could wind up with a “substance-induced” disorder diagnosis on top of the diagnosis that led them to be prescribed a benzo to begin with. That means that even if a person’s initial diagnosis was a purely physical condition (such as muscle spasms), that person could still wind up with a “disorder” label (i.e., a substance-induced disorder) according to the DSM-5 criteria. So if people don’t have a “disorder” or psychiatric label prior to taking the drugs, they most certainly can after (despite physical dependence being an expected, normal physiological response). How convenient a trap for psychiatry to set.

If this all seems hopelessly convoluted, it’s because it is. The lack of clear terminology to describe iatrogenic dependence and withdrawal related to benzos can have outcomes that are devastating for the patient. There is no way around it: we need to start using unambiguous and universal terminology that is accepted by all medical specialties and make a distinction between physical dependence and addiction once and for all.

Exactly why is clear and universal language so important? Because the standard protocol and treatment for SUD/addiction/abuse can be devastating for someone with iatrogenic benzodiazepine dependence—a detoxification program, cold-turkey withdrawal, a rapid taper, and/or attendance at a 12-step program to address the behavior of addiction. We know from The Ashton Manual, written by Dr. Heather Ashton, the world’s leading expert on benzodiazepines, that it is crucial that withdrawal from benzodiazepines not be treated in the same way as addiction:

There is absolutely no doubt that anyone withdrawing from long-term benzodiazepines must reduce the dosage slowly. Abrupt or over-rapid withdrawal, especially from high dosage, can give rise to severe symptoms (convulsions, psychotic reactions, acute anxiety states) and may increase the risk of protracted withdrawal symptoms. Detoxification centres which also deal with alcohol and illegal drugs are not appropriate for prescribed benzodiazepine users. Such clinics tend to withdraw patients too rapidly, apply rigid rules and “contract” methods, and provide inadequate support or follow-up.

Similarly, a consensus statement released by The American Society of Addiction Medicine, The American Academy of Pain Medicine and the American Pain Society states: “When drugs that induce physical dependence are no longer needed, they should be carefully tapered while monitoring clinical symptoms to avoid withdrawal phenomena…Such tapering, or withdrawal, of medication should not be termed detoxification.”

Given that the DSM-5 doesn’t have a category for iatrogenic withdrawal syndrome related to benzos, it’s not surprising that it also doesn’t acknowledge the existence of protracted withdrawal syndrome—a severe form of withdrawal that can cause symptoms that continue as long as several years after a benzo is out of the body. But this lack is troubling, because enlightened medical experts (and many victims) feel that referring to this condition as “withdrawal” or “withdrawal syndrome” does not accurately describe the enormous long-term damage involved, nor does it suggest the extremely slow tapering protocol that is necessary for preventing it. It also fosters the misconception that withdrawal is the result of addiction, or that it should resolve over the course of weeks.

It is precisely this confusion that Dr. Stuart Shipko notes regarding the language used to describe a related syndrome resulting from the discontinuation of SSRIs. He writes:

Protracted withdrawal needs a better name.  The term “protracted withdrawal” does describe the time sequence of symptoms after stopping serotonin based antidepressants, but is a poor choice of language when discussing this with your doctor.  Medicine does not recognize such a thing as protracted withdrawal.  Withdrawal is considered something that goes away within days or weeks of stopping a drug.  If you are going to talk to your doctor about these sorts of problems, then it is best to describe the problem as symptoms that happened after stopping the drugs.  I realize that many physicians will declare these new symptoms the start of a new mental illness—usually bipolar—but calling it protracted withdrawal just confuses the doctor…I refer to protracted withdrawal as drug neurotoxicity.

It seems that a similar argument could—and should—be made for iatrogenic benzodiazepine cessation. Perhaps incorporating a new moniker such as “drug neurotoxicity” would help in the goal of making crucial distinctions and give this condition the universal platform that is so desperately needed.


An acquaintance who is iatrogenically dependent on the benzo Klonopin and is in the process of tapering recently shared the text below, included in a new leaflet attached to her prescription:


“Your healthcare provider can tell you more about the differences between physical dependence and drug addiction,” it states. Is that so? If you asked most people who have been iatrogenically dependent on a benzo, now or in the past, you would likely discover just how far behind the medical community is when it comes to discerning between the two. The fact is, if benzo dependence were diagnosed correctly and patients treated accordingly, there would not be any presenting cases of cold-turkey withdrawal. Yet, sadly, at alarming rates, rehabs and detox centers are essentially cold-turkeying unsuspecting people who are desperate to be free of these drugs and charging significant sums of money—only to send people home sick and indigent to face what may be years of suffering in protracted withdrawal syndromes.

As for those people who do not resort to rehab or detox centers, they are constantly scrambling and struggling to find medical providers who are understanding and educated or at least “benzo-cooperative” and willing to prescribe the drug in a way that allows for a slow, controlled taper (even if the providers know little about benzo withdrawal themselves). There is so little understanding in the medical community about iatrogenic benzo dependence that some patients simply cannot find a prescriber to work with them this way and end up having their prescription cut off by someone who (for whatever reason) feels they should get off the drug sooner.

So when people find themselves caught in this cobweb of iatrogenic benzodiazepine dependence it feels like this: The medical community renders you dependent on these drugs, most often without informed consent or fair warning about their potential for dependence and severe withdrawal. You take the prescription compliantly as directed by your medical provider. Then, once you experience tolerance symptoms or become dependent and are facing withdrawal, your medical provider either turns his or her back on you—in some cases treating you like a drug-seeking addict and refusing to provide the repeat prescriptions you need for a slow and controlled (by you) reduction plan—or else your provider has no clue how to manage benzodiazepine withdrawal at all.

Consider the first two steps in The Ashton Manual—the most respected guide on benzos—under “Before Starting Benzodiazepine Withdrawal”: 1. Consult your doctor or pharmacist and 2. Make sure you have adequate psychological support. Perhaps those initial two steps are more easily achieved in the U.K., where Dr. Ashton is based, but in the U.S., the first step can be impossible, for all the reasons given above, and the second is made extremely difficult when family, friends, doctors, therapists, and much of society considers you an addict or drug abuser and discriminates against you, treats you poorly, or makes statements like “you just need to stop using the drugs.” An overwhelming number of iatrogenically benzo-dependent people are shunned or abandoned by friends and family who might otherwise help and support them through withdrawal if they only understood that dependence is a result of negligence on the part of the medical profession and not a result of abusing the drugs.

A consensus statement released by The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine sought to define the terminology and recommended their definitions for use. The definitions presented in the consensus Statement are as follows:


Physical Dependence:


The consensus statement goes on to explain the reasoning for defining the terms:


Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction. Confusion…results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals.

In countries such as the U.K., where there is universal healthcare, uniform definitions and treatment protocols for benzodiazepine dependence are available for all specialities to reference and follow in the British National Formulary. Yet even in the U.K., many advocates still refer to the benzodiazepine epidemic using addiction terminology, albeit putting the word “involuntary” or “accidental” before “addiction” (which might imply that the person was rendered iatrogenically dependent and then, at some point, began abusing the drugs). In the U.S., where healthcare bodies and regulations operate with less coordination, there are even more inefficiencies when it comes to uniformity, contributing further to the problem.

The simple fact is that much confusion could be resolved if medical professionals would actually listen to what their patients are telling them, much in the same way Dr. Ashton was attentive to the patients she encountered in her clinic. As described by her in The Ashton Manual:

For twelve years (1982-1994) I ran a Benzodiazepine Withdrawal Clinic for people wanting to come off their tranquillisers and sleeping pills. Much of what I know about this subject was taught to me by those brave and long-suffering men and women. By listening to the histories of over 300 “patients” and by closely following their progress (week-by-week and sometimes day-by-day), I gradually learned what long-term benzodiazepine use and subsequent withdrawal entails. Most of the people attending the clinic had been taking benzodiazepines prescribed by their doctors for many years, sometimes over 20 years. They wished to stop because they did not feel well. They realized that the drugs, though effective when first prescribed, might now be actually making them feel ill…It is interesting that the patients themselves, and not the medical profession, were the first to realize that long-term use of benzodiazepines can cause problems.


To understand how ridiculous is it to lump individuals who’ve been made physically dependent on a substance with those who have substance abuse, addiction, or substance use disorder (SUD), consider that it is widely recognized in the medical literature that physical dependence can develop with the chronic use of many classes of medications. These include beta blockers, alpha-2 adrenergic agents, corticosteroids, proton pump inhibitors, antidepressants, and other drugs that are not associated with addictive disorders. One would be hard-pressed to find, say, a cardiologist who would prescribe a hypertensive patient long-term beta-blocker therapy, then diagnose that patient with “addiction” or “SUD” simply because the individual developed tolerance, dependence, and/or withdrawal symptoms when attempting to stop the drug. Equally preposterous would be the idea of sending that patient to a rehab or detox program to deal with his or her “beta blocker addiction,” only to be cold-turkeyed and sent home in a state of beta-blocker withdrawal, a syndrome of sympathetic overactivity that can include agitation, headache, sweating, and nausea as well as rapid upswings in blood pressure or exacerbation of cardiac disease.

Some clinicians (but not nearly enough) are now aware that antidepressants can also cause physical dependence and withdrawal syndromes when used as directed over a long term. In fact, SSRI withdrawal syndromes share many of the symptoms that are characteristic of benzodiazepine withdrawal. But here is where the need for accurate terminology comes glaringly into play.

Consider a case in point: one Danish meta-analysis asserts that antidepressants lead to addiction, but the study’s conclusion is met with serious reservations. Among those objecting is Lars Vedel Kessing, clinical professor and attending physician at the Psychiatric Centre Copenhagen, who argues that SSRIs are not addictive. “Before you can categorize something as addictive there has to be an onset of four fundamental symptoms,” he states:

  1. First, you lose control and the desire to take the drug becomes compulsive. In some sense you could say the drug takes control of you.
  2. Next is the onset of tolerance.The dosage must be increased all the time to get the desired effect and you keep taking more and more of the drug.
  3. Directly related to this is the third symptom; a strong urge to privately obtain more of the drug so it can be taken without the physician’s knowledge.
  4. Lastly, there will be a detrimental effect to the individual who will no longer be able to function socially or physically.

Kessing goes on to say: “Not a single one of these phenomena are present in SSRI discontinuation syndrome, but all four are present in treatments with benzodiazepines.”

Now, let’s go back to the Danish meta-analysis. If its authors had used proper terminology, indicating that both antidepressants and benzodiazepines cause physical dependence that leads to similar withdrawal syndromes, their claim would have been accurate. But because they argue that both classes of drugs are “addictive” and should be classified as such, Kessing makes a counterclaim that is only partially correct. Where Kessing is mistaken is in his final statement that “all four [symptoms] are present in treatments with benzodiazepines.” The fact is—and this distinction could not be more fundamental—all four symptoms are present only in people who abuse or are addicted to benzodiazepines and are not seen in those who are made iatrogenically dependent on the drugs in the same way that SSRI dependence occurs.

This point is made clear in a quote from Dr. Heather Ashton, based on a dozen years spent running a withdrawal clinic to help over three hundred individuals withdraw safely from the benzodiazepines they had been prescribed:

Benzo victims bravely work to return their nervous systems to acceptable function. They must continue to use decreasing dosages of the harmful drug until those nervous systems can run without the GABA agonist. This need is hard for victims to accept. They feel trapped because they must use a poison to safely come off of a poison. They suffer horribly as they work to repair the harm done by a formerly trusted MD. These victims certainly have no cravings or desire to use benzos. When you assume that what is true of addictive-drug patients is true of benzo victims, you have doubly harmed these victims.

Unfortunately, however, Kessing’s opinions are often shared by other misinformed clinicians, leaving people who are physically dependent on benzodiazepines to be thrown to the wolves and in dire need of support as they attempt to discontinue their prescribed drug safely in a slow taper. And while the withdrawal symptoms for benzodiazepines and antidepressants can be very similar, we do not generally see antidepressant-dependent patients being forced into rehab centers, labeled as “Prozac addicts” or “Effexor addicts,” or treated as if they were drug seekers or abusing their drugs. It is safe to say, too, that people who are dependent on SSRIs are unlikely to find themselves searching desperately for an “SSRI-cooperative” physician willing to prescribe them repeat prescriptions of, say, liquid Prozac in order to complete a slow, gradual taper off the drug. The same is sadly not true for vast numbers of people made iatrogenically dependent on benzodiazepines.

Perhaps one reason benzo-dependent individuals encounter so much resistance and misunderstanding from medical professionals, compared to those who are dependent on antidepressants or beta-blockers, is because benzos are classified as schedule IV controlled substances, while SSRIs and beta-blockers are not. A real paradox, then, lies in the fact that the DEA defines schedule IV drugs as “drugs with a low potential for abuse and low risk of dependence.” Anyone who has ever been rendered iatrogenically dependent on benzodiazepines, then tried to reduce their dose, may well respond to the phrase “low risk of dependence” with side-splitting laughter or a shiver of disgust. The fact is that benzodiazepines are so inherently dependence-causing (sometimes in as little as a few weeks) that, for those who experience it, the state of benzo dependency feels as though the drug has deeply penetrated the cytoplasm of one’s neurons and attached to the GABA receptors with the tenacity of a limpet.

Rather than comparing benzodiazepines to beta blockers and SSRIs, then, perhaps a more appropriate comparison would be to opiate narcotics, which are also classified as controlled substances (although, arguably, the withdrawal from benzos can be far more dangerous, painful, and long-lasting). Most (good) pain management specialists recognize that chronic use of opioid analgesics can result in tolerance, dependence, and withdrawal symptoms when discontinued. If, for example, a patient suffers from painful burns resulting from a fire and takes opiates over a long term as prescribed by a pain-management clinician, it would likely be understood that any development of tolerance, dependence, and/or withdrawal symptoms upon cessation of the drug would be an expected pharmacological response and not evidence of “addiction” or “abuse” or “SUD.” It would also be understood that the opiate needs to be tapered slowly after the burns heal and the pain subsides.

From a WebMD article on pain management: “Probably not a week goes by that I don’t hear from a doctor who wants me to see their patient because they think they’re addicted, but really they’re just physically dependent,” says Scott Fishman, MD, professor of anesthesiology and Chief of the Division of Pain Medicine at the University of California Davis School of Medicine. Notes Susan Weiss, PhD, Chief of the Science Policy Branch at the National Institute on Drug Abuse, in the same article: “Physical dependence, which can include tolerance and withdrawal, is different. It’s a part of addiction but it can happen without someone being addicted.” Weiss goes on to say that if people have withdrawal symptoms when they stop taking their pain medication, “it means that they need to be under a doctor’s care to stop taking the drugs, but not necessarily that they’re addicted.” Marvin Seppala, MD, Chief Medical Officer at the Hazelden Foundation, concurs: “The vast majority of people, when prescribed these medications, use them correctly without developing addiction.”

Every one of the quotes in the paragraph above can be applied to iatrogenic benzo dependency. So where are the medical professionals who are advocating for understanding, compassion, and proper care of the patients to whom they themselves have prescribed these drugs?


When it comes to benzodiazepines, confusion and misunderstanding around terminology, definitions, and classifications is not just a matter of semantics—it has very real implications for human beings whose quality of life is at stake, and who—if their providers get it wrong—face the possibility of years of inhumane suffering in protracted withdrawal syndromes. The medical community cannot have it all ways: they need to get on the same page. Yet in the more than 50 years since benzodiazepines were first introduced, this has yet to occur, and as a result, people who find themselves (through no fault of their own) iatrogenically dependent on benzos are met with one of the following responses, depending on how enlightened their provider may be:

  1. Patients are told that the drugs are “safe,” “non-habit forming,” or “not addictive” and “don’t cause withdrawal” and that “the symptoms are all in your head” or “from something else,” as benzos are an “effective treatment.”
  2. Patients are refused a renewed prescription for the benzo, despite being already iatrogenically dependent on it, based on the logic that the drugs are “addictive” or “cause dependence” or “are dangerous.” Of course, this is the very information that should be provided as part of informed consent prior to ever prescribing the drugs—and is a moot point once a patient is already physically dependent and needs a continual supply in order to taper.
  3. As soon as patients experience withdrawal symptoms upon trying to stop, or from making too large a reduction in dose (usually out of ignorance of their iatrogenic dependence and the need for a slow taper), they are told that their symptoms are evidence of “the return of the underlying condition”—i.e., “mental illness”—and demonstrate the ongoing “need” for the drugs. Of course, this reasoning makes little sense in light of the fact that many people are prescribed benzos for non-psychiatric medical conditions—everything from restless leg syndrome to Lyme disease to facial tics to insomnia—and experience the same withdrawal symptoms (some of which mimic psychiatric disorders) as everyone else.
  4. Patients are told just the opposite—that their withdrawal symptoms are “evidence of addiction” and that they should stop the drugs right away without tapering, or through a too-rapid taper in a detox facility, leaving them in a state of protracted withdrawal that potentially lasts for years.
  5. Patients are extremely lucky (and one of the rare few) to encounter a “benzo wise” or “benzo cooperative” practitioner who recognizes and diagnoses iatrogenic dependence and agrees to prescribe the benzo for a slow, controlled (by the patient) taper in order to discontinue safely. (Finding a practitioner who realizes just how slowly some benzo tapers need to be in order to avoid severe withdrawal symptoms would be like finding the Holy Grail.)

I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail. But this matters, profoundly, when you are the nail. Being mislabeled as an “addict” when you are not can potentially lead to serious consequences, such as the loss of a license or professional career. Being told that one’s withdrawal symptoms are a sign of a “resurfacing” mental disorder (when they are not) can be equally damaging. And which is it, anyway? Are people who’ve been prescribed benzos (for whatever reason) addicts who need to get off the drug immediately, or are they mental patients who need to stay on the drug for life? Depending on whom you ask, you’re likely to get a multitude of answers—and there lies the problem. There is no consistency among the medical community, and the people who suffer from this lack of clarity are the patients.

The ultimate goal, of course, would be for medical providers to adhere to the recommended 2-4 week (including tapering) prescribing guidelines for benzodiazepines and prevent the problem of benzodiazepine dependence and withdrawal from ever happening. But until that comes to pass, and while countless people have been made dependent and left to navigate the symptoms of tolerance and withdrawal on their own, something fundamental must change. To those who insist on labeling people: at least learn the terminology and apply it correctly, so that people stop suffering at the hands of ignorance. We need to make sure that the uniform definitions of terms such as addiction, dependence, and tolerance are accepted and used by clinicians, regulators, and the public both nationally and internationally, to ensure the appropriate treatment of iatrogenic benzodiazepine dependence throughout the world.

We all know that medical professionals take an oath to do no harm. But in the case of iatrogenic benzodiazepine dependence, patients are harmed, first when prescribers abuse the drugs themselves by prescribing them for longer than their own regulations recommend, without informed consent from the patient about the potential for dependence, tolerance, and horrific withdrawal syndromes with longer use. And patients are harmed twice when the medical profession fails—or refuses—to recognize tolerance, interdose withdrawal, and physical dependence for what they are, but insists instead on misdiagnosing and mistreating these phenomena as “addiction” or the recurrence of “underlying mental illness” when their patients make a good faith effort to stop taking the drug.

Part II of “Don’t Harm Them Twice,” which focuses on suggestions for how to appropriate accurate terminology, will appear in a future edition of Mad in America.

* * * * *

Special thanks to TK, phenomenal editor and benzo comrade, for your time and editing skills on this piece. My cognitively-impaired “benzo brain” could not have brought it to fruition without you. Thanks also to LD, SS, JF, AN, and LM for your input, continual encouragement, and unwavering support.

* * * * *


“4.1 Hypnotics and Anxiolytics : British National Formulary.” 1 Nov. 2013. Web. 4 Sept. 2015. <>.

Ashton, C H. “Benzodiazepines: How They Work & How to Withdraw.” 2002. Web. 4 Sept. 2015.

Ashton, C Heather. “History of  Benzodiazepines: What the Textbooks May Not Tell You.” Psychiatric Medication Awareness Group. 12 Oct. 2005. Web. 4 Sept. 2015.

Dawson, George. “DSM-IV to DSM-5 Addiction Graphic.” Real Psychiatry Technical Blog. 17 Sept. 2013. Web. 4 Sept. 2015.

“Definitions Related to the Use of  Opioids for the Treatment of Pain: Consensus Statement of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.” American Society of Addiction Medicine. 2001. Web. 4 Sept. 2015.

“Drug Scheduling.” United States Drug Enforcement Administration. Web. 4 Sept. 2015. <>.

Haslam, Barry. “My Successful Campaign for Dedicated Benzo Withdrawal Services – Mad In America.” Mad In America. 15 Aug. 2015. Web. 4 Sept. 2015.

“Highlights of Changes from DSM-IV-TR to DSM-5.” American Psychiatric Association DSM-5 Development. American Psychiatric Publishing, 2013. Web. 4 Sept. 2015.

Hitti, Miranda. “Prescription Painkiller Addiction: 7 Myths.” WebMD. WebMD, 10 Aug. 2011. Web. 4 Sept. 2015.

“Physical Dependence.” Wikipedia. Wikimedia Foundation. Web. 4 Sept. 2015.

Secher, Kristian. “Scientist: Antidepressants Cause Addiction.” 10 May 2013. Web. 4 Sept. 2015.

Shipko, Stuart. “Shooting the Odds, Part III.” Mad In America. 1 Sept. 2015. Web. 4 Sept. 2015.

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J. Doe
The author has a BS in Biology/Health Science and went on to complete a professional post-graduate master's program and certification. While starting their career, a colleague prescribed Xanax for “work stress," which when taken as-directed caused tolerance and interdose withdrawal within a couple months' time. This was their unfortunate introduction to psychiatry, where the Xanax iatrogenesis resulted in multiple “mental illness” misdiagnoses and subsequent psychopharmaceutical polydrugging with six drugs (three of them benzos/Z-drugs) over the next five years. Rendered non-functional from the poly-drugging, they then suffered a barbaric and medically negligent cold-turkey in a detox center. They have been free from all psychiatric drugs for three years, yet still enduring drug neurotoxicity (protracted withdrawal) that doesn't yet allow for employment. While healing, the author enjoys cooking, advocacy work and serving in a withdrawal group offering support to others in their efforts to be free from psychiatric drugs.


  1. Thanks for this article. You have obviously thought carefully for a long time about these issues and amassed a lot of knowledge about benzos and the mental health care systems that manage their use.

    At the time that I took Klonopin several years ago, during a period of overwhelming anxiety and terror, I was fortunately aware of its dangerously addictive potential. For that reason I forced myself to stop taking it after only a few months of relatively low doses. It was hell (the fear, not tapering off; I never got strongly attached to Klonopin) and it could have been easier in the short term if I’d taken higher doses and stayed on the drug. But I’m so glad I did not do that. I really benefitted from accurate information about the addictive potential of these drugs early on, something many people don’t get until it is too late and they are already strongly bound to the drug biologically and psychologically.

  2. JD

    As someone who has worked with people with addictions for over 24 years and has written about and discussed benzodiazepines many times on the MIA blog, I found this article to be very informative and challenging. I certainly have been guilty at times of confusing or misusing the terms ” addiction” with “iatrogenic dependence” when discussing benzos and other prescribed drugs. This blog helps me clearly understand the scientific AND political importance of using these terms correctly; I will try to do better in the future.

    One area where these concepts can become blurred and increasingly confusing is when people prescribed benzodiazepines for the long term are also using other sedative hypnotics such as alcohol and/or other drugs classified as opiates. Now we have exponentially greater risk for a “perfect storm” of dependence or (in some cases) addiction that can often lead to death because of cardiac and lung suppression.

    Because of the high number of benzo prescriptions in the U.S. (94 million in 2013) many of these drugs end up in the street and in the hands of people with major addictions, especially with opiates. This becomes a highly sought after drug cocktail due to the synergistic expansion of the “high.”

    Currently 60% or more of opiate addicted people came to this state of being through negligent prescribing by doctors leading to iatrogenic dependence. This dependence can quickly evolve into full blown addiction and remains one of the primary causes of the opiate epidemic raging in this country, and in other developed countries throughout the world. Perhaps we need to label this as “addiction caused by iatrogenic (or medically induced) dependence.”

    We cannot repeat often enough the statistic that at least 30% of all fatalities in opiate overdoses (that are rapidly growing in numbers) involve the use of benzos – benzos are more often the decisive and fatal component in these drug cocktails (see my recent MIA blog titled “Benzodiazepines: Psychiatry’s Weakest Link.”

    JD thanks again for this blog, the benzodiazepine crisis and the complicit role of Psychiatry and Big Pharma in this oppressive tragedy needs more exposure, education, and activism. Your blogs will play an important role in this process.


  3. .

    I didn’t know what addiction was when I started benzodiazepines.

    I thought addiction was falling in love with the effects so bad that you just want to keep taking it no matter what.

    I started the Xanax 1mg, nice feeling but not the greatest thing ever but it did help with going to bed ‘on time’ like other people did and I never could.

    Then I am given clonopin , didn’t help with sleep as well and the feeling was not as nice but I kept taking it.

    I had no idea that addiction or dependence or what ever you want to call it was because of how BAD you feel when you try and stop taking it, I always wrongly believed people became addicted because a drug made them feel so good they fall in love with the effects and wanted more good effects.

    I ended up in rehab and like the article points out ALL the blame was put on my because “I am an addict” and everyone else takes no blame at all.

    The package did say addictive or habit forming or something like that but again I thought that meant loving the effects and I knew nothing about the part where you get anxiety and withdrawals from hell if you try and quit.

    They need to redo that warning label so it describes what actually happens in regular words people can understand.

    Warning: This drug makes anxiety kind of go away and feels nice but if you take it for a wile and then try and quit you have panic attacks, a scary loss of reality feeling like a trip to hell you cant even imagine and the only way out is to take more of the drug to make that stuff go away.

    That’s an honest warning.

    And PS of course they called my withdrawals “mania” and gave me the bipolar label and all that goes with that.

  4. JD

    Thanks for your responses.

    On the issue of “informed consent,” many psychiatrists and doctors perform a version of so-called informed consent by telling you the dangers (or having you sign a document indicating you were informed/warned) but then go right ahead and negligently prescribe the drugs beyond 2-4 weeks. They do this either out of ignorance or nefariously knowing they will have a patient “forever.”

    Benzos are so damned effective in the short term and the doctors know this. This appeals to the worst of their “Dr. Feelgood” persona. Of course, the patient/victim in these circumstances is usually in a state of desperation due to current problems/stressors and related conflicts with their environment. It is the overriding responsibility of the doctor in these situations to redirect the patient to other avenues and resources to solve their problems with anxiety or insomnia.

    “Do no harm” is suppose to be their guiding mantra in giving medical care to people. Just as with antibiotics, doctors need to set safe boundaries and know when and how to say “No.” They are failing massively in this area of medicine and Big Pharma deserves more than half the blame.

    The negligence and harm done with benzos in today’s world, when looked at from the broadest perspective (numbers harmed and damage done), may represent one of Psychiatry’s greatest crimes against humanity. We must expose these crimes and provide much needed help to all the victims/survivors. I still believe it should be the number one focus of our organizing efforts against psychiatric abuse at this time.


  5. This is amazing, J. Doe. Thank you so much!

    I have experienced both addictions (to alcohol and cigarettes) and iatrogenic dependence (to benzos and SSRIs), and to me they were clearly different phenomena. Both horrible, but different – exactly as you describe. (Not sure I believe that addiction is a disease, but that may be a minor disagreement here.)

    I think this article should be mandatory reading for anyone with a prescription pad, and I can personally vouch for all the points made herein. I’ve been lied to about drug safety over and over by many doctors, have been prescribed benzos for over a decade, have been treated like I was “drug-seeking” when only taking them as directed, have been given dangerous advice about tapering/discontinuation by multiple doctors, have been treated by multiple doctors as if withdrawal symptoms were evidence of returning or emerging psychiatric “disorders,” and have had my experience of protracted withdrawal (I agree that drug neurotoxicity is a more fitting term) flat-out denied over and over by multiple doctors at the time when I needed their help most.

  6. What elegant research! Congratulations on taking control of your healing. I did my taper from benzos (and others) before I ever heard of ‘iatrogenic illness,’ which, when I did become privy to it, I realized that this is what had occurred, that the medical treatment had actually made me ill. It was rough, especially since at that time, I knew of no one else in the world who had released all medication after a long period of using them (for me, it was 20 years before I got rid of them). But I did recover fully in time and found my grounding and health once again, as I know people can, with the kind of focus and diligence you are exemplifying.

    Very best wishes on your remarkable jouney. No doubt you will continue to help a lot of people by sharing so openly.

  7. J. Doe

    This is by far the best article I have ever read about benzo’s.

    It’s very obvious that you have been through w/d yourself.

    I’m in my 13th year of fighting these drugs. I’ve been hauled off by ambulance twice due to w/d and have been driven to the ER so many times that I have lost count. Every time the hospital treated me as an “addict” and booted me out of the ER. I hope this article spreads far and wide. This country has a problem that needs to be addressed and not addressed by big pharma. Somehow, some way, the people who have lived this need to be heard. With this article you have taken the first step to make that happen. Job well done!!!!!!

  8. A topic near and dear to my heart. Thanks for this…really excellent. I am a fellow sufferer. I tapered Klonopin, and also an SSRI. Despite the tapering they have managed to still obliterate five years of my life, although I have managed to hang on to my job, marriage, and family. I was never told what the drugs might do to me. I feel misled extremely and harmed by Western medicine and psychiatry.

    I agree that the terminology matters a great deal and am shocked that the medical negligence of detox centers, who’s business it is to know this subject, continues unabated. No one in medicine seems to know or care enough to put a stop to the atrocities going on there.

    I also agree the term “addiction” is not at all appropriate – it implies drug-seeking behavior. And I think “dependency” or even “physical dependency,” although much closer to the target, do not fully capture it, as I think you alluded to. To me “dependency” still connotes withdrawal and is too close to “addiction.” This is not what’s going on with psych drugs.

    What happens with psych drugs is a physical rearrangement of the receptor systems (new receptors are created or old ones abolished, neurotransmitter levels are increased or decreased, the way receptors systems interact and influence is altered) as the CNS tries as best it can to adapt and function homeostatically in the presence of the drug. To me this is much closer to – and maybe actually is best called – neurological damage (hopefully reversible) as it cannot be reversed over a short time span like other drug withdrawal effects, and remains long after the drug is gone – often years after. The tapering process is truly a physical damage healing process where the CNS has time to slowly reverse the damage done by the drug.

    I’d like to move away from the terms “addiction,” “dependency,” and “withdrawal” completely and really get to the root of what is happening by describing and depicting it for what it really is. The terms “addiction,” “dependency,” and “withdrawal” are borrowed simply because we don’t know what else to call it.

    Thanks for bringing this subject to light and doing a fantastic job with the extensive research.

  9. As a person who has lived experience of long-term addiction to and abstinence from psychiatric drugs, I can say with confidence that you are truly a survivor of psychiatry. In 1999, psychiatry sold me on their drugs and for three years straight, they turned my body into a chemical waste heap. Starting in 2002, I began a five year process of quitting all psychiatric medications. Before I got to the one-year-clean (yes, my body was, literally, filthy with these poisonous drugs) milestone, I had nine relapses which either preceded or followed inpatient psychiatric hospitalizations. All of my attempts at breaking my addiction to these drugs were started, failed, and completed without any medical assistance. I knew that no clinician would help me stop these drugs and that I could be petitioned for court-ordered treatment if anyone knew about my “medication noncompliance”. This was the hardest time of my life and it was all the fault of psychiatry, yet no psychiatric clinician ever tried to help fix or compensate me for the problems their “profession” was putting me through. To endure this and then relive it in detail on the Internet is beyond brave. I am in awe of your indomitable self-worth and your genuine concern for the health and safety of Mad people.

    • Hi J–

      Congratulations on freeing yourself from psychiatric drugs, without any help from the psychiatric profession (a reality that is more common that not). You don’t say whether any of the drugs you were taking was a benzodiazepine.

      I can’t help but notice that you use “addiction language” to talk about your experience with psych meds and the process of getting off them. This is confusing to me, as the whole point of the article you are commenting on is that using words like “addiction” in relation to doctor-prescribed benzos is problematic and perpetuates harmful perceptions and practices. As JD makes clear, calling an iatrogenic dependency on benzos an “addiction” has the very real potential of leading not only to misjudgments (i.e., making assumptions that benzo dependency is in the same category as true addiction) and mistreatment (such as detox or too-rapid tapering) that can have dire and even fatal consequences.

      I salute you in being able to get off psych meds on your own. But for many people who have been made dependent on benzos and need to rely on continuing scripts in order to endure the long and painful process of withdrawing from the drugs, the stubborn misunderstanding of and outright dismissal by the medical community (and much of society) has made the syndrome of withdrawal and neurotoxicity far worse than it is already. Changing language is a step toward changing protocols and potentially toward changing minds. As JD’s article argues for in such depth, I’m hoping we can start using appropriate terminology here–especially those of us who have already been so harmed by these insidious drugs.

  10. Dear J Doe, you write “words can put vulnerable people at risk—not only to their sense of self-worth, their sense of self-knowledge.” A word formulation I agree with, although from the perspective that the words we use for social communication, is not the reality of our motivation. In fact, since acquiring the kind of knowledge which explains a hidden motivation beneath my skin, I’ve embraced R.D. Laing’s intuitive understanding of the paradox of modernity, in his comment: we are all in a posthypnotic trance induced in early infancy.

    Embraced the false-self illusion, that I knew myself, simply because I could speak, read and write, words. Dissolved my normally adjusted ego sense-of-self, by making the words of recent neuroscience discovery, flesh. Which has allowed me to remain medication free, for eight years now. A making words flesh, journey of experiential self-exploration, which has brought me a visceral sense of Jaak Panksepp’s comment: we are all brothers and sisters under the skin. By of how our nervous systems mediate the internal relationships of our body’s major organs, and create our mind’s, subjective experience.

    An under the skin sense of reality, that can bring an embodied sense of limits of language and self-interested survival, to: A WAR OF WORDS: THE DSM AND DEPENDENCE, and the egoic war of words involved in posts and comments here on MIA. A language based delusion about human motivation, which sees the curious paradox of normal self-interested function, which ignores well formulated essays like this one.

    While Laing explained the self-interested illusions of his own profession by drawing attention to human behaviour and how we avoid examining our own, with a language of self-deception: I see you, and you see me. I experience you, and you experience me. I see your behaviour. You see my behaviour. But I do not and never have and never will see your experience of me. Just as you cannot “see” my experience of you. And Allen Frances sums up psychiatry’s behavioural dilemma with: psychiatric diagnoses is seeing something which exists, but with an expectation of what we see.

    A post hypnotic trance addiction to words, which Alexander Johnson sums up with: the delusion is extraordinary by which we exalt language above nature. The hidden nature,of our nervous system motivation, in my experience.

    You mention the words informed consent and I wonder how you feel about the informed consent around the dangers of smoking, and the paradox of normal behaviour, which ignores both written words and graphic visual images of smoking related disease?

    I wish you joy, in your journey towards non medicated self-regulation.

  11. Antidepressants lead to addiction. Why they keep ignoring this is beyond rational common sense. I have all four symptoms of addiction from SSRIs………. Most poeple trying to get off them, yes lie to doctors (if they didnt the doctors will CT them, and that is a big fear, or else demand they take more drugs, and yes, doctors have the power……)………..
    Yes, you end up taking more and more, until you realise how these drugs are horribly addictive, and destroying your life,
    Yes you end up without a life, just like all the “”illegal drug addicts” end up on disability or suicide.
    they destroy your real personality, just like all the illegal drugs do.
    But hey, they are cheap, these drug dealers all backed by governments, and on the PBS schemes, gosh the drugs are cheap. Great con from Legal drug pushers………. Yes so angry, lied to, life destroyed…………..

  12. It was a Ritalin transdermal called Daytrana that threw me into psychosis and cost me the things that mattered, but along the way I had an instructive bout with Ativan. It had been prescribed by the same man who prescribed the Ritalin, and when I expressed misgivings about becoming dependent on it, that MD said “So what? Just take it for the rest of your life.” It was only a few weeks in that I found myself on the way to dinner to meet a man from OkCupid, who’d said lateness was a pet peeve, and realized my planned stop-off at the pharmacy to replace my empty Ativan bottle with a full one would make me late for dinner. It was only meant as a friendly dinner, not a romantic one, but I still felt it best to arrive on time. Before our food was served I began to feel weak, tired, desperate, and very much in need of lying down. He was prattling on about some horrific woman he couldn’t get over, and I was trying to decide between calling paramedics, lying on the floor near my chair, or possibly making it to the restroom and lying on the floor there. I am thankful that I remembered a third or a quarter of an Ativan tablet that I had put in with the oral Ritalin I had in my purse. I took it and felt absolutely normal within 15 minutes. Another blessing is that I felt fine in the morning and that was the end of it.

    I did become fully unhinged by the Daytrana which initially was pleasant and fascinating to the point of magical, but which decayed into hostility, paranoia, seizures, inability to read without rapidly losing consciousness, loss of boyfriend/presumed best friend, and loss (as a victim of forgery and fraud) of long-held investments and thus my retirement income.

    Yes, the packet warns of psychosis, but what on earth good is a warning you read three weeks ago when you are talking to angels, hallucinating demons, and dancing with what you think is the shadow of your skeleton? The same holds for warnings about benzos. They cannot prevent a condition with a silent, insidious onset. Warnings about catastrophe serve only to keep plaintiffs from prevailing in court. The catastrophes roll on.

    The doctor? Up against the medical board, owing $100,000 in back taxes, and with luck, not going to practice in the future. If only they’d taken his license the first time he was brought before them instead of allowing him a period of probation. The state he started his career in did. They caught wind of his first California probation and sent a letter saying he’d never practice in New York again.

  13. Hi J.Doe,

    A really excellent article and I look forward to reading Part 2.

    Can I wish you all the very best on your way to recovery. I am in my 30th year after withdrawing myself in 1986 of 30 mgs of Ativan and 12 Opiate pain killers, both drugs prescribed on a daily basis by my ignorant doctors.

    Life does get better albeit slowly in my case BUT the best thing I have ever done in life was to beat this combined addiction and to return to my wife and daughters.

    Plus, it has given me 30 years of campaigning on the issue of iatrogenic drug addiction and to meet many wonderful, brave people.


    • Hi Barry– Hats off to you for succeeding in withdrawing from high doses of benzos (and opiates) on your own. It sounds as though your life has significantly improved, albeit slowly, in the years since.

      One thing that continues to confuse me about the comments I’m reading, however, is that many people are not acknowledging (never mind honoring) the author’s main point: that using “addiction” language in relation to iatrogenic benzo dependency is harmful. Instead, they seem to ignore the point and perpetuate that very language by using it in their comments. As JD describes in such depth above, referring to iatrogenic benzo use / tolerance / dependency / withdrawal in “addiction” terms only serves to feed misperceptions and mistreatment–and those who have an iatrogenic physical dependency on these drugs continue to suffer the consequences.

  14. Hi Brighid,

    I was told by a UK government health minister and a politician that long term prescribed benzodiazepine drug addicts where ” misusers and abusers”. A deliberate attack on innocent patients by government officials and their senior advisors, to not only muddy the waters but to deflect criticism of their total lack of responsibility and accountability and to deny them dedicated withdrawal services for iatrogenic drug addiction.

    It is governments, doctors and the pharmaceutical industry that has abused and misused patients and world citizens of their human rights.


  15. Hi J.Doe,

    Thank you for your kind words and I really appreciate them.

    In my particular case when I was first prescribed 10 mgs daily of Ativan by my doctors in 1980 after a while the affects of this dosage on me, confused the doctors into thinking that my original breakdown symptoms had returned, so they then increased it to 20 mgs daily. Again this confused them even further so by 1985 I was being prescribed 30 mgs of Ativan daily and when my wife asked the prescribers about the very high dosage, they replied ” Barry, cannot over dose on these drugs.”
    She then asked could we possibly be put in touch with someone else in the Practice on a similar dose ( at the time we obviously where in complete ignorance on the dangers of these drugs ) we then received a letter from the Practice referring us to their Lawyers. You could not make this up. All I ever did was to follow the instructions given to me by the doctors and took the drugs in good faith as to their clinical decision making.

    I do realise that the term ” addict ” does upset many patients taking benzodiazepines who do not see themselves as addicts in the illegal sense of being an addict.

    Within the House of Commons a All Party Political Group on Prescribed Drug Dependence has its 2nd meeting on the 24th of this month with a view to formulate a policy to present to the British Medical Association on this very issue, accompanied by several charities, in order to lobby the British Government to take appropriate action and to prepare a template to be used for a safe withdrawal procedure, so that everyone can be singing from the same hymn sheet in the UK. If you kindly want to email me I can let you have further details after the 24th.

    I also look forward to reading Part 2 of your blog.

    Kindest regards,