Benzodiazepine dependence is a growing public health problem for which very few
evidenced-based treatment approaches are available. Approximately 683,000 individuals met
past year criteria for sedative-hypnotic use disorders in the US during 2010, a prevalence
greater than heroin or methamphetamine dependence. The most commonly prescribed
sedative-hypnotic agents are the benzodiazepines. Chronic use induces pharmacodynamic
tolerance in the GABA neurotransmitter system and individuals with physiological dependence
find benzodiazepines difficult to discontinue because of withdrawal or rebound symptoms,
which include autonomic arousal, depression, anxiety, and insomnia. Available evidence-based
treatment approaches have been primarily directed at therapeutic users of benzodiazepines who
do not meet criteria for a substance use disorder, with a general consensus that the gradual
taper of benzodiazepines over a period of several months is the optimal approach. However,
patients with benzodiazepine dependence are typically referred for inpatient detoxification
treatment, which rapidly tapers patients off benzodiazepines. Protracted withdrawal symptoms
frequently persist after discharge, predisposing patients to relapse. More effective
pharmacotherapeutic strategies are needed for the treatment of benzodiazepine dependence in
the outpatient setting.