Manual for the Benzodiazepine Dependence Questionnaire (BDEPQ)

RATIONALE AND BACKGROUND 3
drome in people who had used BZDs within therapeutic doses (Ashton, 1984�
Covi, Lipman, Pattison, Derogatis, & Uhlenhuth, 1973).
Evidence mounted that BZDs could produce withdrawal symptoms and the
conclusion that they could produced dependence rst appeared in the early 1970s.
A search of the Medline database by the author revealed that the rst use of the
words `benzodiazepine' and `dependence' in the title or subject keywords of a
publication 1 was in late 1974 (Greenblatt & Shader, 1974� Kellett, 1974). Earlier
Eddy et al. (1965, p. 726), reporting on the WHO Expert Committee on
Addiction-Producing Drugs, claimed that
`. . . all agents which produce barbiturate-like sedation, because of the
relief of anxiety, mental stress, etc., should produce some psychic dependence
and, for the reasons enumerated for dosage increase, physical
dependence when a su cient concentration in the organism has
been attained. This possibility has been con rmed for many sedative
agents of di erent types, including barbiturates and the so-called nonbarbiturate
sedatives such as glutethimide, methyprylon, meprobamate,
chlordiazepoxide, bromisoval, chloral hydrate and paraldehyde,
but there may be exceptions.' (emphasis added)
Aside from the assumption that exposure to a drug leads to dependence upon it, it
is surprising to note the inclusion of chlordiazepoxide (Librium) in the discussions
of this eminent committee only four years after Hollister et al. (1961) rst reported
BZD withdrawal symptoms. Their emphasis on `psychic dependence' is notable
as most commentators (Ashton, 1991� Lader, 1983� Marks, 1985) focus on the
production of withdrawal symptoms and tolerance as indicating dependence, the
signs of so-called `physiological' dependence.
It is now widely accepted that humans can become dependent on BZDs (World
Health Organization Review Group, 1983� NH&MRC, 1991� Woods, Katz, &
Winger, 1987, for example) and evidence for this will not be presented. A full
review of the evidence for or against this proposition is available elsewhere (Cappell,
Sellers, & Busto, 1986� Woods et al., 1987). However, it should be noted
that the addiction potential of BZDs is much lower than similar medications like
the barbiturates.
Conceptualization and features of benzodiazepine dependence
Many authors describe dependence on BZDs in terms one or more of the
signs of so-called `physiological' dependence: a withdrawal syndrome and tolerance
to the drugs e ects. The distinction between `psychological' and `physiological'
dependence is implicit in these descriptions. As is the reductionist assumption that
`physiological' dependence is of greater importance. This customary de nition of
1 Excluding those publications describing the use of BZDs as an aid to alcohol detoxi cation