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At the heart of homeostatic theory is the idea that explicit or implicit behavioral demands placed on physiological systems are required for the biological detection of homeostatic disturbances. The detection of drug-induced disturbances is required to drive the development of all systemic tolerance, both associative and nonassociative (i.e., both forms of tolerance are behaviorally contingent). A wide range of findings ranging from morphine-induced analgesia to ethanol-induced hypo-sexuality shows that contingent tolerance is pervasive and may be universal. The theory also stipulates that behavioral demands placed on the target system will govern the loss of both associative and nonassociative tolerance (physiological). The present formulation integrates contingent, associative, and nonassociative tolerance and drug-opposite withdrawal reactions within a unified theory.

In a double-blind outpatient trial, long-term users of therapeutic doses of benzodiazepines seeking treatment were randomly assigned to either gradual tapering of their daily active dose (N=23) or abrupt cessation of benzodiazepine intake (N=19). The latter was achieved by substitution of placebo tablets for active benzodiazepines. All subjects received cognitive-behavioural treatment preceded by a 2-week baseline period during which they took theft benzodiazepine as usual. Both groups received on average about five therapy sessions involving: goal setting, daily self-monitoring, identification of anxiety-provoking situations, and development of cognitive and behavioural coping. Placebo subjects showed more prominent withdrawal symptomatology and supplemented more often with their own prescription. At the end of treatment, no significant differences were observed in rates of attrition (30% for drug and 16% for placebo subjects) or in rates of abstinence (30% for drug and 58% for placebo). However, compared to drug subjects, those treated with placebo were significantly more successful in maintaining abstinence throughout the one-year follow-up period. It was argued that it may be advantageous to expose patients who are dependent on relatively low doses of benzodiazepines to some withdrawal distress during treatment. A relatively inexperienced therapist became as effective as a highly experienced therapist relatively quickly, thus indicating transferability of the treatment. [ABSTRACT FROM AUTHOR]

Features the Addiction Research Foundation of Ontario. Achievements of the foundation; Goals of the foundation; Selection of research.

Patterns of benzodiazepine abuse and dependence are not well known. Data on drug use and other demographic and clinical characteristics were collected in 176 patients consecutively referred to the Addiction Research Foundation Clinical Institute for assessment and treatment of benzodiazepine abuse and/or dependence. Objective confirmation of benzodiazepine use was obtained in 95% of subjects screened. Two groups of subjects emerged: patients who used only benzodiazepines (median daily dose: 15 mg of diazepam or equivalent) for long periods of time (56%) and those who used benzodiazepines (median daily dose: 40 mg of diazepam or equivalent) in the context of multiple drug abuse (44%). Benzodiazepines were the primary drug of abuse in 23 (32%) of the multiple drug abusers. Patients using only benzodiazepines were significantly older, took lower daily doses and their life-time benzodiazepine exposure was lower. Diazepam was most frequently alleged in both groups, but relative preference for other benzodiazepines differed. The results have implications for recognition, assessment, management and treatment of benzodiazepine abuse and dependence. [ABSTRACT FROM AUTHOR]