Abuse of Benzodiazepines

To the Editor.—  The recent article by Woods et al¹ presented a good literature review of benzodiazepine use and abuse based on the reinforcing model of behavioral pharmacology. However, some of the conclusions and recommendations in the article created a sense of unease in those of us who work in a tertiary referral facility and regularly see patients suffering from iatrogenically fostered benzodiazepine dependence.Woods et al¹ concluded that "there is virtually no recreational or inappropriate use of benzodiazepines among patients for whom these drugs are prescribed" and that "psychological dependence is not a substantial risk of benzodiazepine therapy." A collection of seven cases at our institution that documented alprazolam dependence as defined by DSM-III (revised) criteria for psychoactive substance dependence was reported recently.² Between 1986 and 1988, two hundred ninety-three patients were treated in our Alcoholism and Drug Dependence Unit who were diagnosed as having benzodiazepine