Benzodiazepines and Addiction: Xanax Did Not Kill Whitney Houston
Know the difference: dependence vs. addiction.
Posted Feb 18, 2012
First, let me be clear: I am not an authority on addiction, benzodiazepines or Whitney Houston. But the media coverage surrounding the Xanax, a benzodiazepine, found in Whitney Houston's hotel room has made me see red. I'm enraged and deeply, truly sad. So I'm weighing in.
I almost threw something at someone else's television twice while watching The Today Show on Monday (I'm a nanny, the baby was napping). There was so much wrong with the segment I was watching, but because the Today Show is probably not bound by any real ethical boundaries, I point my finger squarely at you, Dr. Julie Holland.
In the interest of fairness, here's a link to the Today Show segment. Unfortunately, I couldn't find a clip shorter than five minutes. And there's a commercial. But if you wait through the commercial (sorry!), then skip ahead to 3 minutes, 10 seconds and watch for about sixty seconds until they start talking music cliches again, you should see the part I'm talking about.
As I watched this live, I found myself waiting for this Dr. Holland to spit out several statements that she is, in my opinion, ethically bound to make. She did not make them. There was this fact, which I found confirmation for at the American Association of Anxiety Disorders:
Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population). [emphasis not mine]
And here's something I didn't even know but doesn't surprise me:
Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
Women are twice as likely to be affected as men.
I also learned from the AAAD that women are more likely (but not twice as likely) than men to suffer from PTSD. So, there's the context that she completely missed as she complained about the "millions of prescriptions" and about all these poor women on benzos and carelessly implied that taking benzos and being addicted to prescription drugs are the same thing. That last bit? That was the most unethical part of all of this, in my opinion. Because she didn't say anything even remotely resembling this:
Benzodiazepines often create a physical dependency, but do not necessarily cause addiction, and are used by many as part of an effective treatment plan. Viewers: consult your doctor before making any changes to your medications.
I would have forgiven her if she had just fit in something like that, somewhere, even as a throw-away. She was, in fact, incorrect in a number of places (Xanax is the least habit-forming benzo and stays in the body for so little time that one of my two psychiatrists won't even prescribe it because she prefers Ativan), but I want to focus on her dangerous confluence of addiction and dependence.
I am angry about that clip and coverage of Xanax in the media in general because taking a potentially habit-forming drug does not give me a drug habit, and I don't appreciate the implication that I must have one if I take Xanax (which I have taken, but don't at the moment). Taking a prescription drug that is habit-forming does not give you an addiction. Addiction is a disease. A person drinking a glass of wine might be an alcoholic and might not be. Alcohol is, nevertheless, a habit-forming substance.
Addiction is a disease that is not the same thing as experiencing a physical dependency on a prescription drug taken for the treatment of an illness. I'm not writing this to prove that I'm not an addict. I know that I'm not addicted to anything. That's good enough for me. All the same, I do not appreciate a psychiatrist going on a popular television show and implying that I am an addict. I don't like that even a few of the millions of patients with prescriptions for Xanax or any benzo might hesitate after her harsh characterization of the drug.
I am physically dependent on benzos. Klonopin, in my case. I feel like electric shocks are charging through my body at random if I haven't taken Klonopin in over ten hours. I experience "textbook" withdrawal symptoms. In fact, I can't even take a low dose without experiencing withdrawal, that's how sensitive I am to the absence of this drug. The American Journal of Psychiatry published an article about "addiction" vs "dependence" in 2006. Here's a neat definition of the term "dependence," from that article:
The term "dependence" has traditionally been used to describe "physical dependence," which refers to the adaptations that result in withdrawal symptoms when drugs, such as alcohol and heroin, are discontinued. Physical dependence is also observed with certain psychoactive medications, such as antidepressants and beta-blockers.
With me so far? Anything that causes your body to change when a substance is used, anything from caffeine to antidepressants to heroin, can cause dependence, and all that means is that your body experiences withdrawal when you take away the chemical. "Withdrawal" means that your body adapted to functioning with that substance (coffee, anyone?) and if that chemical (caffeine) goes away, your body has to adapt again. This adaptation is very different from the kinds of changes that happen with addiction. In fact, the very next sentence in the article I just quoted? It's this:
However, the adaptations associated with drug withdrawal are distinct from the adaptations that result in addiction, which refers to the loss of control over the intense urges to take the drug even at the expense of adverse consequences.
I am physically dependent on Klonopin. I do not and have not experienced anything resembling and intense urge to take the drug. I know the difference: I was hooked on nicotine for about five years, and I know what it means to lose control over an intense urge, even at the expense of adverse consequences. Dead of winter? I was outside shivering with a damn cigarette in my hand. Sick? It seemed perfectly reasonable to me to smoke four cigarettes a day instead of eight. That was helping, right? No, that was denial, a huge problem when you're addicted to something and don't want to admit it! Quitting smoking was hard. Not taking my benzos? All kinds of uncomfortable, but not hard to do. I once (against the advice of my doctors) tried to function on less than my prescribed dose of Ativan (yes, I've tried a number of benzos, only to find that Klonopin is the only thing that really truly works, but I don't them in combination unless directed to do so by a doctor). It felt gross and my anxiety spiked. I had some sort of idea that I'd be a better mother if I took a smaller dose. It was stupid. It cost me a job. I won't do it again. But are you getting the difference between taking benzos and experiencing a physical dependency versus being addicted to the drug?
The following statement (same article) really helped me understand why this Dr. Holland failed to make the distinction between dependence and addiction:
...clinicians who see evidence of tolerance and withdrawal symptoms assume that this means addiction... [there is] tremendous harm that is now being done to the patients who have had needed medication withheld because their doctors believe that they are addicted simply because they are dependent.
And that's not the only harm that a lack of understanding regarding this distinction has caused. I can only pray that the Today Show's irresponsible reporting didn't cause anyone to stop taking needed medication without consulting a doctor. It's not even necessary to publicize any dangers posed by benzos--they don't kill. They just don't, not by themselves, not if you're not trying to kill yourself. For more information on that, I will send you elsewhere: send you here and give gold-stars plus high-fives to the Huffington Post's Walter Armstrong for writing The Truth about Whitney Houston and Xanax. It's a good, informative read. And filled with less rage than this post.
Finally, I do agree with Dr. Irresponsible on one thing: combining alcohol with benzos is really bad. It says so on the label, but take it from me: however low your dose of any benzo might be, it will amplify the effects of the alcohol exponentially. I have actually injured myself (by randomly falling over in public on a date with my now-husband) by thinking that a few drinks would be fine. Nope. One glass of wine puts me to sleep. A whole bottle of wine and an overdose of Klonopin, combined with a hot bath? I am pretty sure that I would drown. Not that we know that that is what happened to Whitney Houston because we don't know anything because the toxicology report isn't back yet. That's my public service announcement, but it's also a reminder to get the whole story before making sweeping judgments.