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Benzodiazepine and “Z-Drug” Dependence: Data From a Tertiary Care Center
Abstract
OBJECTIVE: To examine the clinical characteristics and course of benzodiazepine and �Z-drug� dependence in patients presenting to a tertiary deaddiction center in southern India. METHODS: Case files of 950 inpatients admitted between January 2007 and January 2014 who reported benzodiazepine or Z-drug use were reviewed. Patients (n = 170) with an ICD-10 diagnosis of mental and behavioral disorders due to the use of sedatives or hypnotics-dependence syndrome currently using substance (F13.24) were included in this study. RESULTS: Alprazolam (n = 86, 50.6%), nitrazepam (n = 40, 23.5%), and zolpidem (n = 19, 11.2%) were the most commonly reported drugs of abuse. Alcohol dependence was present in 37 subjects (21.8%) and opioid dependence in 41 subjects (24.1%). Comorbid psychiatric illness was diagnosed in 67 patients (39.0%). Only 28 patients (16.5%) had sedative dependence with no other substance use disorder. CONCLUSION: High comorbidity occurs in this group of patients. Outcome varies significantly (P < .05) between sedative-dependent only and multiple-substance�dependent patients. High attrition should be addressed through follow-up and tracking mechanisms.
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Psychiatric comorbidities are common among individuals with Z-drug use disorder, particularly depressive, anxiety, and personality disorders.
“Psychiatric comorbidities are common among individuals with Z-drug use disorder, particularly depressive, anxiety, and personality disorders.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [63]
In a study of 174 individuals with hypnotic use disorder, 83.5% met the criteria for dependence on at least 1 additional substance, including alcohol, opioids, cannabis, or solvents.
“Although data are limited, Z-drug use disorder may co-occur with other substance use disorders beyond that of alcohol; in a study 63 of 174 individuals with hypnotic use disorder, 83.5% met the criteria for dependence on at least 1 additional substance, including alcohol, opioids, cannabis, or solvents.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [63]
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Schifano, F., Chiappini, S., Corkery, J. M., & Guirguis, A. (2019) · International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz007 · Cited by 194
“, 2018) and clinical dependence issue data from an Indian tertiary care center (Shukla et al., 2017).”
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Frase, L., Nissen, C., Riemann, D. W., & Spiegelhalder, K. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1511705 · Cited by 51
Initiation and long‐term use of benzodiazepines and Z‐drugs in bipolar disorder
Wingård, L., Taipale, H. T., Reutfors, J., Westerlund, A., Bodén, R., Tiihonen, J., Tanskanen, A. J., & Andersen, M. T. (2018) · Bipolar Disorders · doi:10.1111/bdi.12626 · Cited by 35
Werneck, M. A., Kortas, G. T., de Andrade, A. G., & Castaldelli-Maia, J. M. (2018) · CNS Drugs · doi:10.1007/s40263-018-0577-6 · Cited by 25
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Chan, W. L., Wood, D. M., & Dargan, P. I. (2020) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14638 · Cited by 21
“2%) were the most commonly reported drugs of abuse.(28) High misuse prevalence of benzodiazepines and Z-drugs in this study of patients with drug dependence may suggest that there are significant problems with the”
Background‘Z-trip’? A Comprehensive Overview and a Case-series of Zolpidem Misuse
Orsolini, L., Chiappini, S., Grandinetti, P., Bruschi, A., Testa, R., Provenzano, A., Berardis, D. D., & Volpe, U. (2021) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2021.19.2.367 · Cited by 24
“Similarly, according to the data from a tertiary deaddiction center in southern India, zolpidem was the most commonly reported drug together with alprazolam and nitrazepam in patients presenting with a BZDs/Z-drug dependence [34].”
ResultCaillet, P., Rousselet, M., Gérardin, M., Jolliet, P., & Victorri‐Vigneau, C. (2020) · PLoS ONE · doi:10.1371/journal.pone.0228495 · Cited by 21
Leal, G. N., Studart, I., Figueiredo, C. P. M., Santi, T. D., Suen, P. J. C., Brasiliano, S., Hochgraf, P. B., & Bacchi, P. S. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1456148 · Cited by 6
“While zolpidem abuse is frequently associated with concurrent abuse of other substances (i.e, alcohol, cocaine, heroin, cannabis) (18, 21, 30, 31, 32), none of the reported cases exhibited other SUD, with the exception of nicotine in one case.”
Filmer, S., & Maidment, I. (2025) · Scientific Reports · doi:10.1038/s41598-025-25261-4 · Cited by 4
Pauwels, P., Haack, B., Toto, S., Seifert, J., Grohmann, R., Heinze, M., Zolk, O., Proskynitopoulos, P. J., Schneider, M., & Greiner, T. (2025) · Addiction Science & Clinical Practice · doi:10.1186/s13722-025-00579-6 · Cited by 2
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Mendelevich, В. D. (2019) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro20191191275 · Cited by 2
Anxiolytics and Antidepressants: Problem or Solution?
García-Pardo, M. P., Platero Armero, J. L., & De La Rubia Orti, J. E. (2018) · Journal of Neurology and Neuroscience · doi:10.21767/2171-6625.1000247 · Cited by 1
“[19] conducted a study between 2007-2014 to assess the dependence of patients in South India.”
BackgroundBhatia, G., Parmar, A., & Balhara, Y. P. S. (2022) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2022.100032 · Cited by 1
Fairman, K. A., Peckham, A. M., Rucker, M. L., et al. (2018) · BMC Research Notes · doi:10.1186/s13104-018-3632-y · Cited by 1
Chen, Y., Wang, F., Cui, L., Huang, H., Kong, S., Qian, N., Zhang, M., Lyu, D., Wang, M., Liu, X., et al. (2022) · Disease Markers · doi:10.1155/2022/6799898 · Cited by 2
RetractedStelzer, F. G., Bacelar, A., Éckeli, A. L., Negrão, A. B., Almeida, C. M. O., Franco, C. M. R., Pires, G. N., Gitaí, L. L. G., Sobreira-Neto, M. A., Assis, M., et al. (2025) · Arquivos de Neuro-Psiquiatria · doi:10.1055/s-0045-1812323 · Cited by 1
“28,62,63 Studies 28 have shown that a history of psychiatric illness, as well as concurrent use of alcohol or other substances, signi fi cantly increases the riskof Z-drug misuse.”
Epidemiological studies of medication use and effectiveness in bipolar disorder
Wingård, L. (2017) · Figshare
When Treatment Turns to Addiction: Emerging Issues in Over-the-Counter and Prescription Drug Abuse
Li, B. T., Moukaddam, N. J., Parks, K. D. L., & Shah, A. A. (2018) · Psychiatric Annals · doi:10.3928/00485713-20180719-01
Chen, Y., Wang, F., Cui, L., Huang, H., Kong, S., Qian, N., Zhang, M., Lyu, D., Wang, M., Liu, X., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-394328/v1
Benzodiazepines in Psychiatric Disorder Management: The Safe Ways to Use
Kar, S. K. (2023) · Academic Bulletin of Mental Health · doi:10.25259/abmh_7_2023
(2024) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9798894551289.cd07
Metadata
- Authors
- Shukla, L., Bokka, S., Shukla, T., Kandasamy, A., Chand, P., Benegal, V., & Murthy, P.
- Affiliations
- National Institute of Mental Health and Neurosciences (IN)
- Corresponding author
- Shukla, Lekhansh
- Venue
- The Primary Care Companion For CNS Disorders
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-02-16
- Volume
- 19
- Issue
- 1
- ISSN
- 2155-7772 (ISSN-L)
- 2155-7780
- OpenAlex
- W2588465053
- Cited by
- 21
- References
- 0
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 6 · 2017: 1
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Primary Care Companion For CNS Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- benzodiazepine dependence, alprazolam, nitrazepam, zolpidem, alcoholism, opioid use disorder, comorbidities, psychiatric comorbidity, treatment outcomes
- MeSH terms
- Zolpidem, Acetamides, Adult, Bacterial Proteins, Mental Disorders, Benzodiazepines, Female, Humans, Hypnotics and Sedatives, India, Male, Piperazines, Pyridines, Pyrimidines, Unemployment, Substance-Related Disorders, Azabicyclo Compounds, Tertiary Care Centers, Prescription Drug Misuse
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