Benzodiazepines and sleeping pills: when treatment becomes dependence

Sleeping pills and anti-anxiety medications relieve real difficulties. A long stretch of insomnia, anxiety that takes over the day, a difficult period in life: these medicines can provide genuine relief when they are prescribed for a short time.

The problem appears when use stretches on. A treatment planned for a few weeks continues for months, sometimes years. The person takes their tablet « out of habit », « to be sure of sleeping », « to get through the day ». They are not looking for a particular effect, but they can no longer do without it.

This situation is neither a fault nor a sign of weakness. It is a dependence that can develop within a normal medical context. The key is to recognise it early, then talk about it without shame with a professional.

A treatment designed to be short

Benzodiazepines (Xanax, Lexomil, Valium…) and related medicines (zopiclone, zolpidem…) are not made to be taken for a long time.

The French health authority (HAS) is explicit: the approved treatment durations range from a few days (including the tapering phase) for severe occasional insomnia, to four weeks at most for severe transient insomnia. For the symptomatic treatment of severe and/or disabling anxiety, the duration is eight to twelve weeks, including tapering.

These durations are not arbitrary. Beyond a few weeks, the risk of side effects increases: daytime drowsiness, falls, accidents, memory problems. And the risk of dependence grows with the duration of use.

Yet real-world practice often moves away from this framework. The French medicines agency (ANSM) counted more than 9 million benzodiazepine users in France in 2024, making France the second-largest consumer country in Europe. According to data reported by the agency, about 40% of patients exceed the recommended treatment durations, that is roughly 3.6 million people.

Why dependence develops without being noticed

Dependence does not always appear dramatically. It often progresses through small shifts.

At first, the tablet works well. Then the body gets used to it: sometimes the same dose produces less effect, that is tolerance. The person may feel like increasing it, or notice that the treatment « no longer works » as before.

Another mechanism is more insidious: the medicine is no longer used only to sleep or calm anxiety. It is used to avoid the return of symptoms. The person takes their tablet « to be safe », fears running out, plans the prescription renewal in advance. The treatment gradually takes up more and more mental space.

Finally, stopping itself becomes difficult. Rebound anxiety, sleep problems, irritability or unusual sensations can appear when a dose is skipped. This reaction often pushes the person back to the treatment, reinforcing the cycle.

Physical dependence, tolerance, addiction: don’t confuse them

Physical dependence

It corresponds to the body’s adaptation to the medicine. After regular use, the body gets used to its presence. If the treatment is reduced or stopped, withdrawal symptoms can appear: anxiety, sleep problems, irritability, tension, palpitations, sweating.

This adaptation can occur while the person is following their prescription. It does not automatically mean that addiction is present, but it explains why abrupt withdrawal is not recommended.

Tolerance

It is the need to increase the dose to get the same effect. The treatment that helped at first seems less effective. Increasing the dose should never be decided alone: it must be assessed with a doctor, because it increases the risk of dependence and side effects.

Addiction

It involves a loss of control: the medicine takes up more and more space, the person continues despite negative consequences, finds it hard to cut down despite wanting to, or uses it for reasons other than those intended.

Physical dependence, tolerance and addiction can overlap, but they are not synonyms. Only a full assessment can make sense of the situation.

Warning signs

No single sign is enough to conclude that dependence is present. Several changes, however, can justify a discussion with a professional.

The treatment lasts longer than planned

The initial prescription planned a few weeks. Months later, use continues. The HAS considers that daily use for more than 30 days justifies proposing a stopping strategy.

The dose increases or doses get closer together

The person takes the tablet earlier than planned, increases the dose on their own, or combines several medicines to sleep.

The fear of running out sets in

The person counts their tablets, plans the renewal, worries a lot when they might not have enough. The medicine occupies their thoughts outside of taking times.

The medicine changes role

It is no longer used only to sleep or calm anxiety. It is used to face the day, avoid conflict, « switch off » in the evening, cope with a difficult situation. This change of use deserves to be named.

Stopping causes unpleasant symptoms

Anxiety, insomnia, irritability, palpitations, physical tension: these signs can appear when stopping or between doses. They should not lead to changing the treatment alone.

Never stop alone

The first rule is not to stop a benzodiazepine or sleeping pill abruptly if it has been taken daily for several weeks.

Stopping must be gradual, over a period of a few weeks (usually 4 to 10 weeks) to several months for long-term use or high doses. In some cases, the HAS indicates that stopping can take three months to a year.

The family doctor is the first person to talk to. They can assess the situation, propose an adapted tapering rhythm, and use tools such as the ECAB questionnaire (cognitive attachment to benzodiazepines scale) to measure the degree of dependence. They can also point to non-drug alternatives: relaxation, sleep work, psychological support.

Simply reducing the dose is already a positive result, even if complete withdrawal is not immediate.

The opinion of a specialist (psychiatrist, addiction specialist, psychologist) is recommended in certain situations: a history of alcohol or other substance dependence, associated psychiatric disorders, or difficulties already encountered during a previous withdrawal.

When to see an addiction specialist

Addiction medicine is not only about alcohol or illegal drugs. It also addresses dependence on prescribed medicines, including benzodiazepines and sleeping pills.

An addiction specialist can help take stock without judgment, understand the place the treatment has taken, prepare a gradual withdrawal and find alternatives for sleep or anxiety. They can work with the prescribing doctor.

Seeking help early is always better: waiting until the situation becomes unbearable does not make stopping easier. Dependence detected early can be worked on more calmly, without systematic hospitalisation.

It is also possible to talk to a general practitioner or a local addiction service (CSAPA) for a first conversation.

Dependence on prescribed medicines is not limited to sleeping pills: the same mechanism exists for example with certain opioid painkillers such as tramadol or codeine.