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The manual used by mental health professionals to diagnose mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-IV-TR, includes specific diagnostic criteria for four types of anti-anxiety medication abuse. These are:

• dependence

• intoxication

• withdrawal

Dependence, the more severe form of addiction, refers to very significant levels of physiological dependence, with both tolerance and withdrawal symptoms. Abuse, the less severe form of addiction, may still result in risky behavior, such as driving while under the influence. An individual with an abuse disorder may miss work or school, or get into arguments with parents or spouse about substance use. The problem can easily escalate into full-blown dependence.

Intoxication refers to the presence of clinically significant problem behaviors or psychological changes, such as inappropriate sexual or aggressive behavior, mood swings, impaired judgment, or impaired social or work functioning that develop during or shortly after use of an anti-anxiety medication. As with other CNS depressants such as alcohol, these behaviors may be accompanied by slurred speech, unsteady gait, memory or attention problems, poor coordination, and eventually, stupor or coma. Memory impairment is relatively common, especially a kind known as anterograde amnesia that resembles alcoholic blackouts.

Withdrawal is a characteristic syndrome that develops when use of anti-anxiety medication is severely reduced or stopped abruptly. It is similar to abrupt cessation of heavy alcohol use. Symptoms may include increases in heart rate, respiratory rate, blood pressure or body temperature, sweating, hand tremor, insomnia, anxiety, nausea, and restlessness. Seizures may occur in perhaps as many as 20-30% of individuals undergoing untreated withdrawal. In the more severe forms of withdrawal, hallucinations and delirium can occur. Withdrawal symptoms are generally the opposite of the acute effects experience by first-time users of the drugs. Length of withdrawal varies depending upon the drug, and may last as few as 10 hours, or as long as three to four weeks. The longer the substance has been taken, and the higher the dosages used, the more likely that withdrawal will be severe.

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