Psychological mechanisms underlying addictive behaviour are described with particular reference to the role of learning and cognition in long-term benzodiazepine use. The effects of long-term tranquillizer use on cognitive functioning are then discussed, and it is suggested that the long-term use of benzodiazepines is associated with impairment in two areas of cognitive functioning; visual-spatial ability and the ability to sustain attention on a repetitive task under time pressure. Psychological approaches to the management of long-term benzodiazepine users have focused on tailoring cognitive and behavioural therapeutic techniques to the needs of tranquillizer-dependent patients. A follow-up study of patients treated for benzodiazepine dependence is described. It is argued that a gradual withdrawal regimen alone is inadequate for permanent withdrawal for many patients, and that psychological adjuncts should be included in treatment to provide patients with alternative coping strategies.
KEY WORDS -Benzodiazepine, long-term use, cognitive impairment, withdrawal, therapy.
I. CAUSES
By examining underlying psychological mechanisms in the development of drug dependency, psychologists have developed theories which provide a broader explanation of the long-term use of psychotropic drugs than pharmacological explanations alone (see Milby, 1981;Orford, 1985). Behaviour theorists argue that drugs are powerful primary reinforcers, both because they produce pleasant effects and because they can remove aversive states. According to this view it would seem that the long-term use of benzodiazepines develops because these drugs have a pleasant sedating effect and because they relieve feelings of anxiety. Once physical dependence is established, benzodiazepines continue to act as powerful reinforcers by relieving the unpleasant withdrawal symptoms which develop when medication is stopped, and thus the long-term use of these drugs is maintained. Secondary reinforcement also appears to be important in chronic benzodiazepine *Based on a paper presented to the General Practice Research Unit conference on Long-term Tranquillizer Use, Institute of Psychiatry, October 1987.