Below are four different columns showing the types of signs associated with a problem related to the use of tranquilizers or sleeping pills. In particular, the first three columns are indicative of an altered relationship with these medications, whereas the fourth simply describes the psychological disturbances that may occur following abrupt discontinuation. In any case, the fourth column may also indicate a problem, because these symptoms become particularly significant when high doses are discontinued—doses that are characteristic of people who are abusing the medication through the other mechanisms described in the first three columns.
In essence, when the features described in columns 2 and 4 predominate, the person is more likely to be dependent on the medication because of uncontrolled anxiety symptoms, or to have developed a state of physical dependence (tolerance) while still suffering from anxiety syndromes or physical symptoms and being unable to tolerate even mild withdrawal symptoms easily. When the features in columns 1 and 3 predominate, there is more likely to be a situation of misuse or addiction beyond the therapeutic use of the medication. This may be a manifestation of an underlying state of psychological distress or may constitute a problem in its own right.
| Problematic use | Preoccupation | Use beyond agreed limits | Withdrawal |
| I have thought that it would be better for me to stop taking this medication. | I often take an extra dose because I am afraid I might become unwell. | I take the medication at higher doses than those prescribed by my doctor. | Restlessness |
| The effect of the medication is much weaker than what I experienced at the beginning. | I feel safe when I have the medication with me. | In my opinion, the effect wears off too quickly. | Depression |
| I think that using this medication is ruining my life. | I become nervous if I do not have the medication within reach. | I go and ask for additional prescriptions because I have finished the medication earlier than expected. | Fatigue |
| The use of this medication is getting me into trouble. | When it is time to take the medication, I cannot think about anything else. | I take large quantities at once. | Irritability |
| I spend a lot of time thinking about issues concerning the medication. | I falsify the prescription so that I can obtain additional supplies, or obtain them without a prescription, or steal them. | Chills, tremors and shaking |
Singh AN (1983). A clinical picture of benzodiazepine dependence and guidelines for reducing dependence. In: Current Observations on Benzodiazepine Therapy, Excerpta Medica, Amsterdam, pp. 14–18.