Which approach is recommended when prescribing benzodiazepines for chronic anxiety disorders in patients with risk of substance use disorder?

• A. Use short-acting benzodiazepines
• B. Avoid benzodiazepines entirely
• C. Use long-acting benzodiazepines
• D. Use only diazepam

Answer: (C)

When managing chronic anxiety in someone at risk for substance use disorders, the goal is to minimize misuse potential while still providing symptom relief. Long-acting benzodiazepines achieve steadier, more gradual drug effects with longer duration, which reduces the rapid onset and peaks that can reinforce misuse and drive dose escalation. This smoother pharmacokinetic profile also lessens abrupt withdrawal between doses, making it somewhat easier to manage and taper if needed. Consequently, if a benzodiazepine is necessary, opting for a long-acting agent (such as diazepam) is safer in this context than a short-acting one. Of course, use should be at the lowest effective dose, for the shortest feasible period, and always alongside nonpharmacologic therapies and non-benzodiazepine options when possible, with careful monitoring for dependence and withdrawal.