February 09, 2009 
By Michael Craig Miller, M.D., Tribune Media Services
Q: About a month ago, I started having nighttime anxiety and sleeplessness. My doctor suggested that I take one- half tablet of Klonopin to help with this issue. I have read that this drug can be addictive. What are my chances of developing a dependence on this drug?
A: Klonopin (generic name, clonazepam) is a well-known antianxiety drug in a class called "benzodiazepines." Other drugs in this class include diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax). They are very effective and relatively safe. The major difference between them is in how quickly they start to work and how long they stay active in your body.
Let's review the risks of dependence and addiction.
Dependence can be physical or psychological. When people become physically dependent on a drug, they may get physical withdrawal symptoms if they stop the drug suddenly. When people become psychologically dependent, they may find themselves thinking about or wishing for the drug when it is not available.
Addiction is more complicated. It is a complex pattern where a person craves a drug, organizes his or her life around getting the drug, and needs more and more of it to achieve a desired effect.
If you took a small dose of Klonopin every night for several weeks or months, you could become dependent on it. But this is not necessarily a problem. If the drug brings you relief, you have few if any side effects, and you don't find yourself needing higher and higher doses to get that relief, then this is a dependency you may be happy about. It's like depending on any daily medication that helps a medical condition, like taking a blood pressure medicine.
Although some people do use drugs like Klonopin as part of an addiction, the risk is very small if you have never had a problem with addiction, and you are taking a small dose for anxiety.
Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass. Dr. Miller is the editor-in-chief of the Harvard Mental Health Letter.