High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal

Abstract

BackgroundBenzodiazepine withdrawal syndrome has been reported following attempts to withdraw even from low or therapeutic doses and has been compared to barbiturate and alcohol withdrawal. This experience is known to deter patients from future cessation attempts. Research on other psychotropic substances shows that the reasons and motivations for withdrawal attempts – as well as the experiences surrounding those attempts – at least partially predict future efforts at discontinuation as well as relapse. We therefore aimed to qualitatively explore what motivates patients to discontinue this medication as well as to examine their experiences surrounding previous and current withdrawal attempts and treatment interventions in order to positively influence future help-seeking behavior and compliance.MethodsTo understand these patients better, we conducted a series of 41 unstructured, narrative, in-depth interviews among adult Swiss patients with a long-term dependent use of benzodiazepines in doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use (mixing benzodiazepines, escalating dosage, recreational use or illegal purchase). Mayring’s qualitative content analysis was used to evaluate findings.ResultsThese high-dose benzodiazepine-dependent patients decision to change consumption patterns were affected by health concerns, the feeling of being addicted and social factors. Discontinuation attempts were frequent and not very successful with fast relapse. Withdrawal was perceived to be a difficult, complicated, and highly unpredictable process. The first attempt at withdrawal occurred at home and typically felt better than at the clinic. Inpatient treatment was believed to be more effective with long term treatment (approaches) than short term.Patients preferred gradual reduction of usage to abrupt cessation (and had experienced both). While no clear preferences for withdrawal were found for benzodiazepines with specific pharmacokinetic properties, participants frequently based their decision to participate in treatment on the availability of their preferred brand name and furthermore discarding equivalent dosage rationales.ConclusionsOur findings provide greater understanding of the factors that motivate high-dose benzodiazepine-dependent individuals to stop taking these medications, and how they experience withdrawal and treatment strategies. They underscore how patients’ perceptions of treatment approaches contribute to compliant or non-compliant behavior.

Benzodiazepine usage and patient preference for alternative therapies: A descriptive study

“…In our study, the results indicate that concerns about the medication are related to both lower current long‐term use and higher preference for future behavioural alternatives. In fact, health concerns and the fear of being addicted were the most commonly reported reasons for a benzodiazepine withdrawal attempt, as shown in other studies as well . Therefore, discussing concerns in an individualised manner to the patient may be effective in helping patients decide to discontinue long‐term benzodiazepine use.…”

Uso e abuso de benzodiazepínicos na atenção primária à saúde: práticas profissionais no Brasil e em Cuba

“…A impressão dos profissionais é respaldada por autores que estudaram a experiência dos usuários com os benzodiazepínicos e identificaram que ocorre, ao mesmo tempo, situação de alívio e de sofrimento com a dependência 38,39 . O desconforto dos profissionais, entretanto, não impede que os medicamentos continuem sendo prescritos por período prolongado, também por sua aparente segurança.…”

The Lexicon of Drug Abuse

“…In the early 1960s a "normal" prescribed dose of diazepam started at a 2 mg tablet, administered by mouth once, twice or three times a day [19]. That early maximum of 6 mg/day dose pales in comparison to reports in 2015 of "fully functioning" patients being legally prescribed doses of greater than 100 mg/day [20]. As reported by Hollister et al [21], a patient who had been treated with 30 to 45 mg/day of diazepam for 20 months, which was abruptly discontinued, showed a clear-cut withdrawal reaction [22].…”