A.J.J. Mol

Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program

Objective: To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial. Method: We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition, randomized, controlled benzodiazepine discontinuation trial in general practice. Results: Of 180 patients, we completed follow-up for 170 (94%). Of these, 50 (29%) achieved long-term success, defined as no use of benzodiazepines during follow-up. Independent predictors of success were as follows: offering a taper-off program with group therapy (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.5 to 3.9) or without group therapy (HR 2.9; 95%CI, 1.8 to 4.8); a lower daily benzodiazepine dosage at the start of tapering off (HR 1.5; 95%CI, 1.2 to 1.9); a substantial dosage reduction by patients themselves just before the start of tapering off (HR 2.1; 95%CI, 1.4 to 3.3); less severe benzodiazepine dependence, as measured by the Benzodiazepine Dependence Self-Report Questionnaire Lack of Compliance subscale (HR 2.4; 95%CI, 1.1 to 5.2); and no use of alcohol (HR 1.7; 95%CI, 1.2 to 2.5). Patients who used over 10 mg of diazepam equivalent, who had a score of 3 or more on the Lack of Compliance subscale, or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence. Conclusions: Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality, benzodiazepine dosage, psychopathology, and personality characteristics. An identifiable subgroup needs referral to specialized care.

Cross-validation, predictive validity, and time course of the Benzodiazepine Dependence Self-Report Questionnaire in a benzodiazepine discontinuation trial.

The Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ) measures the severity of benzodiazepine (BZ) dependence on four domains: awareness of problematic use, preoccupation with the availability of BZ, lack of compliance with the therapeutic regimen, and withdrawal. Although promising results of the Bendep-SRQ have been obtained in cross-sectional studies, no attention has been paid to its clinical relevance during BZ withdrawal, i.e., predictive validity and time course. We performed cross-validation and evaluated the predictive validity and time course on 180 long-term BZ users who were taking part in a general practice BZ discontinuation trial. Three of the four domains had good scalability. Some concerns arose about the preoccupation scale, which emphasizes the need for cross-validation in clinically relevant populations. All scales showed excellent reliability (subject discriminability, item discriminability), while construct and discriminant validity were adequate. All four scales contributed significantly to the prediction of whether complete abstinence would be achieved directly after taking part in the discontinuation program. This prediction was independent of the other prognostic variables, except for those in the domain problematic use. The scales problematic use and preoccupation showed good sensitivity to changes during follow-up. The insensitivity of the scale, lack of compliance can be explained by low baseline scores in our population, while the insensitivity of the withdrawal scale was probably the result of the study design. In conclusion, our study indicated the clinical relevance of the Bendep-SRQ before and during a BZ discontinuation trial. We recommend the use of the Bendep-SRQ in discontinuation therapy and research into the field of BZ addiction.

A benzodiazepine discontinuation programme does not increase the frequency of contacts with the family practice

Objective. The efficacy of programmes to reduce long-term benzodiazepine use could be compromised by subsequent increases in contacts with the family practice. In this study the hypothesis was tested as to whether participation in a benzodiazepine discontinuation programme affects the frequency of contacts with the family practice. Design. A controlled stepped-care intervention programme to decrease long-term benzodiazepine use. Setting. Family practices in the Netherlands. Subjects. The experimental group consisted of 996 long-term benzodiazepine users and a control group of 883 long-term benzodiazepine users. Main outcome measures. Practice contacts before and up to 12 months after the start of the programme. Results. There was a general tendency visible for contacts to decrease during the follow-up time. The course of the number of contacts during the follow-up was not different for the experimental and control groups (p=0.45). The level of non-benzodiazepine prescriptions was generally not altered. The number of non-benzodiazepine prescriptions decreased in benzodiazepine quitters during the follow-up of the programme. Conclusion. No clinically important differences in practice contacts were observed when the course of the number of contacts and non-benzodiazepine prescriptions were compared between the experimental and control groups. Family practitioners do not have to anticipate an increased workload associated with participation in such a benzodiazepine discontinuation programme.

General practitioners' opinions of a stepped-care benzodiazepine discontinuation programme.

Department Primary Care, Centre of Evidence Based Medicine (EBP), and Department of Psychiatry, Radboud University Nijmegen Medical Centre, the Netherlands, Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands, Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands, and Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands