Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program

Voshaar, Richard C. Oude; Gorgels, W.J.M.J.; Mol, A.J.J.; Balkom, A.J.L.M. van; Mulder, I Jan; Lisdonk, E.H. van de; Breteler, M.H.M.; Zitman, Frans G.

doi:10.1177/070674370605100706

Cited by 48 publications

(29 citation statements)

References 33 publications

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“…44 Initiatives such as these can achieve 20% to 30% reductions in long-term benzodiazepine use. [45][46][47][48] Our data also suggest an association between the number and range of benzodiazepines prescribed. Nova Scotia reimburses 17 benzodiazepines, while Australia only reimburses 5.…”

Section: Implications For Clinical Practice and Policy Changesupporting

confidence: 63%

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

et al. 2008

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Objective: Benzodiazepines can be a problem if used for long periods, or in at-risk populations, such as the elderly. We compared the use of benzodiazepine and related prescription medicines in Nova Scotia and Australia. Methods: The Nova Scotia Pharmacare Program and the Pharmaceutical Benefits Scheme in Australia were used to obtain dispensing data in comparable populations for all publicly subsidized benzodiazepines and related compounds. Usage was compared from 2000 to 2003, using the World Health Organization anatomical therapeutic chemical and defined daily dosage (DDD) system. We also determined differences in the types of benzodiazepines prescribed. Results: The use of benzodiazepines increased at a steady but comparable rate in both areas. However, the use of benzodiazepines in Nova Scotia was more than double that of Australia in 2000 (123 and 48 DDD/1000 beneficiaries per day, respectively) through 2003 (138 and 57 DDD/1000 beneficiaries per day, respectively). Eight different benzodiazepines made up 90% of the drug use in Nova Scotia by contrast to only 4 different benzodiazepines in Australia. Conclusions: Large differences exist between the type and rate of benzodiazepine prescribing in Nova Scotia and Australia, with Nova Scotia reporting more than twice as much use. Benzodiazepine use in both jurisdictions is increasing. The Canadian findings are especially concerning as benzodiazepine use in the Atlantic provinces has been reported to be less than other provinces. The variations between the 2 jurisdictions may be due to factors such as fewer benzodiazepines available in Australia, differences in prescriber, patient attitudes and behaviours, or different initiatives to influence benzodiazepine use.

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Section: Implications For Clinical Practice and Policy Changesupporting

confidence: 63%

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

et al. 2008

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“…34 In a randomized trial of a benzodiazepine withdrawal program involving 180 patients, the independent predictors of successful benzodiazepine discontinuation were offering a tapering program (hazard ratio [HR] 2.9, 95% CI 1.8 to 4.8), combining a tapering program with cognitive behavioural group therapy (HR 2.4, 95% CI 1.5 to 3.9), a lower daily benzodiazepine dose at the start (HR 1.5, 95% CI 1.2 to 1.9), a substantial dosage reduction by patients themselves before the tapering protocol (HR 2.1, 95% CI 1.4 to 3.3), less severe benzodiazepine dependence (HR 2.4, 95% CI 1.1 to 5.2), and no concomitant alcohol use (HR 1.7, 95% CI 1.2 to 2.5). 27 In a placebo-controlled trial involving 38 long-term benzodiazepine users asked by their general practitioner to participate in a discontinuation program in combination with melatonin or placebo, there was no significant difference in outcomes between the groups. 35 However, among older patients who were encouraged to decrease their benzodiazepine doses while taking melatonin or placebo, sleep quality scores, as measured by the Northside Hospital Sleep Medicine Institute Test, were improved in the melatonin group, and 9 of 14 habitual benzodiazepine users were able to discontinue benzodiazepine use.…”

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confidence: 99%

“…27 In a longitudinal study involving older people, long-term benzodiazepine use was associated with treatment for nervous conditions, restless sleep, being female, being divorced and having increased contact with medical services. 7 Similarly, associations between benzodiazepine use and depressive or anxious symptoms, increased use of nonpsychotropic drugs and female sex were found in a study involving older benzodiazepine users in France.…”

mentioning

confidence: 99%

Management of insomnia and long-term use of sedative-hypnotic drugs in older patients

McMillan

Aitken

Holroyd‐Leduc

2013

CMAJ

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“…Future studies might try to elucidate this continuum as well as its potential predictors. Certain personality traits (i.e., neuroticism, dependency, obssessional characteristics), and more severe anxiety and depression have been associated with higher relapse rates and are worthy of future investigation [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Older primary care patients' willingness to consider discontinuation of chronic benzodiazepines

Cook

Biyanova

Thompson

et al. 2007

General Hospital Psychiatry

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Objective-To examine factors related to older primary care patients' willingness to consider tapering/discontinuation of long-term benzodiazepine use.Method-Forty-six long-term anxiolytic benzodiazepine users, aged 61-95 years, were assessed over the telephone using a semi-structured qualitative interview and standardized self-report questionnaires for anxiety (Beck Anxiety Inventory), sleep quality (Pittsburgh Sleep Quality Index), depression (Center for Epidemiological Studies Depression Scale), psychological dependence on benzodiazepines (Severity of Dependence Scale) and anxiety sensitivity (Anxiety Sensitivity Index).Results-Frequency of daily benzodiazepine intake and anxiety sensitivity significantly contributed to willingness to attempt taper/discontinue benzodiazepines.Conclusion-Many older long-term benzodiazepine users and their physicians perceive tapering of use an arduous, low priority, time intensive task. These findings highlight factors that can help identify a subpopulation of patients who may be easier to engage in the discontinuation process.

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Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program

Abstract: 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.

Cited by 48 publications

References 33 publications

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

A Comparison of Benzodiazepine and Related Drug Use in Nova Scotia and Australia

Management of insomnia and long-term use of sedative-hypnotic drugs in older patients

Older primary care patients' willingness to consider discontinuation of chronic benzodiazepines

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