Randomised controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention

Abstract

Previous studies have reported that a letter from the patient's General Practitioner (GP) and a short GP consultation led to reduced intake among long-term benzodiazepine (BZD) users, with no evidence of a deterioration in general or mental health. We aimed to replicate these earlier findings in a single, prospective RCT and compare the effectiveness of the two brief interventions. 273 long-term BZD users (!6 mos) identified from repeat prescription computer records of 7 general practices were randomised to: (i) usual GP care þ assessment only; (ii) the offer of a short consultation with the patient's GP (or practice nurse/ practice pharmacist); (iii) a letter signed by the GP advising gradual reduction in BZD intake. The typical patient entering the study was an elderly woman taking BZDs primarily for sleeping problems. Results showed significantly larger reductions in BZD consumption in the letter (24% overall) and consultation (22%) groups than the control group (16%) but no significant difference between the two interventions. There was no evidence that brief interventions increased psychological distress or had an adverse effect on general health. We conclude that, among long-term BZD users considered by GPs to be suitable to receive advice encouraging them to cut down BZD intake, brief intervention, either in the form of the offer of a short consultation or a letter from the patient's GP, is effective in leading to reduced BZD intake without adverse consequences.

Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis

“…17,18 There was an observed 20-35% reduction in the intervention group compared to the control group (10-15%). The standard deviation of proportional reduction was only available for two studies, 17,18 and is summarised in Table 2.…”

“…In the study by Heather et al, there was no significant difference between study groups on the SF-36 overall scores. 18 However, there was a significant difference in changes on the SF-36 subscore ('mental') in patients who had undergone a true reduction and those who had not (χ 2 = 7.0; P = 0.008), with 'true reducers' showing a mean increase of 5.4, compared to a decline of 2.2 in those who were not 'true reducers'. Similarly, there was no significant change in GHQ-total score between follow-up and initial assessment, nor any significant differences between groups in relation to changes in somatic symptoms, anxiety, or insomnia (on GHQ subscales).…”

“…Fifteen potentially useful full-text articles were retrieved for further evaluation, and only three papers that fulfilled the main inclusion criteria were finally included for review. [16][17][18] Two of these trials were threearm studies that included two active interventions. Hence, five interventions were available (Figure 1).…”

“…Cormack et al -letter only (1994) 17 Cormack et al -letter + follow-up (1994) 17 Heather et al -letter only (2004) 18 Heather et al …”

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross‐site evaluation

“…Further, although SBI for at-risk drug use has not been studied as extensively as at-risk alcohol use [14], earlier clinical studies provide some evidence that SBI may be effective in decreasing at-risk drug use. For example, SBI has been demonstrated to be effective for decreasing subsequent cocaine and heroin use [15], cannabis use [16], amphetamine use [17] and benzodiazepine use [18,19].…”