Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions.
BACKGROUND
Long-term low-dosage dependence on benzodiazepines in traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence.


METHODS
Patients receiving long-term low-dosage benzodiazepines in primary care were asked to take a drug-holiday of at least 3 weeks. Sociodemographic, medication, morbidity and attitudinal variables were assessed in addition to the GPs' perceptions of their patients.


RESULTS
Two-thirds of the patients rejected the drug-holiday proposal. Patients who refused a drug-holiday were less educated and were using a higher percentage of long-acting benzodiazepines than patients who accepted the drug-holiday proposal. Those who refused were seen by their GPs as being more complaining, harder to satisfy and less co-operative.


CONCLUSIONS
These results provide evidence for drug-seeking or craving behaviour of patients who receive low-dosage benzodiazepine prescriptions. A major problem in benzodiazepine withdrawal occurs before the withdrawal programme has even begun. These data show that benzodiazepine low-dosage dependence should be considered a real form of dependence.
Linden
M
M
Department of Psychiatry, Free University of Berlin, Germany.
Bär
T
T
Geiselmann
B
B
D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000009:adverse effects; D001294:Attitude to Health; D001569:Benzodiazepines; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009460:Neurologic Examination / Q000187:drug effects; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010348:Patient Care Team; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology* / Q000534:rehabilitation; D016312:Treatment Refusal / Q000523:psychology
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines