The treatment of sedative-hypnotic dependence: evaluating clinical predictors of outcome.
BACKGROUND
The objectives of this 6-month prospective study were to evaluate the efficacy of detoxification treatment for sedative-hypnotic dependence, examine the demographic and clinical predictors of outcome, and determine whether anxiety or other psychiatric comorbidity has a negative impact on outcome.


METHODS
Eighty-two patients with alcohol or benzodiazepine dependence (DSM-IV diagnostic criteria) were consecutively recruited upon entering treatment and were assessed by clinical and semistructured interviews, the Global Assessment Scale, the Hamilton Rating Scale for Depression, the Beck Depression Inventory, the revised 90-item Symptom Checklist, and urine drug screening.


RESULTS
Both alcohol- and benzodiazepine-dependent patients succeeded in reducing their reported use of sedative-hypnotic substances during the follow-up period. However, at 3 months, benzodiazepine-dependent patients fared less well than alcohol-dependent patients in terms of several outcome measures: they reported a lower rate of achieving abstinence, shorter periods of continuous abstinence, and more frequent drug use. At 6 months, the differences in outcome among the drug groups were not maintained. Variables such as sex, drug group, and indicators of psychiatric status had little impact on outcome measures. Benzodiazepine-dependent patients reported significant decreases in their level of anxiety over the follow-up period despite substantial reductions in benzodiazepine use.


CONCLUSIONS
Clinicians may be encouraged regarding the detoxification of patients who have used benzodiazepines at high doses or for long periods of time, or who have comorbid anxiety or other psychiatric disorders.
Charney
D A
DA
Montreal General Hospital and the Department of Psychiatry, McGill University, QC, Canada.
Paraherakis
A M
AM
Gill
K J
KJ
D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000534:rehabilitation*; D001569:Benzodiazepines / Q000009:adverse effects*; D002998:Clonazepam / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003975:Diazepam / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D002998:Clonazepam; D003975:Diazepam