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.


METHODS
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.
Voshaar
Richard C Oude
RC
Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands. r.oudevoshaar@psy.umcn.nl
Gorgels
Wim J
WJ
Mol
Audrey J
AJ
van Balkom
Anton J
AJ
Mulder
Jan
J
van de Lisdonk
Eloy H
EH
Breteler
Marinus H
MH
Zitman
Frans G
FG
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000523:psychology; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003975:Diazepam / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology; D016016:Proportional Hazards Models; D011615:Psychotherapy, Group; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D003975:Diazepam