title: Strategies for discontinuing long-term benzodiazepine use: meta-analysis.
abstract: BACKGROUND
  The prevalence of benzodiazepine consumption in European countries remains at 2-3% of the general population despite the well-documented disadvantages of long-term use.
  
  
  OBJECTIVE
  To review systematically the success rates of different benzodiazepine discontinuation strategies.
  
  
  METHODS
  Meta-analysis of comparable intervention studies.
  
  
  RESULTS
  Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6-5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0-18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1-9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3-14.2) was superior to systematic discontinuation alone.
  
  
  CONCLUSIONS
  Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.
authors.affiliation: Department of Psychiatry, Radboud University Nijmegen Medical Center, The Netherlands.
authors.forename: Richard C Oude
authors.initials: RC
authors.lastname: Voshaar
authors.forename: Jaap E
authors.initials: JE
authors.lastname: Couvée
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: van Balkom
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines