title: Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of current treatment approaches to assist benzodiazepine discontinuation.
  
  
  METHODS
  A systematic review of approaches to benzodiazepine discontinuation in general practice and out-patient settings was undertaken. Routine care was compared with three treatment approaches: brief interventions, gradual dose reduction (GDR) and psychological interventions. GDR was compared with GDR plus psychological interventions or substitutive pharmacotherapies.
  
  
  RESULTS
  Inclusion criteria were met by 24 studies, and a further eight were identified by future search. GDR [odds ratio (OR) = 5.96, confidence interval (CI) = 2.08-17.11] and brief interventions (OR = 4.37, CI = 2.28-8.40) provided superior cessation rates at post-treatment to routine care. Psychological treatment plus GDR were superior to both routine care (OR = 3.38, CI = 1.86-6.12) and GDR alone (OR = 1.82, CI = 1.25-2.67). However, substitutive pharmacotherapies did not add to the impact of GDR (OR = 1.30, CI = 0.97-1.73), and abrupt substitution of benzodiazepines by other pharmacotherapy was less effective than GDR alone (OR = 0.30, CI = 0.14-0.64). Few studies on any technique had significantly greater benzodiazepine discontinuation than controls at follow-up.
  
  
  CONCLUSIONS
  Providing an intervention is more effective than routine care. Psychological interventions may improve discontinuation above GDR alone. While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use.
authors.affiliation: School of Medicine, University of Queensland, Herston, Queensland, Australia.
authors.forename: Jannette M
authors.initials: JM
authors.lastname: Parr
authors.forename: David J
authors.initials: DJ
authors.lastname: Kavanagh
authors.forename: Lareina
authors.initials: L
authors.lastname: Cahill
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.forename: Ross
authors.initials: R
authors.lastname: McD Young
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines