title: High-dose benzodiazepine dependence: a qualitative study of patients' perception on cessation and withdrawal.
abstract: BACKGROUND
  Benzodiazepine withdrawal syndrome has been reported following attempts to withdraw even from low or therapeutic doses and has been compared to barbiturate and alcohol withdrawal. This experience is known to deter patients from future cessation attempts. Research on other psychotropic substances shows that the reasons and motivations for withdrawal attempts - as well as the experiences surrounding those attempts - at least partially predict future efforts at discontinuation as well as relapse. We therefore aimed to qualitatively explore what motivates patients to discontinue this medication as well as to examine their experiences surrounding previous and current withdrawal attempts and treatment interventions in order to positively influence future help-seeking behavior and compliance.
  
  
  METHODS
  To understand these patients better, we conducted a series of 41 unstructured, narrative, in-depth interviews among adult Swiss patients with a long-term dependent use of benzodiazepines in doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use (mixing benzodiazepines, escalating dosage, recreational use or illegal purchase). Mayring's qualitative content analysis was used to evaluate findings.
  
  
  RESULTS
  These high-dose benzodiazepine-dependent patients decision to change consumption patterns were affected by health concerns, the feeling of being addicted and social factors. Discontinuation attempts were frequent and not very successful with fast relapse. Withdrawal was perceived to be a difficult, complicated, and highly unpredictable process. The first attempt at withdrawal occurred at home and typically felt better than at the clinic. Inpatient treatment was believed to be more effective with long term treatment (approaches) than short term. Patients preferred gradual reduction of usage to abrupt cessation (and had experienced both). While no clear preferences for withdrawal were found for benzodiazepines with specific pharmacokinetic properties, participants frequently based their decision to participate in treatment on the availability of their preferred brand name and furthermore discarding equivalent dosage rationales.
  
  
  CONCLUSIONS
  Our findings provide greater understanding of the factors that motivate high-dose benzodiazepine-dependent individuals to stop taking these medications, and how they experience withdrawal and treatment strategies. They underscore how patients' perceptions of treatment approaches contribute to compliant or non-compliant behavior.
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA. Michael.Liebrenz@uzh.ch.|Psychiatric University Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland. Michael.Liebrenz@uzh.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebrenz
authors.affiliation: Klinik Im Hasel AG, Hasel 837, 5728, Gontenschwil, Switzerland. MGehring@klinikimhasel.ch.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Gehring
authors.affiliation: Psychiatric University Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland. Anna.Buadze@puk.zh.ch.
authors.forename: Anna
authors.initials: A
authors.lastname: Buadze
authors.affiliation: Psychiatric University Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland. Carlo.Caflisch@puk.zh.ch.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caflisch
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D036301:Qualitative Research; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines