title: High-Dose Benzodiazepine Dependence: A Qualitative Study of Patients' Perceptions on Initiation, Reasons for Use, and Obtainment.
abstract: BACKGROUND
  High-dose benzodiazepine (BZD) dependence is associated with a wide variety of negative health consequences. Affected individuals are reported to suffer from severe mental disorders and are often unable to achieve long-term abstinence via recommended discontinuation strategies. Although it is increasingly understood that treatment interventions should take subjective experiences and beliefs into account, the perceptions of this group of individuals remain under-investigated.
  
  
  METHODS
  We conducted an exploratory qualitative study with 41 adult subjects meeting criteria for (high-dose) BZD-dependence, as defined by ICD-10. One-on-one in-depth interviews allowed for an exploration of this group's views on the reasons behind their initial and then continued use of BZDs, as well as their procurement strategies. Mayring's qualitative content analysis was used to evaluate our data.
  
  
  RESULTS
  In this sample, all participants had developed explanatory models for why they began using BZDs. We identified a multitude of reasons that we grouped into four broad categories, as explaining continued BZD use: (1) to cope with symptoms of psychological distress or mental disorder other than substance use, (2) to manage symptoms of physical or psychological discomfort associated with somatic disorder, (3) to alleviate symptoms of substance-related disorders, and (4) for recreational purposes, that is, sensation-seeking and other social reasons. Subjects often considered BZDs less dangerous than other substances and associated their use more often with harm reduction than as recreational. Specific obtainment strategies varied widely: the majority of participants oscillated between legal and illegal methods, often relying on the black market when faced with treatment termination.
  
  
  CONCLUSIONS
  Irrespective of comorbidity, participants expressed a clear preference for medically related explanatory models for their BZD use. We therefore suggest that clinicians consider patients' motives for long-term, high-dose BZD use when formulating treatment plans for this patient group, especially since it is known that individuals are more compliant with approaches they perceive to be manageable, tolerable, and effective.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.|Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebrenz
authors.affiliation: Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Buadze
authors.affiliation: Ulmenhof, Sozialtherapie, Ottenbach, Switzerland.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Gehring
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States of America.
authors.forename: Anish
authors.initials: A
authors.lastname: Dube
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caflisch
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D018755:GABA Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D014151:Anti-Anxiety Agents; D018755:GABA Agonists; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines