title: Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study.
abstract: BACKGROUND
  High-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients' failing discontinuation treatment. While there is some data supporting its effectiveness, patients' perceptions of such an intervention have not been investigated.
  
  
  METHODS
  An exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings.
  
  
  RESULTS
  Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: "Only if I can try to discontinue…and please don't call it that," "More stability and less criminal activity…and that is why I would try it," and "No cure, no brain and no flash…and thus, just for everybody else!"
  
  
  CONCLUSIONS
  Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
authors.affiliation: Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Bern, Switzerland. Michael.Liebrenz@fpd.unibe.ch.|Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Michael.Liebrenz@fpd.unibe.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebrenz
authors.affiliation: Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland. marcelandre.schneider@gmail.com.
authors.forename: Marcel
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Anna.Buadze@puk.zh.ch.
authors.forename: Anna
authors.initials: A
authors.lastname: Buadze
authors.affiliation: Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. marie-therese.gehring@diealternative.ch.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Gehring
authors.affiliation: University of Pennsylvania Health System, Philadelphia, USA. Anish.Dube@gmail.com.
authors.forename: Anish
authors.initials: A
authors.lastname: Dube
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Carlo.Caflisch@puk.zh.ch.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caflisch
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D001569:Benzodiazepines / Q000819:agonists*; D003415:Crime; D003692:Delayed-Action Preparations; D003975:Diazepam / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D057566:Self Report; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D013287:Illicit Drugs; D001569:Benzodiazepines; D003975:Diazepam