Elsevier

Addictive Behaviors

Volume 29, Issue 3, May 2004, Pages 583-593
Addictive Behaviors

Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: A replication

https://doi.org/10.1016/j.addbeh.2004.01.001Get rights and content

Abstract

The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up.

Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.

Introduction

Research in the benzodiazepine (BZD) field points to the influence of psychological factors on withdrawal difficulties and relapse Bélanger et al., 1999, Murphy & Tyrer, 1991, O'Connor et al., 1999, Rickels et al., 1990, Rickels et al., 1986, Schweizer et al., 1990, Schweizer et al., 1998, Tyrer et al., 1983. Psychological differences might explain why some patients do and others do not experience difficulties stopping BZDs, but empirical support on the influence of psychological factors is still scarce. A previous study (O'Connor et al., 1999) examined psychological distress and adaptational problems associated with the discontinuation of BZD. A profile of those likely to experience psychological distress emerged from a multiple regression and correspondence analysis (CA), which indicated that participants with higher neuroticism, higher negative life events, lower quality of life, lower education level, and younger age group clustered together, with a higher reported level of distress.

This previous study (O'Connor et al., 1999) used a cross-sectional design, with measures taken at one point in time, calculated to capture the maximum effect of withdrawal, 2–14 days after cessation. The present study aimed to replicate and extend these previous findings by administering the same psychosocial measures to a group of patients before, during, and after BZD withdrawal. We hypothesized that the same profile of psychosocial measures that had previously characterized psychological distress would, also, in the current study be associated with poorer outcome and greater severity of withdrawal symptoms.

Section snippets

Method

Forty-one participants receiving maintenance BZD therapy for at least 8 weeks, who wished to discontinue BZD use, entered the trial. The patients were all recruited either through clinician referrals or adverts in local media. After a telephone screening, patients were referred for ADIS-IV evaluation, administered by collaborating psychiatrists. The patients had to meet the following criteria: (1) be aged between 18 and 65 years old; (2) be using BZDs as an anxiolytic or hypnotic drug regularly

Analysis

Univariate analyses were performed to assess the impact of the sociodemographic, pharmacological, and psychological variables on the end-point measures. Differences between the success and failure groups and between the two and less and the three and more BWSQ withdrawal complaint groups were assessed through proportion comparisons using chi-square test, or Fisher's Exact Test when needed, one-way analysis of variance, or comparisons of means using unpaired Student t tests, adjusted for

Results

Analysis was conducted on 41 participants, of whom 8 abandoned. Unfortunately, follow-up data were, by definition, not available on those who abandoned, hence, further quantitative analysis was completed on 33 participants in each group. Those who abandoned were less likely to be married (14.3% vs. 66.7%; P<.04). There was a nonsignificant (P<.06) tendency for those who abandoned to be taking more short- than long-acting BZD. Among the 8 who abandoned, 7 were taking short-acting medication.

Discussion

The results replicated the relationship previously reported between psychosocial factors and psychological distress during discontinuation (O'Connor et al., 1999). The profiles of baseline measures characterizing the high levels of psychological distress in the first study were similarly associated with the psychological distress in the current study, that is, low quality of life, low social support, high neuroticism, and high behavioural inhibition. Furthermore, low levels of psychological

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