Psychological Medicine

Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions

M. LINDEN a1c1, T. BÄR a1 and B. GEISELMANN a1
a1 From the Outpatient Research Group, Department of Psychiatry of the Free University of Berlin, Berlin, Germany


Background. Long-term low-dosage dependence on benzodiazepines is traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence.

Methods. Patients receiving long-term low-dosage benzodiazepines in primary care were asked to take a drug-holiday of at least 3 weeks. Sociodemographic, medication, morbidity and attitudinal variables were assessed in addition to the GPs' perceptions of their patients.

Results. Two-thirds of the patients rejected the drug-holiday proposal. Patients who refused a drug-holiday were less educated and were using a higher percentage of long-acting benzodiazepines than patients who accepted the drug-holiday proposal. Those who refused were seen by their GPs as being more complaining, harder to satisfy and less co-operative.

Conclusions. These results provide evidence for drug-seeking or craving behaviour of patients who receive low-dosage benzodiazepine prescriptions. A major problem in benzodiazepine withdrawal occurs before the withdrawal programme has even begun. These data show that benzodiazepine low-dosage dependence should be considered a real form of dependence.

c1 Address for correspondence: Professor M. Linden, Outpatient Research Group, Department of Psychiatry, Free University of Berlin, Eschenallee, 3, 14050 Berlin, Germany.