2003 Study: "Tapering off long-term benzodiazepine use...."

This study from The Netherlands provides some interesting information about tapering off benzodiazepines. One thing I noticed is how few people participated in and completed the program. That alone tells us how reluctant people can be to stop these medications and how difficult it is to do so.

 

Here's the section where the numbers are explained:

 

"Study profile"

 

"Of the 2964 persons identified as long-term users of benzodiazepines, 2004 were advised to stop their benzodiazepine use; 1036 were eligible for the trial ( Fig. 1). The participation rate was low: 180 out of 1036 (17.4%). Participants (n=180) and non-participants (n=876) did not differ with respect to age, gender or benzodiazepine dosage used. Of the 146 participants assigned to one of the withdrawal programmes, 23 discontinued their benzodiazepine use while waiting for the intervention to begin. In order to start therapy groups with at least 4 participants, the mean (s.d.) delay between baseline assessment and intervention was 71 (45) days (range 0–223 days). Thirty-nine participants refused to take part in the outcome assessment. The numbers leaving the study at this stage did not differ significantly across the three groups (χ2=1.85, d.f.=2, P=0.40). Of the 85 participants compliant with the entire intervention programme (tapering off alone or tapering off with group CBT), 78 were assessed at outcome."

 

 

There are many other aspects of the study that make it an interesting read for those who want the details. I noted that the tapering schedule used in the study was faster than Ashton's, and that may have made it more difficult for people. The CBT groups were appreciated by the participants but limited in number, so I find it hard to assess whether CBT is truly useful or not from this study. Nevertheless, it's one of the main questions posed by the study. Also, the best results were found with people taking the equivalent of 10 mg of diazepam or less, so that could have been a big factor. Perhaps a slower taper would have allowed others with higher starting dosages to be successful too.

 

If you read it, I'd be interested to hear your thoughts as well.

 

Here's the link to the full study:

 

http://bjp.rcpsych.org/content/182/6/498

 

Hi Lapis

 

That was interesting. Participation was low.  Wonder if a letter is the best way to recruit for this sort of thing.  Also the authors do say that the fact it was a trial might put people off.  If a doctor suggests tapering during a routine consultation and discusses the pros and cons for that patient it might be better. I don't know.  I certainly did not want to come off nitrazepam after 40 years because I was scared. If I had received a letter in the post I may well have said "no".

 

The number of CBT sessions were few so maybe that is why they did not prove more effective than tapering alone.  It does not mean that CBT will never be useful. 

 

Thanks for all your hard work.

 

LF

 

 

Hi LF,

Perhaps we could design a better program to help people off benzodiazepines! I think the study definitely had limitations, and I do think that the way information is communicated to people can make a big difference. I remember talking to a pharmacist who said that people didn't want to "give up" their beloved benzos, if he ever did talk to them about it. But let's say that someone is told that they'll be supported and helped throughout the process, and the understand how to go about it and what to expect, and if they know WHY they should go off the medications, then perhaps the outcomes can be better.

Wow, Lapis, the study is revealing. These drugs are so hard to come off. I bet a lot of their doctors told them there was no need to come off too. I find when I talk to people about coming off of benzos there are those who are concerned and interested and then a larger group that doesn't see the need and feels like they wouldn't be Ok without the effects. Nothing I say seems to make much difference in those cases so I don't push. I know I didn't see the need at all until I hit tolerance wd. So naive.

There's SO much controversy about this whole issue. Some people want to take them forever, while some want to get off. Some doctors think they're fine, while others know that they're problematic. There's confusion about the facts, and individual genetics determine how people react to anything they take anyway. It's not cut and dried. I'm just glad we found the info that we needed to make good decisions about our health and how to get off these medications safely. We can feel grateful for that.