Spurred by reports in 1980 detailing the ineffectiveness of long-term treatment with benzodiazepines, the authors of this volume began a study to investigate the reasons behind the addiction, quickly adopting a psychological approach to treatment. In testing the efficacy of anxiety management techniques as an alternative to benzodiazepine use, Drs. Cormack, Owen and Dewey strongly emphasize the importance of the working relationship between the general practitioner and the psychologist. Reducing Benzodiazepine Consumption offers management solutions for the clinician in treating patients suffering from addiction to these drugs.
Table of ContentsOne: Background to the Study.- Literature Review.- 1. Introduction.- 2. The Benzodiazepines.- 2.1 History of the benzodiazepines.- 2.2 Pharmacological action of the benzodiazepines.- 2.3 Different types of benzodiazepines.- 2.4 The therapeutic effect of the benzodiazepines.- a) Use as anxiolytics.- b) Use as hypnotics.- c) Benzodiazepines as therapy for depression.- d) Use of benzodiazepines in physical illness.- e) Paradoxical drug reactions.- 2.5 Effects of benzodiazepines on performance.- a) Effects in normal and anxious subjects.- b) Decrements produced by hypnotics.- c) Cognitive impairments.- d) Effects on the elderly.- 3. Prescribing.- 3.1 Trends in prescribing.- 3.2 Extent of use of the benzodiazepines.- 3.3 Sex differences in the use of benzodiazepines.- 3.4 Benzodiazepine consumption in the elderly.- 3.5 Class and employment differences in benzodiazepine use.- 3.6 Reasons for the prescription.- 3.7 Repeat prescribing.- 3.8 Expectations of patients.- 4. Dependence.- 4.1 Definitions of dependence.- 4.2 Tolerance.- 4.3 Withdrawal.- 4.4 Characteristics of long-term users of benzodiazepines.- 5. Alternatives to Benzodiazepine Medication.- 5.1 Psychological therapy as an alternative to medication.- 5.2 Changes in patterns of long-term use of benzodiazepines.- 6. Summary.- Two: A Study of Drug Reduction.- Aims of the Research.- Outline of the Study.- 1. General Practitioner Intervention.- 1.1 Population.- 1.2 Identification of the sample.- 1.3 Criteria for selection of the patients.- 1.4 The practices.- 1.5 The experiment.- 1.6 Allocation of patients to groups.- 1.7 Interventions.- a) Letter.- b) Interview.- c) Control.- 1.8 Calculation of tablet equivalence.- 2. Interview with the Psychologist.- 3. Group Work in Psychological Alternatives.- 3.1 Contracts.- 3.2 Duration of the group.- 3.3 Content of group work.- 3.4 Homework tasks.- 3.5 Tablet withdrawal.- 3.6 Application of strategies.- 4. Summary.- Results.- 1. Subjects.- 1.1 Characteristics of subjects and practices.- 1.2 Age of the sample.- 2. Medication.- 2.1 Duration of medication.- 2.2 Baseline number of tablets.- 3. The Practices.- Description of the practices.- 4. Groups.- 4.1 Allocation of subjects to groups.- 4.2 Differences among the groups.- 4.3 Allocation of control subjects to intervention groups.- 4.4 Summary.- 5. Analysis of Change Over Time in Drug Taking.- 5.1 Control group.- 5.2 Intervention groups.- 5.2.1 Changes over the first six months.- 5.2.2 Comparison of baseline with months seven to twelve of monitoring.- 5.2.3 Comparison of baseline with consumption in the second year of monitoring.- 6. Occurrence of Major Change.- 6.1 Changes over the second six months.- 6.2 Comparison of consumption in months seven to twelve with the second year of monitoring.- 7. Factors Relating to Successful Drug Reduction.- 7.1 Differences between the successful subjects and those not successful.- 7.2 Other factors related to success.- 8. The Psychology Interview.- 8.1 Numbers of patients attending the psychology interview.- 8.2 Differences between attenders and non-attenders.- 8.3 Time of day tablets taken.- 8.4 Strategies employed to reduce medication.- 8.5 Factors linked to successful stopping of medication.- 8.6 Summary.- 9. General Summary of Findings.- 10. Group Psychological Therapy.- 10.1 Formation of the groups.- 10.2 Changes in consumption over the course of the group.- 10.3 Summary of changes in other medication.- 10.4 Summary of outcome of group therapy.- 10.5 Strategies employed by the group members for tablet reduction.- 10.6 Summary.- Discussion.- 1. Sex-ratio of Subjects.- 2. Age of Subjects.- 3. Baseline Tablet Consumption.- 4. Group Differences.- 5. Low Attendance at the Psychology Interview.- 6. Lack of Interest in Group Therapy.- 7. Withdrawal from Diazepam and Lorazepam.- 8. Differences in Success When Taking Single or Combined Benzodiazepines.- 9. Reasons for the Success of the Doctors’ Interventions.- 10. Effect of a Decrease in Benzodiazepines on Alcohol and Tobacco Consumption.- 11. Differences Between the Factors Leading to the Initial Prescription of Benzodiazepines and Those Which Maintained the Drug Consumption.- 12. Strategies Devised by the Patients Leading to Success in Stopping Medication.- 13. Effect of the Group Psychological Therapy on Tablet Consumption.- 14. Components of the Psychological Therapy Which Were Most Useful for Patients.- Comments on the Work.- 1. Methodological Considerations of the Present Study.- 1.1 Limitations of the interview data.- 1.2 Future expansion of the interview.- 1.3 Control of medication in the hospital groups.- 2. Implications of the Study.- 2.1 Benefits for the patients.- 2.2 Cost benefits.- 3. Future Work.- 3.1 The use of bibliotherapy.- 3.2 Expansion of inclusion criteria.- 3.3 Psychology contribution.- References.