Predictors of the incidence and discontinuation of long-term use of benzodiazepines: A population-based study

Division of Mental Health and Addiction Medicine, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Rd., Zhunan, Miaoli County 350, Taiwan.
Drug and alcohol dependence (Impact Factor: 3.42). 07/2009; 104(1-2):140-6. DOI: 10.1016/j.drugalcdep.2009.04.017
Source: PubMed


Long-term use of benzodiazepines (BZDs) has been linked with an array of negative health consequences and increased medical costs and social burden. In this study, we sought to investigate the factors accounting for differential risks in the process from incident BZD use to long-term use and discontinuation in the general population. On the basis of a random sample of 187,413 people enrolled in Taiwan's National Health Insurance program on January 1, 2000, data of 2000-2002 healthcare and pharmacological services utilization were retrieved. Long-term use (LTU) was defined by having received BZD prescriptions for 180 or more days within any given calendar year. Multivariate logistic regression analyses were carried out to assess the strength of associations while adjusting for the effects of individual sociodemographics, service providers, and pharmacological agents simultaneously. Results indicated that males, elderly, and those with physical or mental disorders were more likely to become long-term users of BZDs. Having received BZD prescriptions in multiple pharmacological agents, short-acting or mixed-type agents, and hypnotic indication were associated with a roughly 2- to 5-fold increased risk of BZD LTU soon after prescription initiation. With respect to discontinuation, the effects of pharmacological characteristics seem more salient as compared to those of individual and service-provider factors. Future strategies targeting individual factors and modifying service-provider prescription behaviors may be considered to reduce possible negative consequences of BZD LTU.

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Available from: Chuan-Yu Chen, Mar 18, 2015
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    • "The volume of the initial or overall BZD prescriptions (measured by units or by the overall prescribed dosage) was an important predictor of long-term use (Table 5). Long-term use was also more common if the patient received prescriptions for more than one BZD concurrently [50] [66]. Studies comparing initial and previous BZD users found that previous BZD use was more frequently associated with later long-term use [35] [52] [56] [57]. "
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    ABSTRACT: Background: Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. Methods: Systematic review of register-based studies on long-term BZD use published in 1994-2014. Results: Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. Conclusions: Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
    European Psychiatry 11/2015; 30(8):1037–1047. DOI:10.1016/j.eurpsy.2015.09.003 · 3.44 Impact Factor
    • "Female patients showed a greater reduction of QoL compared to males, at least in some of the explored items. This observation is in line with previous reported data, at least for a higher prevalence of BZD dependence among females (Lader, 2011; Fang et al., 2009; Petitjean et al., 2007). "
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    ABSTRACT: Morbidly obesity is characterized by physical and psychological comorbidities which are associated with reduced quality of life. Bariatric surgery has been linked to a reduction of psychopathology other than to a reduction of weight and improvement in physical functioning. Aim of the present study was to compare psychological features of two groups of morbidly obese patients, before and after bariatric surgery, assessing social phobia and quality of life. A total of 46 morbidly obese patients were enrolled in the study. Of them, 20 were waiting for bilio-pancreatic diversion (group A), while 26 had already undergone surgical procedure (group B). Psychometric evaluation assessed social phobia, fear for the body-shape and quality of life, using appropriate psychometric tests. The percentage of patients showing social phobia was significantly higher compared to a sample of healthy controls (p=0.004), both in group A (p=0.003) and in group B (p=0.029). No differences in percentage of patients affected by social phobia were found between groups. A significantly higher percentage of patients affected by distress about the body (p<0.0001) was found in group A with respect to group B. A reduction of quality of life was found in both groups. The present study shows a high prevalence of social phobia in a population of morbidly obese patients, both before and after surgery. A general reduction of quality of life was also observed, with a partial improvement after surgery. Future studies are needed to clarify the relationship between social phobia and quality of life in surgically-treated morbidly obese patients. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 179:95-100. DOI:10.1016/j.jad.2015.03.030 · 3.38 Impact Factor
    • "Prevalence of benzodiazepine (BZD) use among individuals aged 65 and over varies between 10% and 42% (Madhusoodanan & Bogunovic, 2004). Long-term use, in addition to old age, is related to depressive symptoms and insomnia (Dealberto, Seeman, McAvay, & Berkman, 1997; Isacson, 1997; Luijendijk, Tiemeier, Hofman, Heeringa, & Stricker, 2008), as well as other comorbid physical and psychological health problems (Fang et al., 2009). The usage increases with age (Jorm, Grayson, Creasey, Waite, & Broe, 2000; Pr eville et al., 2012), even after controlling for physical and mental health (Pr eville, H ebert, Boyer, & Bravo, 2001), including individuals aged over 75 (Johnell & Fastbom, 2009). "
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    ABSTRACT: Objectives: Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia despite their documented side effects over time. Method: We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis. Results: Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individual's perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed. Conclusion: We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.
    Aging and Mental Health 03/2015; DOI:10.1080/13607863.2015.1015961 · 1.75 Impact Factor
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