Objective determination of benzodiazepine use and abuse in alcoholics
The extent of concurrent use and abuse of benzodiazepines and alcohol in alcoholics is not known. Prospective data collected on 216 consecutive outpatient referrals between 1 June and 31 July 1981 (age range, 16 to 70 years, 75 per cent men) showed that benzodiazepines were detected in the urine of 33 per cent of patients undergoing medical assessment. Other drugs identified in urine were ethanol (5.0%), codeine (1.99%) and barbiturates (1.5%). According to patient histories, the predictive value of benzodiazepine allegation was high for positive and negative allegation (0.87 and 0.83, respectively), indicating that patients reliably report benzodiazepine use if questioned. However, only one patient considered himself to be a benzodiazepine abuser. The proportion of women with a positive test for benzodiazepines (48%) was significantly higher than that of men (28%; χ2 = 7.7; p < 0.005). Among patients alleging use of benzodiazepines (n = 61), 54 per cent obtained the drug directly by prescription while 46 per cent obtained it indirectly (e.g. a relative, illicit source). Benzodiazepines were taken most frequently for anxiety (53%) and occasionally for alcohol withdrawal (10%). Forty-seven (54%) of the patients could be considered abusers of benzodiazepines (i.e. indirect source and/or cumulative drug exposure of >2700 mg of diazepam or equivalent and a positive urine test). These results indicate that benzodiazepines are very commonly used and abused by alcoholics. Treatment programmes for alcoholics should identify such patients, consider directing treatment toward control of benzodiazepine use, and monitor changes in benzodiazepine use during and after treatment.
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