THE TREATMENT OF BENZODIAZEPINE DEPENDENCE

Withdrawal of benzodiazepines is currently advised for long-term benzo diazepine users because of doubts about continued efficacy, risks of a dverse effects, including dependence and neuropsychological impairment and socio-economic costs. About half a million people in the UK may n eed advice on withdrawal. Successful withdrawal strategies should comb ine gradual dosage reduction and psychological support. The benzodiaze pine dosage should be tapered at an individually titrated rate which s hould usually be under the patient's control. The whole process may ta ke weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepines. Adjuvant medication may occasionally be required (an tidepressants, propranolol) but no drugs have been proved to be of gen eral utility in alleviating withdrawal-related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the p rovision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non-pharmac ological ways of coping with stress. For many patients the degree of s upport required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to with draw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, ra te of withdrawal, symptom severity, psychiatric history or personality disorder. Longer-term outcome is less clear; a considerable proportio n of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved b y careful pharmacological and psychological handling of withdrawal and post-withdrawal phases.