Psychological strategies for discontinuing benzodiazepine treatment

Successful discontinuation of therapeutic drugs requires patients to negoti ate two potentially difficult phases, First, they must complete the drug di scontinuation procedure itself, which may entail coping with rebound and wi thdrawal symptoms as well as anxiety due to stopping a treatment on which t hey depend psychologically, Second, they must maintain drug abstinence over time, despite possible exacerbations or recurrences of the disorder that t he drug was treating. For optimal success, interventions aimed at assisting patients to discontinue drug use must address both of those tasks, Patient s' ability to discontinue benzodiazepines seems to be strongly influenced b y cognitive appraisals of the threat represented by symptoms and of their o wn competence to cope with it without medication. For problems of that kind , cognitive and behavioral techniques such as those developed for the treat ment of panic disorder may be especially well-suited. Currently, the most s uccessful approaches to benzodiazepine discontinuation include the followin g components: (1) assisting with initial drug discontinuation, educating pa tients about benzodiazepine dependence and withdrawal, and about the kinds of symptoms that can emerge as the drug dose is decreased, combined with a flexible drug taper conducted in supportive collaboration with the patient; and (2) dealing with exacerbations of the illness, and providing disorder- specific cognitive-behavioral treatment as an alternative to the resumption of pharmacotherapy, It seems to be crucial that the drug taper be complete d before psychological treatment concludes.