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Cited by 24Substance Abuse Treatment and OutcomesPharmaceutical Practices and Patient OutcomesBehavioral Health and Interventions

'I just thought that it was such an impossible thing': A qualitative study of barriers and facilitators to discontinuing long-term use of benzodiazepine receptor agonists using the Theoretical Domains Framework

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Lynch, Tom, Ryan, Cristín, Cadogan, Cathal A.·2022·Health Expectations
DOI 10.1111/hex.13392PMC PMC8849267
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Abstract

INTRODUCTION: Existing interventions to reduce long-term benzodiazepine receptor agonist (BZRA) use lack theoretical underpinning and detailed descriptions. This creates difficulties in understanding how interventions work and how to replicate them in practice. The Theoretical Domains Framework (TDF) can be used to identify behaviour change determinants to target during intervention development. OBJECTIVE: To explore barriers and facilitators to discontinuing BZRA use from the perspective of both current and previous long-term BZRA users. DESIGN/SETTING AND PARTICIPANTS: Semistructured TDF-based interviews were conducted with community-based individuals with current or previous experience of long-term BZRA use. Data were recorded, transcribed and analysed using the framework method. RESULTS: Twenty-eight individuals were interviewed. Despite commonalities in perceived barriers/facilitators to discontinuing BZRA use within individual TDF domains, individual participants had different experiences of identified determinants of BZRA discontinuation. For example, both similarities and differences existed within and between each participant group in terms of knowledge of the appropriate duration of BZRA use ('Knowledge' domain) and experience of withdrawal symptoms ('Reinforcement' domain). Compared to previous users, current users typically anticipated more barriers to discontinuing BZRA use and fewer positive consequences of discontinuation. CONCLUSION: This study reports on barriers and facilitators to discontinuing BZRA use from the perspectives of current and previous long-term users. The findings highlight the challenging nature of BZRA discontinuation and a multitude of barriers that impact participants' behaviour regarding BZRA use. Future work will involve developing a theory-based intervention to support BZRA discontinuation in primary care. PATIENT CONTRIBUTION: The study included patients as participants.

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  • Brief interventions in primary-care settings are significantly more effective than standard care for discontinuing BZD/Z-drug use at 6 months (RR=2.73; 95%CI 1.84-4.06) and 12 months (RR=3.41; 95%CI 2.22-5.25).

    “Patients who received these interventions were more likely to discontinue BZD/Z-drug use at 6 months (risk ratio [RR] = 2.73; 95%CI = 1.84–4.06) and 12 months (RR = 3.41; 95%CI = 2.22–5.25). 72”

    From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [72]

    The Introduction (page unavailable) says brief interventions have demonstrated effectiveness in reducing and discontinuing long-term BZD/Z-drug use at 6–12 months. It does not give the claimed risk ratios or confidence intervals, or explicitly compare the interventions with standard care. The paper reports this as background evidence, not as a result of its qualitative study. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • CBT-I has been investigated as a therapeutic strategy to support hypnotic deprescription, including Z-drugs.

    “CBT-I has also been investigated 72 73 74 75 76 77 78 79 as a therapeutic strategy to support hypnotic deprescription, including Z-drugs.”

    From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [72]

    The Introduction (page not provided) reports that CBT combined with gradual dose reduction has been investigated for reducing BZRA use, and defines BZRAs to include Z-drugs. It does not identify those interventions specifically as CBT-I or establish a result for Z-drugs separately. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Lynch, T., Ryan, C., & Cadogan, C. A.
Affiliations
  • Royal College of Surgeons in Ireland (IE)
  • Trinity College Dublin (IE)
Corresponding author
Cadogan, Cathal A.
ORCID
Venue
Health Expectations
Publisher
Wiley
Published
2021-12-03
Volume
25
Issue
1
Pages
355-365
ISSN
  • 1369-6513 (ISSN-L)
  • 1369-7625
DOI
10.1111/hex.13392
PMC
PMC8849267
OpenAlex
W3216238263
Cited by
24
References
49
Citations by year
2026: 3 · 2025: 8 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 1
FWCI
2.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Expectations (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Royal College of Surgeons in Ireland (Clement Archer Scholarship)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
benzodiazepine receptor agonists, long-term benzodiazepine use, benzodiazepine discontinuation, barriers and facilitators, Theoretical Domains Framework, withdrawal symptoms, theory-based intervention, primary care, patient perspectives
MeSH terms
Assessment of Medication Adherence, Humans, Receptors, GABA-A, Drug Monitoring, Qualitative Research, Medication Adherence, GABA-A Receptor Agonists

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