Tapering off Long-Term Benzodiazepine Use with or without Group Cognitive-Behavioural Therapy: Three-Condition, Randomised Controlled Trial

Only 36% of patients were able to successfully stop their benzodiazepine in a similar trial with a 4-week taper at 15-month follow-up.

“Only 36% of patients were able to successfully stop their benzodiazepine in a similar trial with a 4-week taper at 15-month follow-up (Voshaar et al., 2003).”

Clinical trials evaluating BZD tapering strategies typically have relatively fast and inflexible dose reduction schedules and often have high patient dropout.

“Clinical trials evaluating BZD tapering strategies, which typically have relatively fast (e.g., 25% every 1–2 weeks) and inflexible dose reduction schedules, often have high patient dropout.75–77”

The second study showing no added value of CBT for withdrawal (62% versus 58%) targeted neither insomnia nor anxiety but supported participants during tapering and focused on withdrawal symptoms only.

“The second study (62% versus 58%) [121] targeted neither insomnia nor anxiety but “supported the participants during the tapering-off process and in preventing relapse” and focused on withdrawal symptoms only.”

To date, there is no manualized and standardized CBT program specifically targeting BZD use disorder alone, although a proposal has been made without benefits compared with short interventions.

“To date, there is no manualized and standardized CBT program specifically targeting BZD use disorder alone, although a proposal has been made in this vein, but without benefits compared with short interventions [121].”

Oude Voshaar et al. evaluated the same pace and found that nearly a quarter of participants dropped out.

“Oude Voshaar et al.76 evaluated the same pace and found that nearly a quarter of participants dropped out.”

Clinical studies have reported that linear tapering is unsuccessful for a significant proportion of patients.

“However, clinical studies have reported that linear tapering is unsuccessful for a significant proportion of patients.”

To date, eight RCTs comparing taper alone versus taper plus CBT and two publications reporting long-term outcomes (>24 months) have been published.

“To date, eight RCTs (see Table 1) comparing the effectiveness of a taper program alone versus a taper program associated with CBT [33,112,118,119,120,121,122,123] and two publications reporting their long-term outcomes (>24 months) have been published [124,125].”

The CBT used in these protocols, except in one study, principally targeted the conditions that initially led to BZD misuse: insomnia in people over 50, panic disorders, or generalized anxiety disorder.

“The CBT used in these protocols, with the exception of one study [121], principally targeted the conditions that initially led to the misuse of BZD: insomnia in people over 50 years old [33,122,123], panic disorders [118,119,120], or generalized anxiety disorder (GAD) [108,124].”

Clinical trials that reduced doses at a faster pace tended to have high patient dropout rates.

“Clinical trials that reduced doses at a faster pace tended to have high patient dropout rates.75,76”

General practitioners write three out of four benzodiazepine prescriptions.

“Since three of four benzodiazepine prescriptions are written by general practitioners (GPs), 14,15 patient withdrawal in the primary care setting is an important goal.”

The control group's discontinuation rate exceeded those reported in comparable studies.

“the discontinuation rate in our control group was higher than in similar studies. 14,16,18,20,36”

The SIF arm's discontinuation rate was comparable to rates found in earlier studies.

“Our SIF group had a discontinuation rate similar to those of previous studies, 14”

A brief GP intervention using gradual dose reduction produced discontinuation rates of 51% at 3 months and 45% at 12 months.

“a brief GP intervention based on gradual dose reduction, resulting in 3-12 months discontinuation rates of 51% and 45% respectively. 14,22”