Psychological correlates of long-term benzodiazepine use in a primary care population

Abstract

OBJECTIVES Long-term use of benzodiazepine medication results in dependence, tolerance, withdrawal symptomatology, and reduced pharmacological efficacy. In addition, long-term use of benzodiazepines can have adverse effects on cognitive, psychomotor and psychological functioning. In response to these problems prescribing guidelines clearly discourage the long-term use of benzodiazepines.

The aim of the study was to examine the long-term use of benzodiazepine medication in a primary care population. The study included patients who were prescribed benzodiazepines by their general practitioners for sleep problems. Detailed information was collected regarding psychopathology, sleep difficulties and benzodiazepine dependence in this patient group with the aim of establishing whether a common psychological profile prevailed amongst those individuals who had been taking prescribed benzodiazepine medication for longer than the recommended period of time

This research study could therefore offer support to general practitioners by providing a greater psychological understanding of this client group, and this knowledge could inform alternative treatment options.

DESIGN The research design employed was a cross-sectional survey of an identified population using standardised questionnaires. The design therefore utilised between subject measures to examine the relationships between subjects on a number of variables.

METHOD Eighty-four participants, recruited from two rural primary care practices, took part in the study. Data were collected using a semi-structured interview and administration of four selfreport questionnaire measures (The Pittsburgh Sleep Quality Index; The Brief Symptom Inventory; The Severity of Dependence Scale; The Psychological Mindedness Scale).

RESULTS Results found significant psychopathology (somatisation and phobic anxiety) in long-term benzodiazepine users. Anxiety was found to significantly predict benzodiazepine dependence and sleep difficulties. The use of long-term benzodiazepine medication did not relieve sleep difficulties. Older benzodiazepine users and daily benzodiazepine users were significantly less psychologically minded than younger users and non-daily users.

CONCLUSION The study concluded that long-term benzodiazepine use is ineffective in treating sleep difficulties and it would appear that anxiety is a significant feature in this cohort. Therefore, the study proposes that to address the problem of long-term benzodiazepine use in the primary care setting, psychological approaches should be employed to treat anxiety and sleep difficulties.