The diagnosis and management of benzodiazepine dependence

@article{Ashton2005TheDA,
  title={The diagnosis and management of benzodiazepine dependence},
  author={Heather Ashton},
  journal={Current Opinion in Psychiatry},
  year={2005},
  volume={18},
  pages={249–255}
}
  • H. Ashton
  • Published 1 May 2005
  • Medicine, Psychology
  • Current Opinion in Psychiatry
Purpose of review Despite repeated recommendations to limit benzodiazepines to short-term use (2–4 weeks), doctors worldwide are still prescribing them for months or years. This over-prescribing has resulted in large populations of long-term users who have become dependent on benzodiazepines and has also led to leakage of benzodiazepines into the illicit drug market. This review outlines the risks of long-term benzodiazepine use, gives guidelines on the management of benzodiazepine withdrawal… 
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References

SHOWING 1-10 OF 114 REFERENCES
Safety of benzodiazepines in the geriatric population
TLDR
Significant adverse effects that may be associated with benzodiazepine use in the elderly include falls, cognitive impairment, sedation, and impairment of driving skills, all of which are particularly related to the long half-life of Benzodiazepines.
Benzodiazepine dependence. A review of the evidence.
TLDR
The withdrawal syndrome is characterised by withdrawal symptoms on stopping treatment; these include perceptual disturbances, epileptic seizures, weight loss, insomnia and autonomic symptoms, and may be associated with altered sensitivity of benzodiazepine receptors.
Benzodiazepine self-administration in humans and laboratory animals – implications for problems of long-term use and abuse
TLDR
A current review of various problems that have been identified with the long-term use and the recreational abuse of benzodiazepines, including memory impairment, risk of accidents, falls and hip fractures in the elderly, a withdrawal syndrome, brain damage, overuse inThe elderly, over use by chronic pain patients, overused by alcoholics and recreational abuse among alcoholic and polydrug abusers are provided.
Theory and practice in managing benzodiazepine dependence and misuse
TLDR
Physical dependence on BZs appears to develop in a minority of users, with injectors possibly least likely to show withdrawal symptoms, and psychological approaches need not be highly specialized, and sometimes minimal interventions are successful.
Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group.
  • F. Zitman, J. Couvée
  • Medicine, Psychology
    The British journal of psychiatry : the journal of mental science
  • 2001
TLDR
Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use and the addition of SSRI treatment is of limited value.
The role of captodiamine in the withdrawal from long-term benzodiazepine treatment
TLDR
Captodiamine represents an interesting strategy for achieving benzodiazepine substitution with a low risk of dependence or impairment of cognitive function and may be an advantage for the overall safety of the anxiolytic treatment, for example with regard to road safety.
Benzodiazepine prescription practices and substance abuse in persons with severe mental illness.
TLDR
Contrary to published guidelines, rates of benzodiazepine use are higher among Medicaid beneficiaries with severe mental illness and co-occurring SUD than among persons with severemental illness alone.
UNCONVENTIONAL INDICATORS OF DRUG DEPENDENCE AMONG ELDERLY LONG-TERM USERS OF BENZODIAZEPINES
TLDR
The results stress the need to take a more elaborate, person-centered view of dependence, and suggest six indicators of dependence.
Benzodiazepine Dependence
TLDR
Benzodiazepine dependence is a frequent complication of regular prescriptions for 4 weeks or longer, occurring in almost one-third of patients, and is characterised by a withdrawal syndrome on stopping treatment.
Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behaviour and psychological characteristics.
TLDR
Having a DSM-IV disorder and psychiatric co-morbidity, being older, less educated, lonely and using more avoidance coping behaviour was associated with long- term use of benzodiazepines compared with short-term use.
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