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01-06-2012

Benzodiazepineverslaving; een stille verslaving onder ouderen

Auteur: Prof. dr. R. C. Oude Voshaar

Gepubliceerd in: Tijdschrift voor Gerontologie en Geriatrie | Uitgave 3/2012

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Benzodiazepin addiction: a silent addiction among older people

Benzodiazepines are frequently prescribed for a longer period of time for anxiety disorders and insomnia in spite of the many guidelines to prescribe these drugs only short-term. These guidelines are based on the risk-benefit balance between long-term effectiveness and side effects like addiction, anterograde amnesia, and increased risk on falling (resulting in hip fractures), traffic accidents and even mortality. Also low-dose benzodiazepine use can lead to benzodiazepine dependence. Although initially most attention has been paid to the physical withdrawal syndrome, psychological aspects of benzodiazepine dependence have received more and more attention in the past decades. Recently, a relationship between the brain-reward system, involved in addiction, and benzodiazepine use, was demonstrated.
When long-term benzodiazepine use is recognised as problematic by both physician and patient, different treatment modalities are available to support patients in achieving abstinence. One of every four patients is able to stop by themselves with the aid of a minimal intervention providing psychoeducation and encouragement. Two out of three long-term uses are able to stop their usage with the aid of systematic tapering protocols guided by a physician or psychologist. In case of an underlying insomnia or anxiety disorder, cognitive-behavioural therapy should be added to the tapering protocol. In contrast to the general opinion, advanced old age has no negative impact on the treatment response.
Literatuur
1.
go back to reference Gorgels WJMJ, Oude Voshaar RC, Mol AJJ, et al. Het langdurig gebruik van benzodiazepinen [Long- term use of benzodiazepines]. Ned Tijdschr Geneeskund 2001; 145: 1342–1346. Gorgels WJMJ, Oude Voshaar RC, Mol AJJ, et al. Het langdurig gebruik van benzodiazepinen [Long- term use of benzodiazepines]. Ned Tijdschr Geneeskund 2001; 145: 1342–1346.
2.
go back to reference Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012; 2: e000850. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012; 2: e000850.
3.
go back to reference Hollister LE, Motzenbecker FP, Degan RO. Withdrawal reactions from chlordiazepoxide ("Librium"). Psychopharmacologia 1961; 2: 63–68.PubMedCrossRef Hollister LE, Motzenbecker FP, Degan RO. Withdrawal reactions from chlordiazepoxide ("Librium"). Psychopharmacologia 1961; 2: 63–68.PubMedCrossRef
4.
go back to reference Woody GE, O’Brien CP, Greenstein R. Misuse and abuse of diazepam: An increasingly common medical problem. Int J Addiction 1975; 10: 843–848. Woody GE, O’Brien CP, Greenstein R. Misuse and abuse of diazepam: An increasingly common medical problem. Int J Addiction 1975; 10: 843–848.
5.
go back to reference Soumarei SB, Simoni-Wastila L, Singer C, et al. Lack of relationship between long-term use of benzodiazepines and escalation to high dosages. Psychiatr Serv 2003 ;54: 1006–1011.CrossRef Soumarei SB, Simoni-Wastila L, Singer C, et al. Lack of relationship between long-term use of benzodiazepines and escalation to high dosages. Psychiatr Serv 2003 ;54: 1006–1011.CrossRef
6.
go back to reference Covi L, Lipman RS, Pattison JH, et al. Length of treatment with anxiolytic sedatives and response to their sudden withdrawal. Acta Psychiatr Scand 1973; 49: 51–64.PubMedCrossRef Covi L, Lipman RS, Pattison JH, et al. Length of treatment with anxiolytic sedatives and response to their sudden withdrawal. Acta Psychiatr Scand 1973; 49: 51–64.PubMedCrossRef
7.
go back to reference Busto U, Sellers EM, Naranjo CA, et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. New Engl J Med 1986; 315: 854–859.PubMedCrossRef Busto U, Sellers EM, Naranjo CA, et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. New Engl J Med 1986; 315: 854–859.PubMedCrossRef
8.
go back to reference Linssen SM, Breteler MHM, Zitman FG. Defining benzodiazepine dependence: the confusion persists. Eur Psychiatry 1995; 10: 306–311.CrossRef Linssen SM, Breteler MHM, Zitman FG. Defining benzodiazepine dependence: the confusion persists. Eur Psychiatry 1995; 10: 306–311.CrossRef
9.
go back to reference Baillie AJ, Mattick RP. The benzodiazepine dependence questionnaire: development, reliability and validity. Br J Psychiatry 1996; 169: 276–281.PubMedCrossRef Baillie AJ, Mattick RP. The benzodiazepine dependence questionnaire: development, reliability and validity. Br J Psychiatry 1996; 169: 276–281.PubMedCrossRef
10.
go back to reference Kan CC, Breteler MHM, Zitman FG. High prevalence of benzodiazepine dependence in outpatient uers, based on DSM-III-R and ICD-10 criteria. Acta Psychiatr Scand 1997; 96: 85–93.PubMedCrossRef Kan CC, Breteler MHM, Zitman FG. High prevalence of benzodiazepine dependence in outpatient uers, based on DSM-III-R and ICD-10 criteria. Acta Psychiatr Scand 1997; 96: 85–93.PubMedCrossRef
11.
go back to reference Préville M, Boyer R, Grenier S, et al. The epidemiology of psychiatric disorders in Quebec’s older adult population. Can J Psychiatry 2008; 53: 822–832.PubMed Préville M, Boyer R, Grenier S, et al. The epidemiology of psychiatric disorders in Quebec’s older adult population. Can J Psychiatry 2008; 53: 822–832.PubMed
12.
go back to reference Tan KR, Brown M, Labouebe G, et al. Neural bases for addictive properties of benzodiazepines. Nature 2010; 463: 760–74.CrossRef Tan KR, Brown M, Labouebe G, et al. Neural bases for addictive properties of benzodiazepines. Nature 2010; 463: 760–74.CrossRef
13.
go back to reference Victorri-Vigneau C, Dailly E, Veyrac G et al. Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. Br J Clin Pharmacol 2007; 64: 198–209.PubMedCrossRef Victorri-Vigneau C, Dailly E, Veyrac G et al. Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. Br J Clin Pharmacol 2007; 64: 198–209.PubMedCrossRef
14.
go back to reference Licata SC, Rowlett JK. Abuse and dependence liability of benzodiazepine-type drugs: GABAA receptor modulation and beyond. Pharmacol Biochem Behav 2008; 90: 74–89.PubMedCrossRef Licata SC, Rowlett JK. Abuse and dependence liability of benzodiazepine-type drugs: GABAA receptor modulation and beyond. Pharmacol Biochem Behav 2008; 90: 74–89.PubMedCrossRef
15.
go back to reference GorgelsWJ, Oude Voshaar RC, Mol AJ, et al. Discontinuation of long term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study. Drug Alc Depend 2005; 78: 49–56.CrossRef GorgelsWJ, Oude Voshaar RC, Mol AJ, et al. Discontinuation of long term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study. Drug Alc Depend 2005; 78: 49–56.CrossRef
16.
go back to reference Oude Voshaar RC, Couvée JE, Van Balkom AJLM, & Zitman FG. Strategies to discontinue long-term benzodiazepine use: a meta-analysis. Br J Psychiatry 2006; 189: 213–220.CrossRef Oude Voshaar RC, Couvée JE, Van Balkom AJLM, & Zitman FG. Strategies to discontinue long-term benzodiazepine use: a meta-analysis. Br J Psychiatry 2006; 189: 213–220.CrossRef
17.
go back to reference Parr JM, Kavanagh DJ, Cahill L, et al. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction 2009; 104: 13–24.PubMedCrossRef Parr JM, Kavanagh DJ, Cahill L, et al. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction 2009; 104: 13–24.PubMedCrossRef
18.
go back to reference Oude Voshaar RC, Gorgels WJ, Mol AJ, et al. Predictors of relapse after discontinuation of longterm benzodiazepine use by minimal intervention: a 2-year follow-up study. Fam Practice 2003; 20: 370–372.CrossRef Oude Voshaar RC, Gorgels WJ, Mol AJ, et al. Predictors of relapse after discontinuation of longterm benzodiazepine use by minimal intervention: a 2-year follow-up study. Fam Practice 2003; 20: 370–372.CrossRef
19.
go back to reference Cook JM, Marshall R, Masci C, et al. Physicians’ perspective on prescribing benzodiazepines for older adults: a qualitative study. J Gen Intern Med 2007; 22: 303–307.PubMedCrossRef Cook JM, Marshall R, Masci C, et al. Physicians’ perspective on prescribing benzodiazepines for older adults: a qualitative study. J Gen Intern Med 2007; 22: 303–307.PubMedCrossRef
20.
go back to reference Stewart R, Niessen WJ, Broer J. General practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application. J Clin Epidemiol 2007; 60: 1076–1084.PubMedCrossRef Stewart R, Niessen WJ, Broer J. General practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application. J Clin Epidemiol 2007; 60: 1076–1084.PubMedCrossRef
21.
go back to reference Bish A, Golombok S, Hallstrom C, et al. The role of coping strategies in protecting against longterm tranquillizer use. Br J Med Psychol 1996; 69: 101–115.PubMedCrossRef Bish A, Golombok S, Hallstrom C, et al. The role of coping strategies in protecting against longterm tranquillizer use. Br J Med Psychol 1996; 69: 101–115.PubMedCrossRef
22.
go back to reference Oude Voshaar RC, GorgelsW, Mol AJJ, et al. Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three condition, randomised controlled trial. Br J Psychiatry 2003; 182: 489–504. Oude Voshaar RC, GorgelsW, Mol AJJ, et al. Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three condition, randomised controlled trial. Br J Psychiatry 2003; 182: 489–504.
23.
go back to reference Vicens C, Fiol F, Llobera J, et al. Withdrawal from long-term benzodiazepine use: randomised trial in family practice. Br J Gen Practice; 56: 958–963 Vicens C, Fiol F, Llobera J, et al. Withdrawal from long-term benzodiazepine use: randomised trial in family practice. Br J Gen Practice; 56: 958–963
24.
go back to reference Sanchez-Craig M, Cappell H, Busto U, et al. Cognitive-behavioural treatment for benzodiazepine dependence: a comparison of gradual versus abrupt cessation of drug intake. Br J Addict 1987; 82: 1317–1327.PubMedCrossRef Sanchez-Craig M, Cappell H, Busto U, et al. Cognitive-behavioural treatment for benzodiazepine dependence: a comparison of gradual versus abrupt cessation of drug intake. Br J Addict 1987; 82: 1317–1327.PubMedCrossRef
25.
26.
go back to reference Rickels K, Schweizer E, Case WG, et al. Longterm therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry 1990; 47:899–907.PubMedCrossRef Rickels K, Schweizer E, Case WG, et al. Longterm therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry 1990; 47:899–907.PubMedCrossRef
27.
go back to reference Schweizer E, Rickels K, Case WG, et al. Longterm therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry 1990;47:908–915.PubMedCrossRef Schweizer E, Rickels K, Case WG, et al. Longterm therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry 1990;47:908–915.PubMedCrossRef
28.
go back to reference Lader M, Tylee A, Donoghue J. Withdrawing benzodiazepines in primary care. CNS Drugs 2009;23:19–34.PubMedCrossRef Lader M, Tylee A, Donoghue J. Withdrawing benzodiazepines in primary care. CNS Drugs 2009;23:19–34.PubMedCrossRef
29.
go back to reference Oude Voshaar RC. Consecutive treatment strategies to discontinue long-term benzodiazepine use. A systematic evaluation in general practice. Ponsen & Looijen BV, Wageningen 2003. Oude Voshaar RC. Consecutive treatment strategies to discontinue long-term benzodiazepine use. A systematic evaluation in general practice. Ponsen & Looijen BV, Wageningen 2003.
30.
go back to reference Oude Voshaar RC. Capter 35 Sedative-hypnotics abstinence. In: Ruiz P, Strain E (eds). Lowinson and Ruiz’s Substance Abuse. A comprehensive textbook. Wolters Kluwer | LippincottWilliams & Wilkins, Philadelphia 2011. Oude Voshaar RC. Capter 35 Sedative-hypnotics abstinence. In: Ruiz P, Strain E (eds). Lowinson and Ruiz’s Substance Abuse. A comprehensive textbook. Wolters Kluwer | LippincottWilliams & Wilkins, Philadelphia 2011.
31.
go back to reference Couvée JE, Zitman FG. The Benzodiazepine Withdrawal Symptom Questionnaire: Psychometric evaluation during a discontinuation program in depressed chronic benzodiazepine users in general practice. Addiction 2002; 97: 337–345.PubMedCrossRef Couvée JE, Zitman FG. The Benzodiazepine Withdrawal Symptom Questionnaire: Psychometric evaluation during a discontinuation program in depressed chronic benzodiazepine users in general practice. Addiction 2002; 97: 337–345.PubMedCrossRef
32.
go back to reference Busto UE, Sykora K, Sellers EM. A clinical scale to assess benzodiazepine withdrawal. J Clin Psychopharmacol 1989; 9: 412–416.PubMedCrossRef Busto UE, Sykora K, Sellers EM. A clinical scale to assess benzodiazepine withdrawal. J Clin Psychopharmacol 1989; 9: 412–416.PubMedCrossRef
33.
go back to reference Tyrer P, Murphy S, Riley P. The Benzodiazepine withdrawal symptom questionnaire. J Aff Disord 1990; 19: 53–61.CrossRef Tyrer P, Murphy S, Riley P. The Benzodiazepine withdrawal symptom questionnaire. J Aff Disord 1990; 19: 53–61.CrossRef
34.
go back to reference Lader M. Anxiety or depression during withdrawal of hypnotic treatments. J Psychosom Res 1994; 38: 113–123.PubMedCrossRef Lader M. Anxiety or depression during withdrawal of hypnotic treatments. J Psychosom Res 1994; 38: 113–123.PubMedCrossRef
35.
go back to reference Tyrer P, Rutherford D, Huggett T. BenzodiazepineWithdrawal Symptoms and Propranolol. Lancet 1981;1:520–522.PubMedCrossRef Tyrer P, Rutherford D, Huggett T. BenzodiazepineWithdrawal Symptoms and Propranolol. Lancet 1981;1:520–522.PubMedCrossRef
36.
go back to reference Schweizer E, Rickels K, Case WG, et al. Carbamazepine treatment in patients discontinuing long-term benzodiazepine therapy. Effects on withdrawal severity and outcome. Arch Gen Psychiatry 1991;48:448–452.PubMedCrossRef Schweizer E, Rickels K, Case WG, et al. Carbamazepine treatment in patients discontinuing long-term benzodiazepine therapy. Effects on withdrawal severity and outcome. Arch Gen Psychiatry 1991;48:448–452.PubMedCrossRef
37.
go back to reference Klein E, Colin V, Stolk J, et al. Alprazolam withdrawal in patients with panic disorder and generalized anxiety disorder: Vulnerability and effect of carbamazepine. Am J Psychiatry 1994;151:1760–1766.PubMed Klein E, Colin V, Stolk J, et al. Alprazolam withdrawal in patients with panic disorder and generalized anxiety disorder: Vulnerability and effect of carbamazepine. Am J Psychiatry 1994;151:1760–1766.PubMed
38.
go back to reference Oude Voshaar RC, Gorgels WJMJ, Mol AJJ, et al. Long-term outcome of two forms of randomised benzodiazepine discontinuation. Br J Psychiatry, 2006; 188: 188–189.CrossRef Oude Voshaar RC, Gorgels WJMJ, Mol AJJ, et al. Long-term outcome of two forms of randomised benzodiazepine discontinuation. Br J Psychiatry, 2006; 188: 188–189.CrossRef
39.
go back to reference Vorma H, Naukkarinen H, Sarna S, et al. Treatment of out-patient with complicated benzodiazepine dependence: comparison of two approaches. Addiction 2002; 97: 851–859.PubMedCrossRef Vorma H, Naukkarinen H, Sarna S, et al. Treatment of out-patient with complicated benzodiazepine dependence: comparison of two approaches. Addiction 2002; 97: 851–859.PubMedCrossRef
40.
go back to reference Rickels K, De Martinis N, Garcia-Espana F, et al. Imipramine and buspirone in treatment of patients with generalized anxiety disorder who are discontinuing long-term benzodiazepine therapy. Am J Psychiatry 2000; 157: 1973–1979.PubMedCrossRef Rickels K, De Martinis N, Garcia-Espana F, et al. Imipramine and buspirone in treatment of patients with generalized anxiety disorder who are discontinuing long-term benzodiazepine therapy. Am J Psychiatry 2000; 157: 1973–1979.PubMedCrossRef
41.
go back to reference Charney DA, Paraherakis AM, Gill KJ. The treatment of sedative-hypnotic dependence: Evaluating clinical predictors of outcome. J Clin Psychiatry 2000; 61: 190–195.PubMedCrossRef Charney DA, Paraherakis AM, Gill KJ. The treatment of sedative-hypnotic dependence: Evaluating clinical predictors of outcome. J Clin Psychiatry 2000; 61: 190–195.PubMedCrossRef
42.
go back to reference Oude Voshaar RC, Gorgels WJ, Mol AJ, et al. Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program. Can J Psychiatry, 2006; 51: 56–63. Oude Voshaar RC, Gorgels WJ, Mol AJ, et al. Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program. Can J Psychiatry, 2006; 51: 56–63.
43.
go back to reference Petrovic M, Pevernagie D, Van Den NN, et al. A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality. Int J Geriatr Psychiatry 1999; 14: 754–60.PubMedCrossRef Petrovic M, Pevernagie D, Van Den NN, et al. A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality. Int J Geriatr Psychiatry 1999; 14: 754–60.PubMedCrossRef
44.
go back to reference Schweizer E, Rickels R, de Martinis N, et al. The effect of personality on withdrawal severity and taper outcome in benzodiazepine dependent patients. Psychol Med 1998; 28: 713–720.PubMedCrossRef Schweizer E, Rickels R, de Martinis N, et al. The effect of personality on withdrawal severity and taper outcome in benzodiazepine dependent patients. Psychol Med 1998; 28: 713–720.PubMedCrossRef
45.
go back to reference Belleville G, Morin CM. Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and selfeffecacy. Health Psychology 2008;27:239–248.PubMedCrossRef Belleville G, Morin CM. Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and selfeffecacy. Health Psychology 2008;27:239–248.PubMedCrossRef
46.
go back to reference Zandstra SM, van Rijswijk E, Rijnders CATh, et al. Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behaviour and psychological characteristics. Fam Practice 2004; 21: 266–269.CrossRef Zandstra SM, van Rijswijk E, Rijnders CATh, et al. Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behaviour and psychological characteristics. Fam Practice 2004; 21: 266–269.CrossRef
Metagegevens
Titel
Benzodiazepineverslaving; een stille verslaving onder ouderen
Auteur
Prof. dr. R. C. Oude Voshaar
Publicatiedatum
01-06-2012
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Gerontologie en Geriatrie / Uitgave 3/2012
Print ISSN: 0167-9228
Elektronisch ISSN: 1875-6832
DOI
https://doi.org/10.1007/s12439-012-0020-2