Reducing Benzodiazepine Consumption

One: Background to the Study.- Literature Review.- 1. Introduction.- 2. The Benzodiazepines.- 2.1 History of the benzodiazepines.- 2.2 Pharmacological action of the benzodiazepines.- 2.3 Different types of benzodiazepines.- 2.4 The therapeutic effect of the benzodiazepines.- a) Use as anxiolytics.- b) Use as hypnotics.- c) Benzodiazepines as therapy for depression.- d) Use of benzodiazepines in physical illness.- e) Paradoxical drug reactions.- 2.5 Effects of benzodiazepines on performance.- a) Effects in normal and anxious subjects.- b) Decrements produced by hypnotics.- c) Cognitive impairments.- d) Effects on the elderly.- 3. Prescribing.- 3.1 Trends in prescribing.- 3.2 Extent of use of the benzodiazepines.- 3.3 Sex differences in the use of benzodiazepines.- 3.4 Benzodiazepine consumption in the elderly.- 3.5 Class and employment differences in benzodiazepine use.- 3.6 Reasons for the prescription.- 3.7 Repeat prescribing.- 3.8 Expectations of patients.- 4. Dependence.- 4.1 Definitions of dependence.- 4.2 Tolerance.- 4.3 Withdrawal.- 4.4 Characteristics of long-term users of benzodiazepines.- 5. Alternatives to Benzodiazepine Medication.- 5.1 Psychological therapy as an alternative to medication.- 5.2 Changes in patterns of long-term use of benzodiazepines.- 6. Summary.- Two: A Study of Drug Reduction.- Aims of the Research.- Outline of the Study.- 1. General Practitioner Intervention.- 1.1 Population.- 1.2 Identification of the sample.- 1.3 Criteria for selection of the patients.- 1.4 The practices.- 1.5 The experiment.- 1.6 Allocation of patients to groups.- 1.7 Interventions.- a) Letter.- b) Interview.- c) Control.- 1.8 Calculation of tablet equivalence.- 2. Interview with the Psychologist.- 3. Group Work in Psychological Alternatives.- 3.1 Contracts.- 3.2 Duration of the group.- 3.3 Content of group work.- 3.4 Homework tasks.- 3.5 Tablet withdrawal.- 3.6 Application of strategies.- 4. Summary.- Results.- 1. Subjects.- 1.1 Characteristics of subjects and practices.- 1.2 Age of the sample.- 2. Medication.- 2.1 Duration of medication.- 2.2 Baseline number of tablets.- 3. The Practices.- Description of the practices.- 4. Groups.- 4.1 Allocation of subjects to groups.- 4.2 Differences among the groups.- 4.3 Allocation of control subjects to intervention groups.- 4.4 Summary.- 5. Analysis of Change Over Time in Drug Taking.- 5.1 Control group.- 5.2 Intervention groups.- 5.2.1 Changes over the first six months.- 5.2.2 Comparison of baseline with months seven to twelve of monitoring.- 5.2.3 Comparison of baseline with consumption in the second year of monitoring.- 6. Occurrence of Major Change.- 6.1 Changes over the second six months.- 6.2 Comparison of consumption in months seven to twelve with the second year of monitoring.- 7. Factors Relating to Successful Drug Reduction.- 7.1 Differences between the successful subjects and those not successful.- 7.2 Other factors related to success.- 8. The Psychology Interview.- 8.1 Numbers of patients attending the psychology interview.- 8.2 Differences between attenders and non-attenders.- 8.3 Time of day tablets taken.- 8.4 Strategies employed to reduce medication.- 8.5 Factors linked to successful stopping of medication.- 8.6 Summary.- 9. General Summary of Findings.- 10. Group Psychological Therapy.- 10.1 Formation of the groups.- 10.2 Changes in consumption over the course of the group.- 10.3 Summary of changes in other medication.- 10.4 Summary of outcome of group therapy.- 10.5 Strategies employed by the group members for tablet reduction.- 10.6 Summary.- Discussion.- 1. Sex-ratio of Subjects.- 2. Age of Subjects.- 3. Baseline Tablet Consumption.- 4. Group Differences.- 5. Low Attendance at the Psychology Interview.- 6. Lack of Interest in Group Therapy.- 7. Withdrawal from Diazepam and Lorazepam.- 8. Differences in Success When Taking Single or Combined Benzodiazepines.- 9. Reasons for the Success of the Doctors' Interventions.- 10. Effect of a Decrease in Benzodiazepines on Alcohol and Tobacco Consumption.- 11. Differences Between the Factors Leading to the Initial Prescription of Benzodiazepines and Those Which Maintained the Drug Consumption.- 12. Strategies Devised by the Patients Leading to Success in Stopping Medication.- 13. Effect of the Group Psychological Therapy on Tablet Consumption.- 14. Components of the Psychological Therapy Which Were Most Useful for Patients.- Comments on the Work.- 1. Methodological Considerations of the Present Study.- 1.1 Limitations of the interview data.- 1.2 Future expansion of the interview.- 1.3 Control of medication in the hospital groups.- 2. Implications of the Study.- 2.1 Benefits for the patients.- 2.2 Cost benefits.- 3. Future Work.- 3.1 The use of bibliotherapy.- 3.2 Expansion of inclusion criteria.- 3.3 Psychology contribution.- References.