Cognitive-Behavioural Treatment for Benzodiazepine Dependence: a comparison of gradual versus abrupt cessation of drug intake.

In a double-blind outpatient trial, long-term users of therapeutic doses of benzodiazepines seeking treatment were randomly assigned to either gradual tapering of their daily active dose (N=23) or abrupt cessation of benzodiazepine intake (N=19). The latter was achieved by substitution of placebo tablets for active benzodiazepines. All subjects received cognitive-behavioural treatment preceded by a 2-week baseline period during which they took theft benzodiazepine as usual. Both groups received on average about five therapy sessions involving: goal setting, daily self-monitoring, identification of anxiety-provoking situations, and development of cognitive and behavioural coping. Placebo subjects showed more prominent withdrawal symptomatology and supplemented more often with their own prescription. At the end of treatment, no significant differences were observed in rates of attrition (30% for drug and 16% for placebo subjects) or in rates of abstinence (30% for drug and 58% for placebo). However, compared to drug subjects, those treated with placebo were significantly more successful in maintaining abstinence throughout the one-year follow-up period. It was argued that it may be advantageous to expose patients who are dependent on relatively low doses of benzodiazepines to some withdrawal distress during treatment. A relatively inexperienced therapist became as effective as a highly experienced therapist relatively quickly, thus indicating transferability of the treatment. [ABSTRACT FROM AUTHOR]