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Tijdschrift voor Psychiatrie 46 (2004) 11, 725 - 737

New research

Attempts to stop long-term use of benzodiazepine by means of controlled dose reduction with or without the help of group therapy

R.C. Oude Voshaar, W.J.M.J. Gorgels, A.J.J. Mol, A.J.L.M. van Balkom, E.H. van de Lisdonk, M.H.M. Breteler, H.J.M. van den Hoogen, F.G. Zitman

background Research is needed into ways of reducing patients' dependence on benzodiazepine. So far, dose reduction has never been compared with reduction without intervention. Furthermore, the added value of combining treatment with psychotherapy has never been evaluated in a randomised controlled study.
aim To evaluate the efficacy and feasibility of controlled dose reduction with and without the help of group cognitive behavioural therapy (cbt) in primary care.
method One hundred and eighty chronic users of benzodiazepine unable to stop taking the drug on their own accord participated in a randomised controlled trial. They were assigned to 3 groups: a controlled dose-reduction group; a controlled dose-reduction group receiving groupcbt; and a group receiving usual care.
results Of the patients subjected to controlled reduction 62% stopped taking benzodiazepine entirely, which significantly differed from the control group (21%). Adding group-cbt did not increase the success rate in the controlled dose-reduction group. The intention to participate in the controlled reduction programme motivated 1 in 5 patients to stop taking benzodiazepine on their own accord. Neither discontinuation nor the type of intervention had any influence on patients' psychological functioning. Both intervention programmes could be performed successfully by family doctors although only 17% of the 1036 eligible benzodiazepine users agreed to participate in this study.
conclusion In primary care controlled dose reduction is an effective way of helping motivated long-term users of benzodiazepine to stop taking the drug. The addition of group-cbt, however, provides no added value. No definitive conclusions can be drawn until long-term followup data recording relapse rates become available. 

keywords benzodiazepine, long-term use, psychotherapy, withdrawal