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Evidence summaries

Psychosocial Interventions for Benzodiazepine Harmful Use, Abuse or Dependence

Cognitive behavioural therapy plus taper may be effective in the short term (3 months) vs. taper only in reducing benzodiazepine (BZD) use. A tailored vs. generic GP letter and both standardised interview and relaxation vs. treatment as usual (TAU) are also probably effective. Level of evidence: "C"

Comment: The quality of evidence is downgraded by imprecise results (most of the studies were small) and indirectness (most follow-up periods were less than 12 months).

Summary

A Cochrane review [Abstract] 1 included 25 studies with a total of 1666 subjects. The studies tested many different psychosocial interventions including cognitive behavioural therapy (CBT) (some studies with taper, other studies with no taper), motivational interviewing (MI), letters to patients advising them to reduce or quit benzodiazepine (BZD) use, relaxation studies, counselling delivered electronically and advice provided by a general practitioner (GP). There were two meta-analyses: One assessed the effectiveness of CBT plus taper vs. taper only (n=575), and another MI vs. treatment as usual (TAU) (n=80).

  • Cognitive behavioural therapy plus taper vs. taper only: CBT plus taper was more likely to result in successful discontinuation of BZDs vs. taper only within 4 weeks post treatment (RR 1.40, 95% CI 1.05 to 1.86; 9 trials, n=423) and at 3 month follow-up (RR 1.51, 95% CI 1.15 to 1.98; 9 trials, n=460). The effects were less certain at later time-points, up to 24 months follow-up. The effect of CBT on reducing BZDs by > 50% was not seen for any time points examined.
  • Motivational interviewing vs. treatment as usual: The effect for all time intervals is unclear; post treatment (RR 4.43, 95% CI 0.16 to 125.35; 2 trials, n=34), at 3 month follow-up (RR 3.46, 95% CI 0.53 to 22.45; 4 trials, n=80), 6 month (RR 0.14, 95% CI 0.01 to 1.89) and 12 month follow-up (RR 1.25, 95% CI 0.63 to 2.47). The effect of MI on reducing BZDs by > 50% was not seen at 3 month follow-up (RR 1.52, 95% CI 0.60 to 3.83) or 12 month follow-up (RR 0.87, 95% CI 0.52 to 1.47). The following interventions reduced BZD use: tailored GP letter vs. generic GP letter at 12 month follow-up (RR 1.70, 95% CI 1.07 to 2.70; one trial, n=322), standardised interview vs. TAU at 6 month follow-up (RR 13.11, 95% CI 3.25 to 52.83; one trial, n=139) and 12 month follow-up (RR 4.97, 95% CI 2.23 to 11.11), and relaxation vs. TAU at 3 month follow-up (RR 2.20, 95% CI 1.23 to 3.94; one trial, n=60).

Clinical comments

Note

Date of latest search:

    References

    • Darker CD, Sweeney BP, Barry JM et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015;5():CD009652. [PubMed]

Primary/Secondary Keywords