Mol Audrey J J, Oude Voshaar Richard C, Gorgels Wim J M J, Breteler Marinus H M, van Balkom Anton J L M, van de Lisdonk Eloy H, Kan Cornelis C, Zitman Frans G
Department of Psychiatry, Radboud University Nijmegen Medical Centre, the Netherlands.
J Clin Psychiatry. 2007 Dec;68(12):1894-900. doi: 10.4088/jcp.v68n1209.
Craving for benzodiazepines has never been examined as a factor of relapse after successful benzodiazepine discontinuation. In this study, we examined the predictive value of craving on benzodiazepine relapse.
A stepped-care intervention trial aimed to discontinue long-term benzodiazepine use in general practice. The first step was the sending of a letter to users advising them to gradually quit their use by themselves (i.e., minimal intervention). The second step, a supervised tapering-off program, was offered to those unable to discontinue by themselves. Craving was assessed by means of the Benzodiazepine Craving Questionnaire (BCQ). Multiple Cox proportional hazards regression analyses were performed to examine the effect of craving on subsequent relapse during a 15-month follow-up period in patients who had successfully quit their benzodiazepine use by themselves after the minimal intervention (N = 79) and in those patients who had successfully quit after the supervised tapering-off program (N = 45). Data were collected from August 1998 to December 2001.
Thirty-five (44%) and 24 (53%) patients had relapsed after the minimal intervention and tapering-off program, respectively. Patients able to quit by themselves experienced very little craving. In this sample, craving was not related to relapse (p = .82). In patients who needed an additional supervised tapering-off program, higher craving scores were significantly related to relapse (hazard ratio = 1.26, 95% CI = 1.02 to 1.54, p = .029), when corrected for benzodiazepine characteristics, psychopathology, and personality characteristics.
Craving is an independent factor of subsequent relapse after successful benzodiazepine discontinuation in long-term benzodiazepine users who are not able to quit their usage of their own accord.
对苯二氮䓬类药物的渴求从未被作为成功停用苯二氮䓬类药物后复发的一个因素进行过研究。在本研究中，我们检验了对苯二氮䓬类药物的渴求对其复发的预测价值。
一项逐步护理干预试验旨在在全科医疗中停用长期使用的苯二氮䓬类药物。第一步是给使用者寄一封信，建议他们自行逐渐停药（即最小干预）。第二步，为那些无法自行停药的人提供一个有监督的逐渐减量计划。通过苯二氮䓬类药物渴求问卷（BCQ）评估渴求程度。对在最小干预后自行成功停用苯二氮䓬类药物的患者（N = 79）以及在有监督的逐渐减量计划后成功停药的患者（N = 45），进行多重Cox比例风险回归分析，以检验渴求对15个月随访期内后续复发的影响。数据收集于1998年8月至2001年12月。
在最小干预和逐渐减量计划后，分别有35名（44%）和24名（53%）患者复发。能够自行停药的患者几乎没有渴求感。在这个样本中，渴求与复发无关（p = 0.82）。在需要额外有监督的逐渐减量计划的患者中，校正苯二氮䓬类药物特征、精神病理学和人格特征后，较高的渴求得分与复发显著相关（风险比 = 1.26，95%可信区间 = 1.02至1.54，p = 0.029）。
对于无法自行停用苯二氮䓬类药物的长期使用者，渴求感是成功停用苯二氮䓬类药物后后续复发的一个独立因素。
