Project: Research project

Project Details


Benzodiazepines are safer and have lesser abuse potential than the
barbiturates they replaced. However, dependence can occur with chronic
therapy and result in withdrawal symptoms including anxiety, insomnia,
tumor, muscle twitching, nausea, and perceptual distortions. Although
benzodiazepines are considered modest reinforcers, such effects may
combine with withdraws symptoms to sustain further drug taking. Because
many withdrawal symptoms mimic anxiety disorder, it is difficult to know
whether discontinuation symptoms represent disease reemergence or drug
withdrawal. Also, because of the chronicity of anxiety disorders, it is
not clear whether discontinuation failure or drug use relapse represents
addictive behavior or continued pharmacotherapy. Whereas pharmacological
factors involved in benzodiazepine physical dependence are well studied;
behavioral factors related to "psychological dependence" have been rarely
considered and are often ignored in discontinuation treatment. The proposed research addresses behavioral factors presumably involved
in psychological dependence on benzodiazepines. Three studies examine
patient compliance with benzodiazepine dose reduction and discontinuation
by focusing on behavioral factors related to patient anxiety. These
anxieties may be caused by an original disorder or by withdrawal
reactions, but also may be related to psychological dependence on
medication. Exp. #1 compares a short-term stabilization treatment prior
to dose reduction with the effects of long-term dose stabilization and
maintenance intended to acclimate the patients and appease their
anxieties about dose reduction. Exp. #2 compares blind vs. open-label
drug administration during dose reductions with the idea that blind dose-
reduction may reduce anticipatory anxiety reactions. Exp. #3 compares
control and cognitive/behavioral therapies to examine the effects of
helping patients manage their anxiety levels during dose reduction or
discontinuation. Measures for all studies include objective and
subjective assessments of withdrawal, subject complaints, and medication
compliance. These studies should: 1) clarify the role of psychological dependence in
chronic benzodiazepine use; 2) help to optimize strategies for treating
benzodiazepine dependence; 3) clarify behavioral determinants of
persistent drug use in therapeutic drug dependence; 4) suggest
interventions for other drug abusing patient populations (e.g., cocaine
or opioid users) who also use benzodiazepines.
Effective start/end date9/1/947/31/00


  • National Institutes of Health


  • Medicine(all)


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