The Role of Craving in Relapse After Discontinuation of Long-Term Benzodiazepine Use

Audrey J. J. Mol, Ph.D.; Richard C. Oude Voshaar, M.D., Ph.D.; Wim J. M. J. Gorgels, M.D.; Marinus H. M. Breteler, Ph.D.; Anton J. L. M. van Balkom, M.D., Ph.D.; Eloy H. van de Lisdonk, M.D., Ph.D.; Cornelis C. Kan, M.D., Ph.D.; and Frans G. Zitman, M.D., Ph.D.

Objective: 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.

Method: 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.

Results: 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.

Conclusion: 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.

(J Clin Psychiatry 2007;68:1894-1900)

Received July 10, 2006; accepted March 7, 2007. From the Department of Psychiatry, Radboud University Nijmegen Medical Centre (Drs. Mol, Oude Voshaar, and Kan); the Department of General Practice and Family Medicine, Radboud University Nijmegen (Drs. Gorgels and Van de Lisdonk); the Department of Clinical Psychology, Radboud University Nijmegen (Dr. Breteler); the Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Centre Amsterdam (Dr. Van Balkom); and the Department of Psychiatry, Leiden University Medical Centre (Dr. Zitman), the Netherlands.

The study was funded by a grant from the Dutch Health Care Insurance Council (grant number: OG 97 15), The Hague, the Netherlands, to the Department of Psychiatry, Radboud University Nijmegen Medical Centre.

In the spirit of full disclosure and in compliance with all Accreditation Council for Continuing Medical Education Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Drs. Mol, Oude Voshaar, Gorgels, Breteler, Van Balkom, Van de Lisdonk, Kan, and Zitman have no personal affiliations or financial relationships with any commercial interest producing health care goods or services to disclose relative to the article.

Corresponding author and reprints: Audrey J.J. Mol, Ph.D., Rivierduinen, Centrum Autisme, P.O. Box 750, 2300 AT Leiden, the Netherlands (e-mail: MolA@rivierduinen.nl).