Skip to main content

Advertisement

Log in

Psychiatrist Decision-Making Towards Prescribing Benzodiazepines: The Dilemma with Substance Abusers

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Psychiatrists’ decision making about prescribing benzodiazepines (BZD) was evaluated in a community mental health center. An anonymous survey of outpatient psychiatrists in an academic-affiliated public mental health center was conducted using a 45-item questionnaire developed based on the results of a previous study. Sixty-six percent of responses indicate that, at times, psychiatrists experienced requests for behaviors suspicious for abuse, including ‘lost/missing prescriptions’ and ‘use of BZD by others’. Patient characteristics such as ‘history of abuse’, ‘unknown patient’, and ‘patient use of illicit substances’ were occasional or common reasons for NOT prescribing BZDs (75 %). The most common contexts in which the majority of our sample was uncomfortable prescribing BZDs involved a patient history of substance abuse, fear of initiation of dependence, diversion, and feeling manipulated by the patient. Time limitations were a dilemma for 20 %. Psychiatrist self-reported dilemma and behavior in prescribing BZDs largely reflected concerns with substance abuse and less frequently workload or time issues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Merikangas KR, Mehta RL, Molnar BE, et al.: Comorbidity of substance use disorders with mood and anxiety disorders: Results of the international consortium in psychiatric epidemiology. Addictive Behaviors 23(6):893–907, 1998

    Article  PubMed  CAS  Google Scholar 

  2. Kessler RC, Nelson CB, McGonagle KA, et al.: The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry 66(1):17–31, 1996

    Article  PubMed  CAS  Google Scholar 

  3. Warneke LB: Benzodiazepines: Abuse and new use. Canadian Journal of Psychiatry 36(3):194–205, 1991

    CAS  Google Scholar 

  4. Lader M: Effectiveness of benzodiazepines: Do they work or not? Expert Review of Neurotherapeutics 8(8):1189–91, 2008

    Article  PubMed  CAS  Google Scholar 

  5. Beland SG, Preville M, Dubois MF, et al.: Benzodiazepine use and quality of sleep in the community-dwelling elderly population. Aging & Mental Health 14(7):843–50, 2010

    Article  Google Scholar 

  6. Brunette MF, Noordsy DL, Xie H, et al.: Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatric Services 54(10):1395–401, 2003

    Article  PubMed  Google Scholar 

  7. Cloos JM, Ferreira V: Current use of benzodiazepines in anxiety disorders. Current Opinion in Psychiatry 22(1):90–5, 2009

    Article  PubMed  Google Scholar 

  8. Zaider TI, Heimberg RG: Non-pharmacologic treatments for social anxiety disorder. Acta Psychiatrica Scandinavica Supplementum (417):72–84, 2003

    Article  PubMed  Google Scholar 

  9. Olatunji BO, Cisler JM, Deacon BJ: Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America 33(3):557–77, 2010

    Article  PubMed  Google Scholar 

  10. Haw C, Stubbs J: Benzodiazepines: A necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. Journal of Psychopharmacology 21(6):645–9, 2007

    Article  PubMed  Google Scholar 

  11. Ravindran LN, Stein MB: The pharmacologic treatment of anxiety disorders: A review of progress. Journal of Clinical Psychiatry 71(7):839–54, 2010

    Article  PubMed  CAS  Google Scholar 

  12. Posternak MA, Mueller TI: Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. American Journal on Addictions 10(1):48–68, 2001

    Article  PubMed  CAS  Google Scholar 

  13. Rosenbaum JF: Attitudes toward benzodiazepines over the years. Journal of Clinical Psychiatry 66 Suppl 2(4):4–8, 2005

    Google Scholar 

  14. Clark RE, Xie H, Brunette MF: Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. Journal of Clinical Psychiatry 65(2):151–5, 2004

    Article  PubMed  Google Scholar 

  15. Bendtsen P, Hensing G, McKenzie L, et al.: Prescribing benzodiazepines: A critical incident study of a physician dilemma. Social Science & Medicine 49(4):459–67, 1999

    Article  CAS  Google Scholar 

  16. Fischer B, Bibby M, Bouchard M: The global diversion of pharmaceutical drugs non-medical use and diversion of psychotropic prescription drugs in North America: A review of sourcing routes and control measures. Addiction 105(12):2062–70, 2010

    Article  PubMed  Google Scholar 

  17. Straand J, Rokstad K: General practitioners’ prescribing patterns of benzodiazepine hypnotics: Are elderly patients at particular risk for overprescribing? A report from the Møre & Romsdal Prescription Study. Scandinavian Journal of Primary Health Care 15(1):16–21, 1997

    Article  PubMed  CAS  Google Scholar 

  18. Cook JM, Marshall R, Masci C, et al.: Physicians’ perspectives on prescribing benzodiazepines for older adults: A qualitative study. Journal of General Internal Medicine 22(3):303–7, 2007

    Article  PubMed  Google Scholar 

  19. Parr JM, Kavanagh DJ, Cahill L, et al.: Effectiveness of current treatment approaches for benzodiazepine discontinuation: A meta-analysis. Addiction 104(1):13–24, 2009

    Article  PubMed  Google Scholar 

  20. de las Cuevas C, Sanz EJ: Controversial issues associated with the prescription of benzodiazepines by general practitioners and psychiatrists. Medical Science Monitor 10(7):CR288–93, 2004

    PubMed  Google Scholar 

  21. Siriwardena AN, Qureshi Z, Gibson S, et al.: GPs’ attitudes to benzodiazepine and ‘Z-drug’ prescribing: A barrier to implementation of evidence and guidance on hypnotics. British Journal of General Practice 56(533):964–7, 2006

    PubMed  Google Scholar 

  22. Rogers A, Pilgrim D, Brennan S, et al.: Prescribing benzodiazepines in general practice: A new view of an old problem. Health (London) 11(2):181–98, 2007

    Article  Google Scholar 

  23. Hamilton IJ, Reay LM, Sullivan FM: A survey of general practitioners’ attitudes to benzodiazepine overprescribing. Health Bull (Edinb) 48(6):299–303, 1990

    CAS  Google Scholar 

  24. Parr JM, Kavanagh DJ, Young RM, et al.: Views of general practitioners and benzodiazepine users on benzodiazepines: A qualitative analysis. Social Science & Medicine 62(5):1237–49, 2006

    Article  Google Scholar 

  25. Lader M, Tylee A, Donoghue J: Withdrawing benzodiazepines in primary care. CNS Drugs 23(1):19–34, 2009

    Article  PubMed  CAS  Google Scholar 

  26. Cook JM, Biyanova T, Masci C, et al.: Older patient perspectives on long-term anxiolytic benzodiazepine use and discontinuation: A qualitative study. Journal of General Internal Medicine 22(8):1094–100, 2007

    Article  PubMed  Google Scholar 

  27. Barter G, Cormack M: The long-term use of benzodiazepines: Patients’ views, accounts and experiences. Family Practise 13(6):491–7, 1996

    Article  CAS  Google Scholar 

  28. Iliffe S, Curran HV, Collins R, et al.: Attitudes to long-term use of benzodiazepine hypnotics by older people in general practice: Findings from interviews with service users and providers. Aging & Mental Health 8(3):242–8, 2004

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carla Beth Marienfeld.

Additional information

The information in this paper has not been presented or published elsewhere. However, an abstract with most of the data was presented at the conference of the College on Problems of Drug Dependence.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marienfeld, C.B., Tek, E., Diaz, E. et al. Psychiatrist Decision-Making Towards Prescribing Benzodiazepines: The Dilemma with Substance Abusers. Psychiatr Q 83, 521–529 (2012). https://doi.org/10.1007/s11126-012-9220-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-012-9220-8

Keywords

Navigation