A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

  • Coral SirdifieldEmail author
  • Susan Y. Chipchase
  • Sara Owen
  • Aloysius Niroshan Siriwardena
Systematic Review



Benzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.


The aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.


A systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.


Nine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients’ negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use.


Inappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.


Healthcare Professional Cognitive Behavioural Therapy Zolpidem Zopiclone Zaleplon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Thank you to Rebecca Porter (School of Health and Social Care, University of Lincoln) for her support with data extraction for this project.

Author contributions

Sirdifield led the study and contributed to all stages of the analysis and write-up. Chipchase contributed to all stages of the analysis and write up. Owen read and commented on drafts of the paper and model, and proof read the final version. Siriwardena had the idea for this study, and has contributed to the design, conception, analysis and drafts of the paper (including final revisions).

Compliance with Ethical Standards

This study was funded by a University of Lincoln College Research Fund grant. There are no conflicts of interest for Sirdifield, Chipchase, Owen or Siriwardena.

Supplementary material

40271_2016_182_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)
40271_2016_182_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 21 kb)
40271_2016_182_MOESM3_ESM.docx (16 kb)
Supplementary material 3 (DOCX 16 kb)


  1. 1.
    National Institute for Clinical Excellence. Managing long-term insomnia (>4 weeks). 2015.!scenario:1. Accessed 17 Nov 2015.
  2. 2.
    National Institute for Clinical Excellence. Scenario: managing short-term insomnia (<4 weeks). 2015.!scenariorecommendation. Accessed 17 Nov 2015.
  3. 3.
    National Institute for Health and Clinical Excellence. Guidance on the use of zaleplon, zolpidem and zopiclone for the short term management of insomnia. London: NICE; 2004.Google Scholar
  4. 4.
    National Institute for Clinical Excellence. Generalised anxiety disorder and panic disorder in adults: management. NICE guidelines [CG113]. National Institute for Clinical Excellence. 2011. Accessed 24 Nov 2015.
  5. 5.
    Neutel CI. The epidemiology of long-term benzodiazepine use. Int Rev Psychiatry. 2005;17(3):189–97. doi: 10.1080/09540260500071863.CrossRefPubMedGoogle Scholar
  6. 6.
    Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–55.CrossRefPubMedGoogle Scholar
  7. 7.
    Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2015;72(2):136–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Sirdifield C, Anthierens S, Creupelandt H, Chipchase SY, Christiaens T, Siriwardena AN. General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis. BMC Fam Prac. 2013. doi: 10.1186/1471-2296-14-191.
  9. 9.
    Canham SL. What’s loneliness got to do with it? Older women who use benzodiazepines. Australas J Ageing. 2015;34(1):E7–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Public Health Resource Unit. C.A.S.P: Critical Appraisal Skills Programme: 10 questions to help you make sense of qualitative research. England: Public Health Resource Unit; 2006.Google Scholar
  11. 11.
    Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008. doi: 10.1186/1471-2288-8-45.
  12. 12.
    Andrews LK, Coviello J, Hurley E, Rose L, Redeker NS. “I’d eat a bucket of nails if you told me it would help me sleep:” perceptions of insomnia and its treatment in patients with stable heart failure. Heart Lung J Crit Care. 2013;42(5):339–45. doi: 10.1016/j.hrtlng.2013.05.003.CrossRefGoogle Scholar
  13. 13.
    Anthierens S, Habraken H, Petrovic M, Deveugele M, De Maeseneer J, Christiaens T. First benzodiazepine prescriptions: qualitative study of patients’ perspectives. Can Fam Physician. 2007;53:1200–1.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Canham SL, Gallo J, Simoni-Wastila L. Perceptions of benzodiazepine dependence among women age 65 and older. J Gerontol Soc Work. 2014;57(8):872–88.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cook JM, Biyanova T, Masci C, Coyne JC. Older patient perspectives on long-term anxiolytic benzodiazepine use and discontinuation: A qualitative study. J Gen Intern Med. 2007;22(8):1094–100. doi: 10.1007/s11606-007-0205-5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Dollman WB, LeBlanc VT, Roughead EE. Managing insomnia in the elderly—what prevents us using non-drug options? J Clin Pharm Ther. 2003;28(6):485–91. doi: 10.1046/j.0269-4727.2003.00523.x.CrossRefPubMedGoogle Scholar
  17. 17.
    Dyas JV, Apekey TA, Tilling M, Ørner R, Middleton H, Siriwardena AN. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. Br J Gen Prac. 2010;60(574):e180–200.CrossRefGoogle Scholar
  18. 18.
    Kapadia N, Fox D, Rowlands G, Ashworth M. Developing primary care services for high-dose benzodiazepine-dependent patients: a consultation survey. Drugs Educ Prev Policy. 2007;14(5):429–42. doi: 10.1080/09687630601108256.CrossRefGoogle Scholar
  19. 19.
    Parr JM, Kavanagh DJ, Young RM, McCafferty K. Views of general practitioners and benzodiazepine users on benzodiazepines: a qualitative analysis. Soc Sci Med. 2006;62(5):1237–49. doi: 10.1016/j.socscimed.2005.07.016.CrossRefPubMedGoogle Scholar
  20. 20.
    Mechanic D. Editorial. The concept of illness behaviour: culture, situation and personal predisposition. Psychol Med. 1986;16:1–7.Google Scholar
  21. 21.
    Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Aikens JE, Rouse ME. Help-seeking for insomnia among adult patients in primary care. J Am Board Fam Med. 2005;18(4):257–61.CrossRefGoogle Scholar
  23. 23.
    Roness A, Mykletun A, Dahl AA. Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatr Scand. 2005;111:51–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Barker C, Pistrang N, Shapiro DA, Shaw I. Coping and help-seeking in the UK adult population. Br J Clin Psychol. 1990;29(3):271–85.CrossRefPubMedGoogle Scholar
  25. 25.
    Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807. doi: 10.1007/s40266-013-0106-8.CrossRefPubMedGoogle Scholar
  26. 26.
    Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education. The EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Morin CM, Espie CA. Insomnia. A clinical guide to assessment and treatment. New York: Kluwer Academic/Plenum Publishers; 2003.Google Scholar
  28. 28.
    Kemani MK, Olsson GL, Lekander M, Hesser H, Andersson E, Wicksell RK. Efficacy and cost-effectiveness of acceptance and commitment therapy and applied relaxation for longstanding pain: a randomized controlled trial. Clin J Pain. 2015;31(11):1004–16. doi: 10.1097/AJP.0000000000000203.CrossRefPubMedGoogle Scholar
  29. 29.
    Andrews G, Cuijpers P, Craske MG, McEnvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. Plos One. 2010;5(10):e13196.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hofmann SG, Smits JAJ. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Vincent N, Lewycky S. Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep. 2009;32(6):807–15.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Pollmann AS, Murphy AL, Bergman JC, Gardner DM. Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review. BMC Pharmacol Toxicol. 2015;16:19.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Horsch C, Lancee J, Beun RJ, Neerincx MA, Brinkman WP. Adherence to technology-mediated insomnia treatment: a meta-analysis, interviews, and focus groups. J Med Internet Res. 2015;17(9):e214. doi: 10.2196/jmir.4115.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Cullinan S, O’Mahony D, Fleming A, Byrne S. A meta-synthesis of potentially inappropriate prescribing in older patients. Drugs Aging. 2014;31:631–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Coral Sirdifield
    • 1
    Email author
  • Susan Y. Chipchase
    • 2
  • Sara Owen
    • 3
  • Aloysius Niroshan Siriwardena
    • 1
  1. 1.Community and Health Research Unit, School of Health and Social Care, Bridge House, Brayford CampusUniversity of LincolnLincolnUK
  2. 2.School of Psychology, Bridge House, Brayford CampusUniversity of LincolnLincolnUK
  3. 3.College of Social Science, Brayford CampusUniversity of LincolnLincolnUK

Personalised recommendations