Strategies for discontinuing long-term benzodiazepine use: Meta-analysis

Background: The prevalence of benzodiazepine consumption in European countries remains at 2-3% of the general population despite the well-documented disadvantages of long-term use. Aims: To review systematically the success rates of different benzodiazepine discontinuation strategies. Method: Meta-analysis of comparable intervention studies. Results: Twenty-nine articles met inclusion criteria.Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8,95% CI 1.6-5.1); systematic discontinuation alone (one study,OR=6.l,95% CI 2.0-18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1-9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5,95% CI 2.3-14.2) was superior to systematic discontinuation alone. Conclusions: Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.