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.
