Hostname: page-component-5d59c44645-zlj4b Total loading time: 0 Render date: 2024-02-20T15:17:02.862Z Has data issue: false hasContentIssue false

The Prevalence of Benzodiazepine Dependence among Community-Dwelling Older Adult Users in Quebec According to Typical and Atypical Criteria*

Published online by Cambridge University Press:  27 April 2010

Philippe Voyer*
Affiliation:
Faculty of Nursing at Laval University and Center for Excellence in Aging – Research Unit
Michel Préville
Affiliation:
Faculty of Medicine, Université de Sherbrooke, and Research Center of the Hôpital Charles LeMoyne
David Cohen
Affiliation:
School of Social Work, Florida International University
Djamal Berbiche
Affiliation:
Centre de recherche de l’Hôpital Charles LeMoyne
Sarah-Gabrielle Béland
Affiliation:
Sherbrooke University
*
Correspondence concerning this article should be addressed to / La correspondance concernant cet article doit être adressées à: Philippe Voyer, Faculty of Nursing, Université Laval, 1050, rue de la Médecine, Pavillon Ferdinand-Vandry, bureau 3445 Université Laval, Québec (Québec) CANADA G1V 0A6 (Philippe.Voyer@fsi.ulaval.ca)

Abstract

Background: Use of benzodiazepines, common among older people, may lead to substance dependence. DSM-IV-TR criteria for this iatrogenic problem may apply poorly to older persons following a physician-prescribed regimen. This study, first of its kind, aimed to determine the prevalence rate of benzodiazepine dependence in older persons according to DSM-IV-TR and other atypical criteria.

Methods: Descriptive study based on face-to-face interviews conducted in the homes of 2,785 persons aged 65 years or older who were randomly selected from across the province of Quebec, Canada.

Results: Use of benzodiazepines was reported by 25.4% of respondents. Among them, 9.5% met DSM-IV-TR criteria for substance dependence. However, 43% of users reported being dependent, and one third agreed that it would be a good thing to stop taking benzodiazepines.

Interpretation: Benzodiazepine substance dependence is established at one tenth of community-dwelling older persons taking these medications, although a much larger proportion self-labels as dependent.

Résumé

Contexte: La consommation de benzodiazépines est reconnue pour pouvoir entraîner un problème de dépendance. Les critères diagnostiques de la dépendance du DSM-IV-TR ne s’appliqueraient pas toujours à la situation d’un médicament prescrit par un médecin. Cette recherche vise à déterminer la prévalence de la dépendance aux benzodiazépines chez les aînés selon les critères classiques et des critères atypiques.

Méthode: Étude descriptive basée sur des entrevues réalisées au domicile de 2785 aînés sélectionnés de façon aléatoire dans la province de Québec, Canada.

Résultats: Le quart (25,4%) des participants de l’étude étaient consommateurs de benzodiazépines et 9,5% d’entre eux étaient dépendants selon le DSM-IV-TR. Toutefois, 43% des aînés consommateurs se disaient dépendants du médicament et un tiers souhaite arrêter de le consommer.

Interprétation: La dépendance aux benzodiazépines se présenteraient chez environ 10% des aînés consommateurs selon les critères classiques, pourtant plus de 40% d’entre eux se disent dépendants.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The authors thank the Canadian Institute for Health Research for its financial support (reference number: 52350). This work was also supported through a Fonds de la recherche en santé du Québec (Quebec Health Research Fund) and Quebec Nursing Research Fund (Fonds de la recherche en sciences infirmières du Québec) Investigator Award to Philippe Voyer.

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-revised). Washington, DC: Author.Google Scholar
Aparasu, R.R., Mort, J.R., & Sitzman, S. (1998). Psychotropic prescribing for the elderly in office-based practice. Clinical Therapeutics, 20(3), 603616.Google Scholar
Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18, 249255.Google Scholar
Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J.-P., Grégoire, J.-P., & Morin, C.M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: A randomized trial. Canadian Medical Association Journal, 169(10), 10151020.Google Scholar
Baillie, A.J., & Mattick, R.P. (1996). The benzodiazepine dependence questionnaire: Development, reliability and validity. British Journal of Psychiatry, 169(3), 276281.Google Scholar
Baker, R., & Shaw, E.J.; Department of General Practice & Primary Health Care UoL. (2001). Audit protocol: Benzodiazepine prescribing in primary care. CT17. Leicester, England: Clinical Governance Research & Development Unit.Google Scholar
Barbone, F., McMahon, A.D., Davey, P.G., Morris, A.D., Reid, I.C., McDevitt, D.G., et al. . (1998). Association of road-traffic accidents with benzodiazepine use. Lancet, 352(9137), 13311336.Google Scholar
Bartlett, G., Abrahamowicz, M., Tamblyn, R., Grad, R., Capek, R., & du Berger, R. (2004). Longitudinal patterns of new benzodiazepine use in the elderly. Pharmacoepidemiology and Drug Safety, 13(10), 669682.Google Scholar
Béland, S.G., Préville, M., Tournier, M., Voyer, P., Moride, Y., Bouharaoui, F., et al. . (2008). The use of long half-life benzodiazepines in the community dwelling elderly population. Journal of Public Health Pharmacy, 1(1), 3550.Google Scholar
Blazer, D., Steffens, D.C., & Busse, E.W. (2004). Textbook of Geriatric Psychiatry. Washington, DC: American Psychiatric Publishing.Google Scholar
Brymer, C., & Rusnell, I. (2000). Reducing substance dependence in elderly people: The side effects program. Canadian Journal of Clinical Pharmacology = Journal canadien de pharmacologie clinique, 7(3), 161166.Google Scholar
Bucholz, K.K., Marion, S.L., Shayka, J.J., Marcus, S.C., & Robins, L.N. (1996). A short computer interview for obtaining psychiatric diagnoses. Psychiatric Services, 47(3), 293297.Google Scholar
Canadian Heritage. (2008). The French Language. [retrieved date 2008 3 July]. Ottawa: Government of Canada. Retrieved from: http://www.patrimoinecanadien.gc.ca/progs/lo-ol/pubs/census2001/4_e.cfmGoogle Scholar
Cook, J.M., Biyanova, T., Masci, C., & Coyne, J.C. (2007). Older patient perspectives on long-term anxiolytic benzodiazepine use and discontinuation: A qualitative study. Journal of General Internal Medicine, 22(8), 10941100.Google Scholar
Cox, B.G., & Cohen, S.B. (1985). Methodological issues for health care surveys. New York: CRC Press.Google Scholar
Damestoy, N., Collin, J., & Lalande, R. (1999). Prescribing psychotropic medication for elderly patients: Some physicians perspectives. Canadian Medical Association Journal, 161(2), 143145.Google Scholar
de las Cuevas, C., Sanz, E., & de la Fuente, J. (2003). Benzodiazepines: More “behavioural” addiction than dependence. Psychopharmacology (Berlin), 167(3), 297303.Google Scholar
de las Cuevas, C., Sanz, E.J., de la Fuente, J.A., Padilla, J., & Berenguer, J.C. (2000). The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction, 95(2), 245250.Google Scholar
Erdman, H.P., Klein, M.H., Greist, J.H., Bass, S.M., Bires, J.K., & Machtinger, P.E. (1987). A comparison of the Diagnostic Interview Schedule and clinical diagnosis. American Journal of Psychiatry, 144(11), 14771480.Google Scholar
Erdman, H.P., Klein, M.H., Greist, J.H., Skare, S.S., Husted, J.J., Robins, L.N., et al. . (1992). A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule. Journal of Psychiatric Research, 26(1), 8595.Google Scholar
Gleason, P.P., Schulz, R., Smith, N.L., Newsom, J.T., Kroboth, P.D., & Kroboth, F.J. (1998). Correlates and prevalence of benzodiazepine use in community-dwelling elderly. Journal of General Internal Medicine, 13(4), 243250.Google Scholar
Holbrook, A.M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 162(2), 225233.Google Scholar
Holroyd, S., & Duryee, J.J. (1997). Substance use disorders in a geriatric psychiatry outpatient clinic: Prevalence and epidemiologic characteristics. Journal of Nervous and Mental Disease, 185(10), 627632.Google Scholar
Institut-de-la-Statistique-du-Québec (Ed.). (2009). Utilisation de services et consommation de médicaments liées aux problèmes de santé mentale chez les adultes québécois. Quebec City: Gouvernement du Québec.Google Scholar
Isacson, D., Carsjö, K., Bergman, U., & Blackburn, J.L. (1992). Long-term use of benzodiazepines in a Swedish community: An eight-year follow-up. Journal of Clinical Epidemiology, 45(4), 429436.Google Scholar
Jorm, A.F., Grayson, D., Creasey, H., Waite, L., & Broe, G.A. (2000). Long-term benzodiazepine use by elderly people living in the community. Australian and New Zealand Journal of Public Health, 24(1), 710.Google Scholar
Kan, C.C., Breteler, M.H., Timmermans, E.A., van der Ven, A.H., & Zitman, F.G. (1999). Scalability, reliability, and validity of the benzodiazepine dependence self-report questionnaire in outpatient benzodiazepine users. Comprehensive Psychiatry, 40(4), 283291.Google Scholar
Laurila, J.V., Pitkala, K.H., Strandberg, T.E., & Tilvis, R.S. (2004). Detection and documentation of dementia and delirium in acute geriatric wards. General Hospital Psychiatry, 26(1), 3135.Google Scholar
Levitan, R.D., Blouin, A.G., Navarro, J.R., & Hill, J. (1991). Validity of the computerized DIS for diagnosing psychiatric inpatients. Canadian Journal of Psychiatry, 36(10), 728731.Google Scholar
Mort, J.R., & Aparasu, R.R. (2002). Prescribing of psychotropics in the elderly: Why is it so often inappropriate? CNS Drugs, 16(2), 99109.Google Scholar
Pimplott, N.J.G., Hux, J.E., Wilson, L.M., Kahan, M., Li, C., & Rosser, W. (2003). Educating physicians to reduce benzodiazepine use by elderly patients: A randomized controlled trial. Canadian Medical Association Journal, 168(7), 835839.Google Scholar
Preville, M., Boyer, R., Grenier, S., Dube, M., Voyer, P., Punti, R., et al. . (2008). The epidemiology of psychiatric disorders in Quebec’s older adult population. Canadian Journal of Psychiatry, 53(12), 822832.Google Scholar
Rickels, K., Schweizer, E., Csanalosi, I., Case, G., & Chung, H. (1988). Long-term treatment of anxiety and risk of withdrawal. Archives of General Psychiatry, 45(5), 444450.Google Scholar
Robins, L.N., & Cottler, L.B. (2004). Making a structured psychiatric diagnostic interview faithful to the nomenclature. American Journal of Epidemiology, 160(8), 808813.Google Scholar
Robins, L.N., Slobodyan, S., & Marcus, S. (1999). The C-DIS IV. St. Louis, MO: Washington University.Google Scholar
Silber, M.H. (2005). Clinical practice. Chronic insomnia. New England Journal of Medicine, 353(8), 803810.Google Scholar
Sleath, B., Svarstad, B., & Roter, D. (1997). Physician vs patient initiation of psychotropic prescribing in primary care settings: A content analysis of audiotapes. Social Science and Medicine, 444(4), 541548.Google Scholar
Tombaugh, T.N., & McIntyre, N.J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922935.Google Scholar
Trudel, G., Courtemanche, R., & Tarte, F. (1992). Validation, coding, entry and weighting of data for the Québec Health Survey, Technical Manual 87–07. In sociaux MdlSedS (Ed.). Gouvernement du Québec.Google Scholar
Verster, J.C., Veldhuijzen, D.S., & Volkerts, E.R. (2004). Residual effects of sleep medication on driving ability. Sleep Medicine Review, 8(4), 309325.Google Scholar
Voyer, P., Cappeliez, P., Perodeau, G., & Preville, M. (2005). Mental health for older adults and benzodiazpine use. Journal of Community Health Nursing, 22(4), 213229.Google Scholar
Voyer, P., Cohen, D., Lauzon, S., & Collin, J. (2004). Factors associated with psychotropic drug use among community-dwelling older persons: A review of empirical studies. BMC Nursing, 3(1), 3.Google Scholar
Voyer, P., Landreville, P., Moisan, J., Tousignant, M., & Preville, M. (2005). Insomnia, depression and anxiety disorders and their association with benzodiazepine drug use among the community-dwelling elderly: Implications for mental health nursing. International Journal of Psychiatric Nursing Research, 10(2), 10931116.Google Scholar
Voyer, P., McCubbin, M., Cohen, D., Lauzon, S., Collin, J., & Boivin, C. (2004). Unconventional indicators of drug dependence among elderly long-term users of benzodiazepines. Issues in Mental Health Nursing, 25(6), 603628.Google Scholar