Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

10. Sedatives/Hypnotics and Benzodiazepines 233tinuation of benzodiazepine use. For some patients, this requires inpatient treatment.IDENTIFICATION OF PROBLEMSAMONG LONG-TERM BENZODIAZEPINE USERSPhysicians frequently encounter patients, or family members of patients, whoare concerned about the possible adverse effects of long-term use of a benzodiazepinein the treatment of anxiety or insomnia. In helping to structure thedecision making for such a patient, we use the Benzodiazepine Checklist(DuPont, 1986; see Table 10.2). There are four questions to be answered:1. Diagnosis. Is there a current diagnosis that warrants the prolonged use ofa prescription medicine? The benzodiazepines are serious medicines that shouldonly be used for serious illnesses.2. Medical and nonmedical substance use. Is the benzodiazepine dose thepatient is taking reasonable? Is the clinical response to the benzodiazepinefavorable? Is there any use of nonmedical drugs, such as cocaine or marijuana? Isthere any excessive use of alcohol (e.g., a total of more than four drinks a week,or more than two drinks a day)? Are other medicines being used that candepress CNS functioning?3. Toxic behavior. Is the patient free of evidence of slurred speech, staggering,accidents, memory loss, or other mental deficits or evidence of sedation?4. Family monitor. Does the family confirm that there is a good clinicalresponse and no adverse reactions to the patient’s use of a benzodiazepine?Because people who abuse drugs deny drug-caused problems and often lie toTABLE 10.2 Benzodiazepine Checklist for Long-Term Use1. Diagnosis. Is there a current diagnosis that warrants the prolonged use of aprescription medicine?2. Medical and nonmedical substance use. Is the dose of the benzodiazepine the patient istaking reasonable? Is the clinical response to the benzodiazepine favorable? Is thereany use of nonmedical drugs, such as cocaine or marijuana? Is there any excessive useof alcohol (e.g., a total of more than four drinks a week, or more than two drinks aday)? Are there other medicines being used that can depress the functioning of theCNS?3. Toxic behavior. Is the patient free of evidence of slurred speech, staggering, accidents,memory loss, or other mental deficits or evidence of sedation?4. Family monitor. Does the family confirm that there is a good clinical response and noadverse reactions to the patient’s use of a benzodiazepine?Standard for continued benzodiazepine use: a “yes” to all four questions.