Am J Psychiatry 1995; 152:1161-1167
Copyright © 1995 by American Psychiatric Association
Clinical aspects of chronic use of alprazolam and lorazepam
M Romach, U Busto, G Somer, HL Kaplan and E Sellers
Clinical Research and Treatment Institute, Addiction Research Foundation, Toronto, Ont., Canada.
OBJECTIVE: The authors' goal was to determine the clinical characteristics
of persistent users of alprazolam or lorazepam who wished to discontinue
their medication. METHOD: Long-term users (daily use for more than 3
months) of alprazolam (N = 34) or lorazepam (N = 97) who entered an
outpatient treatment program for discontinuation of benzodiazepines were
carefully assessed. Detailed histories of benzodiazepine use were obtained;
a structured interview was used to make psychiatric diagnoses based on
DSM-III-R criteria. RESULTS: The majority of patients were using low
therapeutic doses of medication (lorazepam: mean = 2.7 mg/day; alprazolam:
mean = 1.2 mg/day) and had either maintained their initial daily dose over
time or decreased it. Individuals tended to shift their use of medication
from an as- prescribed to an as-needed pattern. Forty-seven percent of the
patients were diagnosed with at least one current anxiety disorder, most
commonly generalized anxiety. At least one diagnosable personality disorder
was found in 45% of the patients, most commonly obsessive- compulsive
personality disorder. Patterns of benzodiazepine use were influenced by
age, gender, and past history of alcohol dependence. CONCLUSIONS: Long-term
users of alprazolam/lorazepam seeking treatment for discontinuation had
clinically important past and current psychiatric histories. They used a
constant or decreasing dose of medication and made attempts to stop their
use. Persistent use of alprazolam/lorazepam for therapeutic purposes did
not represent abuse or addiction as the terms are usually understood. A
substantial proportion of these patients may be receiving appropriate
maintenance therapy for a chronic psychiatric condition.
