Encouraging a Patient to Withdraw

Many prescribers report that they have long-term benzodiazepine users who have a variety of complaints that the prescriber believes are related to benzodiazepine tolerance.  They want to taper the patients off the benzodiazepines, but the patients are convinced that they need the drugs, and that their symptoms must be related to other diseases.  This presents a dilemma.  Continuing the prescription of benzodiazepines will please the patient, but not cure the problems.  On the other hand, mandated tapers, without complete understanding and assent by the patient, often fail.

The solution revolves around patient education.  Patients must first be shown that their symptoms are part of the well-established phenomena of tolerance and benzodiazepine withdrawal syndrome.  This often requires the physician to address messages of safety and intrinsic need for benzodiazepines, which patients have heard from other physicians who are unaware of the dangers and symptoms of physiologic dependency.  For long-term benzodiazepine users, this is a tidal shift in thinking, and will take time, reinforcement, and assurance that the prescriber will help them though the withdrawal and recovery processes.