Patient Tools

Benzodiazepine Informed Consent Tool

This tool outlines the risks associated with benzodiazepine use. It is designed as a contract between the provider and the patient. Its purpose is to ensure that patients understand the potential problems before using benzodiazepines. We also encourage those currently suffering negative effects from the use of benzodiazepines to present this tool to their prescriber. This tool was developed by the Colorado Consortium for the Prescription Drug Abuse Prevention, of which both the Alliance and the Benzodiazepine Information Coalition are members.

Click here to view and download the informed consent tool

Tools to help convert your prescriber to be a partner in your recovery.

These downloadable tools are for patients who feel like their clinician is not sufficiently aware of benzodiazepine withdrawal syndrome (BZWS) and its treatment. Such prescribers are rare, and many BZWS sufferers need, for a variety of reasons, to find the best ways possible to work with their current prescriber.

The Alliance has developed two sets of tools to help you.

“By Topic”

The “By Topic” toolset equips you with several tools, each focused on a separate topic. These tools are designed to help your prescriber understand the benzodiazepine withdrawal syndrome puzzle, piece by piece. Use these tools if you are unsure if your prescriber is willing to listen to you. You will need to approach your prescriber with medical information in more than one office visit.

Click here to view specific tools by topic

“All in One”

The “All In One” toolset allows you to approach your prescriber one time with a large amount of information designed to inform and hopefully make them your ally. Use this if you feel confident in your communications ability about medical information, and are reasonably sure that your prescriber will be willing to listen to you.

The “All-In One” tool is the “Prescriber Information Pamphlet” (PIP), and its accompanying “Pamphlet Communication Guide” and its summary. These provide you with language and specific information designed to both educate and motivate prescribers to form collaborative partnerships with patients. The PIP gives the prescribers the evidence-based information they need to understand BZWS. The Pamphlet Communication Guide instructs you on how to approach the prescriber with the PIP and talk about it successfully, so that prescribers increase their knowledge of benzodiazepines and become more open to discussing matters with you.

STEP 1: Review and understand the Prescriber Information Pamphlet.

The Prescriber Information Pamphlet contains an appeal for dialog and teamwork with you. You will hand it directly to the prescriber. It focuses on medical information on benzodiazepines in a format that prescribers are used to seeing, including primary source documents. It is important for you to review and understand this pamphlet before using it. You do not need to become an expert on the PIP, but you should generally know what it contains.

View or print the Prescriber Information Pamphlet HERE.

STEP 2: Review and understand the Pamphlet Communication Guide.

After you’ve become generally familiar with the Prescriber Information Pamphlet, read the PIP Communication Guide. After you’ve become generally familiar with the Prescriber Information Pamphlet, read the Pamphlet Communication Guide. This document explains how to form a partnership with your prescriber. You will be more successful in getting your prescriber to team up with you if you follow this guide. It is research-based, and explains how to approach the inevitably unequal relationship with your clinician. It guides you through presenting the Prescriber Information Pamphlet to your prescriber, and the dos and don’ts of establishing trust and respect. This mutual trust and respect is essential to move your prescriber towards becoming benzo-wise. The Pamphlet Communication Guide allows you to prepare in advance to deliver the pamphlet, and provides a guide for its delivery. It also helps you to decide what to do if the prescriber is reluctant to team up with you. The Pamphlet Communication Guide is for your use, and not to give to the prescriber.

View or print the Pamphlet Communication Guide HERE.

STEP 3: Review the Pamphlet Communication Guide Summary

This is a brief summary of the most important points of Pamphlet Communications Guide that you reviewed in step 2. We developed this take-along summary to increase your confidence when asking your prescriber to team up with you. It also contains, for those who want it, a suggested script for that important first introduction of the Prescriber Information Pamphlet to the prescriber. This summary is for your use, and not to give to the prescriber.

View or print the Pamphlet Communication Guide Summary HERE.

STEP 4: Print the PIP and the Pamphlet Communication Guide Summary and prepare for your appointment.

After completing steps 1-3, it is suggested that you print both the Prescriber Information Pamphlet and the Pamphlet Communication Guide Summary to take with you to your appointment with your prescriber. For your reference at the appointment, you may want to print a second copy of the PIP.At the appropriate time in the appointment, you will hand one copy of the PIP to your prescriber. You keep the Pamphlet Communication Guide Summary in your own hands to remind you of what you could say and how to say it.