TREATMENTS FOR BENZODIAZEPINE DEPENDENCE

苯二氮卓类药物比阿司匹林更安全，滥用可能性更小 他们替换了巴比妥酸盐。然而，依赖可能会发生在慢性 治疗并导致戒断症状，包括焦虑，失眠， 肿瘤、肌肉抽搐、恶心和知觉扭曲。虽然 苯二氮卓类药物被认为是适度的增强剂，这种影响可能 与撤除症状相结合，以维持进一步的吸毒。因为 许多戒断症状类似焦虑症，很难知道 停药症状是否代表疾病复发或药物 戒烟。此外，由于焦虑症的慢性，它是 不清楚停药失败或吸毒复发是否代表 成瘾行为或持续药物治疗。鉴于药理学 对苯二氮卓类药物身体依赖的因素进行了深入研究； 与“心理依赖”相关的行为因素很少。 在停药治疗中被考虑并经常被忽视。 这项拟议的研究解决了可能涉及的行为因素 对苯二氮类药物的心理依赖。三项研究检验 患者对苯二氮类药物减量和停药的依从性 通过关注与患者焦虑相关的行为因素。这些 焦虑可能是由最初的障碍或戒断引起的 反应，也可能与心理依赖有关 药物治疗。实验#1比较短期稳定治疗之前 在长期剂量稳定的效果下减少剂量 维护旨在适应患者并安抚他们 对减少剂量的焦虑。实验#2比较盲人与开放标签 在剂量减少期间给药的想法是盲目剂量- 减少可能会减少预期的焦虑反应。实验#3比较 控制和认知/行为疗法，以检查 帮助患者在减少剂量或 停产。所有研究的衡量标准包括客观和 对停药、受试者投诉和用药的主观评估 合规性。 这些研究应该：1)阐明心理依赖在 慢性使用苯二氮卓类药物；2)有助于优化治疗策略 苯二氮类药物依赖；3)阐明行为决定因素 持续用药治疗药物依赖；4)建议 针对其他药物滥用患者群体的干预措施(例如，可卡因 或阿片类药物使用者)也使用苯二氮卓类药物。

Benzodiazepines are safer and have lesser abuse potential than the barbiturates they replaced. However, dependence can occur with chronic therapy and result in withdrawal symptoms including anxiety, insomnia, tumor, muscle twitching, nausea, and perceptual distortions. Although benzodiazepines are considered modest reinforcers, such effects may combine with withdraws symptoms to sustain further drug taking. Because many withdrawal symptoms mimic anxiety disorder, it is difficult to know whether discontinuation symptoms represent disease reemergence or drug withdrawal. Also, because of the chronicity of anxiety disorders, it is not clear whether discontinuation failure or drug use relapse represents addictive behavior or continued pharmacotherapy. Whereas pharmacological factors involved in benzodiazepine physical dependence are well studied; behavioral factors related to "psychological dependence" have been rarely considered and are often ignored in discontinuation treatment. The proposed research addresses behavioral factors presumably involved in psychological dependence on benzodiazepines. Three studies examine patient compliance with benzodiazepine dose reduction and discontinuation by focusing on behavioral factors related to patient anxiety. These anxieties may be caused by an original disorder or by withdrawal reactions, but also may be related to psychological dependence on medication. Exp. #1 compares a short-term stabilization treatment prior to dose reduction with the effects of long-term dose stabilization and maintenance intended to acclimate the patients and appease their anxieties about dose reduction. Exp. #2 compares blind vs. open-label drug administration during dose reductions with the idea that blind dose- reduction may reduce anticipatory anxiety reactions. Exp. #3 compares control and cognitive/behavioral therapies to examine the effects of helping patients manage their anxiety levels during dose reduction or discontinuation. Measures for all studies include objective and subjective assessments of withdrawal, subject complaints, and medication compliance. These studies should: 1) clarify the role of psychological dependence in chronic benzodiazepine use; 2) help to optimize strategies for treating benzodiazepine dependence; 3) clarify behavioral determinants of persistent drug use in therapeutic drug dependence; 4) suggest interventions for other drug abusing patient populations (e.g., cocaine or opioid users) who also use benzodiazepines.