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Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse.
Behav Res Ther 2005; 43(1):1-14BR

Abstract

Discontinuation of benzodiazepine (BZD) treatment for insomnia can be a difficult task. Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal but there is limited evidence on long-term outcome after discontinuation. The objective of this study was to examine medication-free survival time and predictors of relapse (i.e., resumed BZD hypnotics) over a 2-year period in 47 older adults (mean age 62.1 years) with persistent insomnia and prolonged BZD use (average duration of 18.9 years), who had successfully discontinued BZD following CBT for insomnia, a supervised medication taper program, or a combined approach. The Kaplan-Meier product-limit method was used to estimate survival time, defined as time between end-of-treatment and relapse or end of follow-up. By the end of the 24-month follow-up, 42.6% of the samples had resumed BZD use. Participants in the Combined (33.3%) and Taper (30.8%) groups relapsed significantly less than their counterparts from the CBT group (69.2%). Survival rates at 3 months were 61.5% (CBT), 100% (Taper), and 80.9% (Combined). At 12 months, they were 38.5%, 83.3%, and 70.8%, respectively; and, at 24 months, they were 28.9%, 64.8% and 64.9%, respectively. Mean survival time was significantly longer for both the Taper (18.6 months, SE = 2.1) and Combined groups (12.6 months, SE = 1.4), relative to the CBT group (8.5 months, SE = 1.8). Significant predictors of relapse included treatment condition, end of treatment insomnia severity, and psychological distress. In conclusion, there is a substantial relapse rate following BZD discontinuation among prolonged users. CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse.

Authors+Show Affiliations

Ecole de Psychologie, Université Laval, Quebec City, Que., Canada G1K 7P4. cmorin@psy.ulaval.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15531349

Citation

Morin, Charles M., et al. "Long-term Outcome After Discontinuation of Benzodiazepines for Insomnia: a Survival Analysis of Relapse." Behaviour Research and Therapy, vol. 43, no. 1, 2005, pp. 1-14.
Morin CM, Bélanger L, Bastien C, et al. Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behav Res Ther. 2005;43(1):1-14.
Morin, C. M., Bélanger, L., Bastien, C., & Vallières, A. (2005). Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy, 43(1), pp. 1-14.
Morin CM, et al. Long-term Outcome After Discontinuation of Benzodiazepines for Insomnia: a Survival Analysis of Relapse. Behav Res Ther. 2005;43(1):1-14. PubMed PMID: 15531349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. AU - Morin,Charles M, AU - Bélanger,Lynda, AU - Bastien,Célyne, AU - Vallières,Annie, PY - 2003/07/25/received PY - 2003/11/26/revised PY - 2003/12/05/accepted PY - 2004/11/9/pubmed PY - 2005/2/16/medline PY - 2004/11/9/entrez SP - 1 EP - 14 JF - Behaviour research and therapy JO - Behav Res Ther VL - 43 IS - 1 N2 - Discontinuation of benzodiazepine (BZD) treatment for insomnia can be a difficult task. Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal but there is limited evidence on long-term outcome after discontinuation. The objective of this study was to examine medication-free survival time and predictors of relapse (i.e., resumed BZD hypnotics) over a 2-year period in 47 older adults (mean age 62.1 years) with persistent insomnia and prolonged BZD use (average duration of 18.9 years), who had successfully discontinued BZD following CBT for insomnia, a supervised medication taper program, or a combined approach. The Kaplan-Meier product-limit method was used to estimate survival time, defined as time between end-of-treatment and relapse or end of follow-up. By the end of the 24-month follow-up, 42.6% of the samples had resumed BZD use. Participants in the Combined (33.3%) and Taper (30.8%) groups relapsed significantly less than their counterparts from the CBT group (69.2%). Survival rates at 3 months were 61.5% (CBT), 100% (Taper), and 80.9% (Combined). At 12 months, they were 38.5%, 83.3%, and 70.8%, respectively; and, at 24 months, they were 28.9%, 64.8% and 64.9%, respectively. Mean survival time was significantly longer for both the Taper (18.6 months, SE = 2.1) and Combined groups (12.6 months, SE = 1.4), relative to the CBT group (8.5 months, SE = 1.8). Significant predictors of relapse included treatment condition, end of treatment insomnia severity, and psychological distress. In conclusion, there is a substantial relapse rate following BZD discontinuation among prolonged users. CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse. SN - 0005-7967 UR - https://www.unboundmedicine.com/medline/citation/15531349/Long_term_outcome_after_discontinuation_of_benzodiazepines_for_insomnia:_a_survival_analysis_of_relapse_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0005796703002985 DB - PRIME DP - Unbound Medicine ER -