Clinical aspects of chronic use of alprazolam and lorazepam

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.