Professionals' treatment goals for long-term benzodiazepine and Z-drugs management: a qualitative study

[en] BACKGROUND: Benzodiazepines and Z-drugs (BZD/Z) are prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication.
AIM: To explore how primary care and mental health care professionals set treatment goals with long-term BZD/Z users.
DESIGN & SETTING: Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care in Belgium.
METHOD: Inductive thematic content analysis was performed.
RESULTS: Seven themes were identified from the analysis. Professionals tend not to use the DSM-V standard to diagnose a substance use disorder to BZD/Z. They describe criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appear to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them report feeling trapped into continuing to prescribe and consider BZD/Z withdrawal to be difficult. Some are afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations which they perceive to be too broad currently.
CONCLUSION: Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.