The Effectiveness of a Novel Psychosocial Intervention "Programme d'Aide au Succès du Sevrage " (PASSE-65+) Designed to Help Older Benzodiazepine Users to Gradually Wean Their Medication

Benzodiazepines (BZD) represent the most frequently consumed drugs by the elderly persons in Canada. Indeed, there is 7.5 times more BZD users in older people (65 years and over) than in adults (18-64 years). Importantly, more than 50% of seniors who received a prescription of BZD do not display any severe psychiatric symptoms and are physically in good health.

Results from a survey including 2811 community-dwelling older adults (65 years and over) showed that 32% of the respondents consumed BZD for an average of 205 days and 60% of them had at least received one potentially inappropriate prescription during this period (e.g. a prescription of a BZD with a long half-life or a prescription of 2 BZD for more than 6 consecutive weeks, etc.). Another study showed that 45% of new BZD users take these drugs for more than 30 days. It should be noted that the definition of a long-term BZD use varies from three to four months of consumption, which corresponds to the average period used by almost all seniors.

Long-term use of BZD by older people is a complex phenomenon that can be explained by several personal, psychological, and social factors interacting with each other. Systemic model of BZD consumption in late-life implies the following five elements which contribute to initiate and maintain BZD taking: 1) history (i.e. autonomy loss, stress, disease apparition, etc.); 2) the prescription process; 3) personal dispositions (i.e. sexe, age, education, loneliness, etc.); 4) sociocultural factors (i.e. positive attitude of their family or their physician toward BZD use); and 5) cognitive strategies (e.g. trivialization of concerns about the drugs, etc.).

To the researcher's knowledge, very few randomized controlled clinical trials have tested the effectiveness of non-pharmacological interventions in patients with a mean age of 60 years and older. Data from these studies showed that brief intervention (e.g. receiving either an informative leaflet on BZD withdrawal during a meeting with the doctor or an informative letter by post mail) or psychological interventions (including cognitive behavioral therapy or CBT) are most likely more effective than the standard care and in some cases, to the gradual dose reduction (GDR) supervised by a physician. However, only 10% (brief intervention) to 85% (cognitive behavioral therapy designed to treat insomnia) of participants completely stopped BZD use at the end of treatment. Furthermore, Parr and colleagues indicate that the complete stop of BZD consumption remains difficult and still a big challenge to patients, clinicians and researchers.

Nevertheless, one of the limitations of these studies is the large variation of age of their participants (ranging from 18 to 85 years, despite a mean age of over 60 years), thus restricting the generalization of the findings to older patients. Moreover, these results derive from efficacy studies (vs effectiveness studies) designed to improve internal validity at the expense of external validity. Although these results demonstrate the potential efficacy (vs effectiveness) of non-pharmacological treatments to facilitate BZD withdrawal, very few elderly users receive such interventions due to lack of resources, expertise and time or simply due to their expensive implementation cost. Finally, to the investigator's knowledge, no psychosocial intervention based on cognitive-behavioral therapy (CBT) and including other specific personal, psychological, and social components associated to aging, and targeting older people with different psychological problems (i.e. not only insomnia but also anxiety or depression) has been tested. Therefore, the researcher hypothesized that the "Programme d'Aide au Succès du SEvrage (PASSE-65+)" could be more suitable and effective to help older people in their BZD withdrawal management.