Characterization of benzodiazepine misuse and comorbidities in patients with alcohol use disorder

摘要

Background Due to the frequent presence of anxious symptoms and sleep disorders, benzodiazepines (BZD) are often prescribed to patients with alcohol use disorder (AUD). Objectives To assess BZD misuse and psychiatric comorbidities in patients with AUD. Methods This prospective, monocentric study included all adult patients with AUD hospitalized in a French addiction unit for alcohol withdrawal from November 2017 to May 2018. Results Among the 153 patients included, 75 (49) were using BZD at the time of their hospitalization. Duration of alcohol addiction was longer in BZD users: (33 +/- 27 years vs. 29 +/- 11 years; P = 0.001). BZD misuse was noted in 27 patients consuming benzodiazepines (36 of BZD users and 18 of all included patients), mainly increase in the dose (on average, 3 +/- 4 times the prescribed dose). The most frequently misused benzodiazepines were diazepam (43.2), alprazolam (18.9), and lormetazepam (13.5). The frequency of patients with lifetime use of cocaine or heroin was higher among BZD misusers than among non-misusers (84.6 vs. 42.2; P = 0.04). The frequency of patients consuming cocaine in the last month was higher in BZD misusers than in others: 16 versus 6, P = 0.002. In multivariate analysis, age (OR=1.65 for 5 years, 95 CI = 1.19-2.27; P = 0.023), psychiatric comorbidities (at least one comorbidity: OR=6.03, 95 CI = 1.40-25.83; P = 0.015) and lifetime cocaine consumption (OR=4.37, 95 CI = 1.21-15.86; P = 0.025) were independently associated with BZD misuse. Conclusion BZD prescription for long periods might result in tolerance and dose increase. Educational therapy, prescribers' awareness, and development of therapeutic alternatives are essential to limit BZD misuse.