First benzodiazepine prescriptions: qualitative study of patients' perspectives

OBJECTIVE To explore patients’ views and expectations regarding their first prescription for benzodiazepines (BZDs). DESIGN Qualitative study using semistructured interviews. SETTING Patients were recruited from general practices in the regions of Ghent and Brussels in Belgium and were interviewed at home. PARTICIPANTS Fifteen family practice patients who had received prescriptions for BZDs for the first time. METHOD Interviews were audiotaped and transcribed verbatim. Data were analyzed by themes using a phenomenologic approach. MAIN FINDINGS Patients had asked their physicians for "something" because they thought they were in serious distress and needed help. They seemed to feel a conflict between the need for medication and the negative connotations surrounding BZD use. Patients used 2 strategies to justify consumption of BZDs: maximizing their problems and minimizing use. Patients knew very little about the medication and did not ask about it. Their expectations regarding continued use were vague, even though they seemed to be aware of the risk of psychological dependency and conditioning mechanisms. Patients did not actively ask for nonpharmacologic alternatives, but when they were offered them, their attitudes toward them were generally positive. CONCLUSION First-time BZD users ask for help with distress, but place the responsibility for solving their problems on their family physicians. Even when short-term users were aware of the concept of psychological dependency, they did not feel the need for more information. Physicians should develop communication strategies to persuade their patients that they take the patients’ problems seriously even though consultations do not always end with prescriptions. It is important that doctors clearly explain the risks and benefits of starting BZD treatment and set limits from the start. This will help doctors manage first-time BZD users more effectively and will help patients avoid chronic use