Correlates of benzodiazepine dependence in the Netherlands Study of Depression and Anxiety

Aims Benzodiazepines (BZDs) are effective in the short term against anxiety and insomnia. However, some BZD users develop BZD dependence after a relatively short period of time. Therefore, we aimed to identify the risk factors of BZD dependence. Design An observational cohort study. Setting The Netherlands. Participants Four hundred and one BZD users of the 2981 participants of the Netherlands Study of Depression and Anxiety (NESDA) were included. Measurements Socio-demographic, physical, psychological, addiction-related and BZD use-related characteristics were investigated as possible correlates of BZD dependence severity. Dependence severity was measured by the three subscales of the Benzodiazepine Self-Report Questionnaire, comprising problematic use, preoccupation and lack of compliance. Findings In multivariate analyses, problematic use was associated with more GP contacts in the past 6 months (beta = 0.170, P = 0.001) and severity of insomnia (beta = 0.145, P = 0.004). Preoccupation was related to anxiety severity (beta = 0.194, P = 0.001), antidepressant use (beta = 0.197, P <0.001), alcohol dependence (beta = 0.185, P <0.001) and a higher daily dosage of BZD (beta = 0.160, P = 0.001). Lack of compliance was associated with higher age (beta = 0.122, P = 0.03), unemployment (beta = 0.105, P = 0.04), insomnia (beta = 0.129, P = 0.01), antidepressant use (beta = 0.148, P = 0.002) and alcohol dependence (beta = 0.108, P = 0.02). Conclusions Insomnia, antidepressant use and alcohol dependence may increase the risk of benzodiazepine dependence among individuals who use benzodiazepines.