“…Initially I took mostly heroin and when I wanted to sleep I just waited until the flash wore off. But when I could not fall asleep this way, then I thought, instead of taking more Heroin, I take a benzodiazepine, then I did not just save money, but it also helped better to fall asleep. O.k. with heroin you can also fall asleep, but actually out of cost considerations I switched over to benzodiazepines...”
VP 22, male, 46 years
Furthermore, participants associated “substitution” with the replacement of BZDs with a non-BZD class of agents such as antipsychotics or antidepressants, which was something they had often experienced during treatment. In addition, some participants described a long-term BZD maintenance approach with a slow-onset, long-acting BZD, when referring to previous experiences and preferences for different kinds of BZDs. Only few participants had heard of a “maintenance” approach by their treating physicians, reflecting the heterogeneity of this sample in regard to treatment duration (weeks to years) and form of intervention, ranging from abstinence-oriented benzodiazepine discontinuation approach to the more permanent prescription of slow-onset, long-acting BZDs.
Perceptions and beliefs about an agonist treatment (or “maintenance”) approach had to be elucidated using non-judgmental questions: “How would you feel about a substitution for benzodiazepines? Like, for example, heroin, that gets substituted with methadone?” Furthermore and in cases of highly knowledgeable participants, we gave more specific examples for slow-onset, long-acting benzodiazepines usually by mentioning specific brand names.
However, participants’ statements in regard to such a treatment strategy sometimes appeared to contradict their previous statements or explanations. Although we tried to clarify apparent inconsistencies using additional probes, they persisted in four instances:
“…For me, personally, that is nothing…I think that is a stupid question, but with heroin you have, but I never tried heroin, as far as I know you have a “high.” And that is something you don’t have with methadone. The “high” feeling is removed with methadone—it just eases withdrawal effects…And benzodiazepines do not make a “high,” so there is no “high” feeling, at least not with me…so I would not take (substituting drugs) since I don’t have side effects from benzodiazepines…if someone just overcomes feelings of anxiety and then does not need benzos anymore, then I think it is good, if there is such a development…but I am very happy that they are around...”
VP6, male, 30 years...
Full article at: http://goo.gl/NhY0yN
- 1Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Bern, Switzerland. Michael.Liebrenz@fpd.unibe.ch.
- 2Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Michael.Liebrenz@fpd.unibe.ch.
- 3Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland. firstname.lastname@example.org.
- 4Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Anna.Buadze@puk.zh.ch.
- 5Ulmenhof, Sozialtherapie, Ottenbach, Switzerland. email@example.com.
- 6University of Pennsylvania Health System, Philadelphia, USA. Anish.Dube@gmail.com.
- 7Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Carlo.Caflisch@puk.zh.ch.
- Harm Reduct J. 2016 Jan 8;13(1):1. doi: 10.1186/s12954-015-0090-x.
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