Acceptability of cognitive-behaviour therapy via the Internet for cessation of benzodiazepine use JANNETTE M. PARR 1 , DAVID J. KAVANAGH 2 , ROSS MD. YOUNG 2 & GEOFFREY MITCHELL 3 1 The University of Queensland, School of Medicine, Discipline of Psychiatry, Brisbane, Australia, 2 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane,Australia, and 3 The University of Queensland, School of Medicine, Discipline of General Practice, Brisbane, Australia Abstract Introduction and Aims: Long-term use of benzodiazepines remains common, and conveys significant risk. Providing psychological intervention in association with gradual dose reduction increases cessation rates above dose reduction alone, but appropriate psychological support is difficult to obtain.This study was undertaken to assess the outcomes of an uncontrolled case series of an Internet-based cognitive-behaviour therapy for benzodiazepine cessation. Design and Methods: Users of benzodiazepines for >3 months who wanted to reduce or cease benzodiazepines participated in the trial.They completed online assessments and accessed 13 newsletters on managing withdrawal symptoms and developing alternate ways to cope with life events.Therapist assistance was provided by email.Follow up was at 3 and 6 months and feedback was obtained via comments and emails. Results: Program ratings and emailed comments of the program were positive.Thirty-two people registered for the program and 14 (44%) completed a 6 month follow up. Of these, eight (57%) reduced weekly intake by at least half, including five (36%) who ceased use. Shorter duration of use and birth outside Australia predicted greater percentage reductions at 3 months, while being living with a partner and being in paid employment predicted reductions at 6 months. Discussion and Conclusions: While results were encouraging, controlled research is required to confirm the efficacy of the program, and engagement of both users and prescribers needs further attention. [Parr JM, Kavanagh DJ, Young RM, Mitchell G. Acceptability of cognitive-behaviour therapy via the Internet for cessation of benzodiazepine use. Drug Alcohol Rev 2011;30:306–314] Key words: benzodiazepine, cognitive-behaviour therapy, Internet, self-management, substance-related disorders. Introduction Benzodiazepines remain widely used in management of many problems, including anxiety, insomnia and muscle tension [1–3]. They are recommended only for short-term prescription, as long-term use has potentially significant adverse consequences, including cognitive impairment, injury risk, mood and sleep dis- turbances, and physiological dependence [4]. In one study, 71% of long-term users of therapeutic doses of benzodiazepines reported an inability to stop taking them, due to withdrawal symptoms [5]. Recent meta-analyses of intervention trials have established that a letter from a patient’s general practi- tioner (GP, or family physician) encouraging them to cease long-term benzodiazepine use results in better cessation rates than routine care. Higher rates are achieved when GPs actively use gradual dose reduction (GDR) rather than abrupt withdrawal, and substitutive medication does not raise cessation rates above those from GDR alone. However, adjunctive psychological intervention does increase cessation [6,7]. A variety of treatments have been trialled, including cognitive- behaviour therapy (CBT) for insomnia [8,9], anxiety [10], panic [11,12] or management of withdrawal [13,14]. Components often include psycho-education, relaxation and cognitive restructuring [13,14]. Psychological treatments in previous benzodiazepine cessation trials were conducted face-to-face [7]. For other substance use disorders, alternate delivery modes Jannette M. Parr MAP(clin.),Acting Program Director, David J. Kavanagh PhD, Professor, Ross McD.Young PhD, Professor, Geoffrey Mitchell MBBS, PhD, Professor. Correspondence to Professor David Kavanagh, Institute of Health & Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia. Tel: +61 (0)7 3138 6143; Fax: +61 (0)7 3138 6030; E-mail: david.kavanagh@ qut.edu.au Conflict of interest: None declared. Received 30 August 2009; accepted for publication 5 January 2010. REVIEW Drug and Alcohol Review (May 2011), 30, 306–314 DOI: 10.1111/j.1465-3362.2010.00183.x © 2011 Australasian Professional Society on Alcohol and other Drugs