Drug deprivation and reinforcement by diazepam in a dependent population (1987)

FRANÇAIS :
Etude en double aveugle pour vérifier si l'autoadministration de faibles doses de benzodiazépines à une population dépendante était déterminée par des facteurs pharmacologiques ou psychologiques. Un groupe de toxicomanes, utilisant régulièrement des doses thérapeutiques de benzodiazépine (15mg/j de diazepam ou équivalent) et qui souhaitent arrêter cet usage, ont été recrutés pour une étude offrant un traitement comportemental ambulatoire avec surveillance médicale. Ce traitement était centré sur le développement de stratégies de gestion de l' abstinence et d'alternative à l'usage de benzodiazépine. Son but était d'atteindre l'abstinence au bout de 8 semaines en diminuant progressivement les doses quotidiennes. D'une façon aléatoire, certains sujets (23) recevront des doses décroissantes, d'autres (13)recevront un placebo. La variable dépendante principale était l'approvisionnement personnel en substances a base de benzodiazépines autre que celles autorisées par le thérapeute, approvisionnement détecté par l'analyse du plasma sanguin et par le rapport personnel du sujet. Les résultats semblent indiquer que la dépendance à de faibles doses de benzodiazépine a un support pharmacologique et qu'une relation causale existe entre la privation de benzodiazépine et son auto-administration dans une population de toxicomanes.
ENGLISH:
Individuals who were using therapeutic doses (approximately 15 mg diazepam or its equivalent daily) of a benzodiazepine persistently and wished to attempt to stop were recruited into a study offering a medically supported outpatient behavioral treatment with a goal of abstinence. All subjects received the same behavioral treatment that emphasized the development of strategies for coping with abstinence and alternatives to benzodiazepines as a coping mechanism. The goal of abstinence was to be achieved within approximately 8 weeks by means of gradual tapering of the daily dose. Some subjects (Group D, n=23) were randomly assigned to a condition in which their dose was to be tapered on a regime of active diazepam. Others (Group P, n=19) were switched to placebo at the first treatment session and ldquotaperedrdquo from this pharmacologically inert substitute for diazepam. Supplies of tablets of each preparation were provided by the experimenters, and subjects were specifically requested to use only those tablets. The principal dependent variable was ldquosupplementationrdquo, or use of a benzodiazepine other than that specifically authorized by the therapist. Supplementation was detected by measures of plasma benzodiazepine levels as compared to levels predicted if there had been strict compliance with the therapeutic regime. These comparsions were made by two expert judges who were blind to the subjects' experimental assignment. Self-report of supplementation was also obtained. Plasma level determinations indicated a significantly greater frequency of supplementation (84% versus 33% of subjects) for subjects in Group P. This was corroborated by self-report. These data support the assertion that dependence on low doses of benzodiazepines has a pharmacologic basis, and that there is a causal relationship between deprivation of a benzodiazepine and its self-administration in dependent persons.