The BDEPQ was developed because no measure existed to assess dependence on BZDs on a continuum.
Existing measures of benzodiazepine dependence either focus on withdrawal symptoms [AshtonAshton1984, AshtonAshton1991, Busto, Sykora, SellersBusto et al.1989, Merz BallmerMerz Ballmer1983, Pecknold, McClure, Fleuri, ChangPecknold et al.1982, Petursson LaderPetursson \ Lader1984, Rickels, Schweizer, Case, GreenblattRickels et al.1990b, Tyrer, Murphy, RileyTyrer et al.1990] or categorical diagnosis (Cottler et al. 1991, Wittche et al.,1991). For other drugs of dependence self-report scales yielding continuous measures have been used clinically and in research [DavidsonDavidson1987, Stockwell, Murphy, HodgsonStockwell et al.1983, Sutherland, Edwards, Taylor, Phillips, Gossop, \ BradySutherland et al.1986].
Many authors have developed rating scales to quantify BZD withdrawal symptoms [AshtonAshton1984, AshtonAshton1991, Busto, Sykora, SellersBusto et al.1989, Merz BallmerMerz Ballmer1983, Pecknold, McClure, Fleuri, ChangPecknold et al.1982, Petursson LaderPetursson \ Lader1984, Rickels, Schweizer, Case, GreenblattRickels et al.1990b, Tyrer, Murphy, RileyTyrer et al.1990]. Others have used general anxiety rating scales such as the Hamilton Anxiety Rating Scale [HamiltonHamilton1959] to assess BZD withdrawal [LaderLader1983, Noyes, Garvey, Cook, SuelzerNoyes et al.1991, Petursson LaderPetursson \ Lader1981, Power, Jerrom, Simpson, MitchellPower et al.1985, Rickels, Schweizer, Case, GreenblattRickels et al.1990b, Schweizer, Rickles, Case, GreenblattSchweizer et al.1991]. While some of these scales may be of use in research and in the management of BZD withdrawal syndromes, none assess the wider concept of dependence.
Structured diagnostic interviews [Cottler, Robins, Grant, Blaine, Towle, Wittchen, \ SartoriusCottler et al.{1991, Wittchen, Robins, Cottler, Sartorius, Burke, \ RegierWittchen et al.1991, for example,] provide categorical assessment of ICD and DSM criteria for BZD dependence. Counts of the BZD dependence symptoms present can be used as a more sensitive indication of the severity of dependence.
Non-categorical assessment of BZD dependence from a broader view is desirable for more than conceptual purity. Golombok et al. (1987) have reported that the severity of withdrawal symptoms reported do not predict longer term abstinence from BZDs. A fuller assessment of BZD dependence may be able to make predictions of BZD withdrawal as measures of alcohol dependence can predict severity of withdrawal during alcohol detoxification[Stockwell, Murphy, HodgsonStockwell et al.1983]. The relationship between BZD dependence and related constructs such as state-anxiety or neuroticism needs further work. a0411 have reported that higher scores on Eysenck's neuroticism scale [Eysenck EysenckEysenck \ Eysenck1975] predict severity of withdrawal symptoms.
Careful assessment must be part of any intervention to assist people to withdraw from BZDs. As recommendations for the use of BZDs have changed in the last decade [Priest MontgomeryPriest \ Montgomery1988, NH&MRCNH&MRC1991] a substantial number of people may be using BZDs more frequently and for longer than is currently appropriate. a0505 has estimated that about 330,000 Australians (2.7% of the adult population) used a BZD every day for six months or more in 1989/90. This is outside current guidelines. Appropriate assistance for these people when they choose to withdraw should be guided by careful assessment.
There are three reasons for developing a broader measure of BZD dependence. Firstly such a measure may be able to predict the success of attempts to cease BZD use. Secondly a broader concept may assist in the understanding of the processes underlie BZD dependence. Finally there is a pressing need for assessment devices to assist clinicians to withdraw those patients whose long term BZD use is harmful.
The WHO dependence syndrome [Edwards GrossEdwards Gross1976, Edwards, Arif, HodgsonEdwards et al.1981] had a significant influence over the conception of dependence from which the BDEPQ was developed. In addition ideas about craving [Kozlowski WilkinsonKozlowski \ Wilkinson1987] and beliefs and attitudes [Wright, Beck, Newman, LieseWright et al.1993] to BZD use were considered. The notion of psychological dependence has been prevalent for some time. a0486 claim that any agent that produces a reduction in tension or anxiety will lead initially to `psychic' dependence. They list chlordiazepoxide, the first BZD to be marketed, among other sedating and tranquillising agents as confirming their claim. DSM-IV [American Psychiatric AssociationAmerican Psychiatric Association1994] describes a diagnosis of substance dependence without physiological dependence were neither tolerance or withdrawal is evident. One aim of this paper was to explore the psychological aspects of dependence on BZDs from a cognitive perspective. From such a perspective a person's beliefs and attitudes about their use of BZDs may have some role in their continued use [Wright, Beck, Newman, LieseWright et al.1993]. When applied to other substances cognitive theories have yielded useful interventions such as relapse prevention[Marlatt GordonMarlatt \ Gordon1985]. Our understanding of concepts is advanced by our ability to measure them, thus items reflecting beliefs about BZDs were included in the scale.