Psychiatrist decision-making towards prescribing benzodiazepines: the dilemma with substance abusers

Psychiatrists' decision making about prescribing benzodiazepines (BZD) was evaluated in a community mental health center. An anonymous survey of outpatient psychiatrists in an academic-affiliated public mental health center was conducted using a 45-item questionnaire developed based on the results of a previous study. Sixty-six percent of responses indicate that, at times, psychiatrists experienced requests for behaviors suspicious for abuse, including 'lost/missing prescriptions' and 'use of BZD by others'. Patient characteristics such as 'history of abuse', 'unknown patient', and 'patient use of illicit substances' were occasional or common reasons for NOT prescribing BZDs (75%). The most common contexts in which the majority of our sample was uncomfortable prescribing BZDs involved a patient history of substance abuse, fear of initiation of dependence, diversion, and feeling manipulated by the patient. Time limitations were a dilemma for 20%. Psychiatrist self-reported dilemma and behavior in prescribing BZDs largely reflected concerns with substance abuse and less frequently workload or time issues.