# 55 - References

# References

542
The Maudsley® Prescribing Guidelines in Psychiatry
CHAPTER 4
■
■Benzodiazepine misuse is frequently seen in multisubstance misuse where opioids 
may be the primary drug of dependence.
■
■Consider cognitive behavioural therapy (CBT) when withdrawing from 
benzodiazepines.
More detailed information on benzodiazepine withdrawal is given in The Maudsley 
Deprescribing Guidelines.13
References
1. Olfson M, et al. Benzodiazepine use in the United States. JAMA Psychiatry 2015; 72:136–142.
2. Milani SA, et al. Trends in the use of benzodiazepines, Z-­hypnotics, and serotonergic drugs among US women and men before and during the 
COVID-­19 pandemic. JAMA Netw Open 2021; 4:e2131012.
3. Advisory Council on the Misuse of Drugs (ACMD). A review of the evidence of use and harms of novel benzodiazepines. London: Home 
Office. 2020; https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881969/ACMD_report_-­_ 
a_review_of_the_evidence_of_use_and_harms_of_novel_benzodiazepines.pdf.
4. Manchester KR, et  al. The emergence of new psychoactive substance (NPS) benzodiazepines: a review. Drug Test Anal 2018; 
10:392–393.
5. Sarker A, et al. Evidence of the emergence of illicit benzodiazepines from online drug forums. Eur J Public Health 2022; 32:939–941.
6. National Institute for Health and Care Excellence. Medicines associated with dependence or withdrawal symptoms: safe prescribing and 
withdrawal management for adults. NICE guideline [NG215]. 2022 (last checked April 2024); https://www.nice.org.uk/guidance/ng215.
7. Lader M, et al. Withdrawing benzodiazepines in primary care. CNS Drugs 2009; 23:19–34.
8. Department of Health. Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health. 2017; 
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/673978/clinical_guidelines_2017.pdf.
9. Darker CD, et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015; 
5:CD009652.
10. Soni A, et al. Feasibility and effectiveness of deprescribing benzodiazepines and Z-­drugs: systematic review and meta-­analysis. Addiction 
2023; 118:7–16.
11. Gould RL, et al. Interventions for reducing benzodiazepine use in older people: meta-­analysis of randomised controlled trials. Br J Psychiatry 
2014; 204:98–107.
12. Baandrup L, et al. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database 
Syst Rev 2018; 3:CD011481.
13. Horowitz M, et  al. The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-­drugs. Oxford: 
Wiley-­Blackwell; 2024.
Table 4.24  Typical diazepam withdrawal schedule 
for iatrogenic dependence.
Week
Dose
Baseline
30mg/day
Week 2
25mg/day
Week 4
20mg/day
Week 6
18mg/day
Week 8
16mg/day
Week 10
14mg/day
Week 12
12mg/day
Week 14
10mg/day
Then reduce by 2mg/day every 2 weeks if tolerated.