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Making Alliances With Patients Dependent on Benzodiazepines: A Provider's Experience.

Tens of millions of benzodiazepine (BZD) prescriptions are written annually for the outpatient management of anxiety disorders and insomnia. Many prescribers do not follow published treatment guidelines for these disorders. Psychiatric-mental health nurse practitioners (PMHNPs) regularly meet patients who have been treated with BZDs for years. The dangers posed by outpatient BZD use are recognized, especially among older adults, and their use should be minimized or eliminated. There are multiple manualized approaches to outpatient down-titration of BZDs, but little evidence about which methods really work. To effect change, it is essential that PMHNPs establish a sound therapeutic alliance with these patients, especially by using their skills in therapeutic communication. One major conflict that may occur early in the relationship is the patient's expectation that the BZD medication regimen will continue indefinitely and their unwillingness to risk discontinuing the drug. This conflict commonly raises nonadherence to a down-titration plan or patient termination of the relationship. It is essential that PMHNPs take the time and patience to build strong therapeutic alliances with patients to design and implement a successful BZD discontinuation regimen. [Journal of Psychosocial Nursing and Mental Health Services, 58(1), 29-32.].