***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Disturbed sleep is a common problem , particularly among elderly people , and is usually treated with hypnotics . The side effects of longterm administration of hypnotic drugs are well known , but despite this there remains a substantial population of chronic users . These people can be helped to reduce their dependence on hypnotics through psychological techniques . A group of longterm users treated in this manner were shown to reduce their intake of hypnotics  significantly more than a group of users who did not receive any psychological treatment . Furthermore , the treated patients did not experience any deterioration in their sleep patterns , and their subjective refreshment from sleep improved significantly . For the patient with sleep problems , psychological techniques are preferable to the longterm use of hypnotics both as a weaning-off agent and as an alternative to drugs Chronic normal-dose benzodiazepine users requesting drug withdrawal were allocated to substitution with either the new anxiolytic alpidem  ( n = 13 ) or placebo  ( n = 12 ) . During the first 2 weeks of the tapering programme , the dose of benzodiazepine was kept constant ; for the next 2 weeks it was halved and half-dose alpidem ( 25 mg twice daily ) or placebo substituted ; for weeks 5 and 6 , the benzodiazepine was discontinued and full-dose alpidem or placebo given ; next alpidem or placebo were tapered to half-dose and then finally discontinued . Regular anxiety and tranquillizer withdrawal ratings were made . Nine of 12 patients given placebo  withdrew successfully compared with four of 13 alpidem-treated patients .  Anxiety and other symptom levels increased in the alpidem but not the placebo patients . It was concluded that alpidem is not helpful in helping patients withdrawing from a benzodiazepine withdrawal perhaps because of partial agonist properties . These actions may imply a lesser propensity to induce dependence on long-term use This study evaluated the specific effectiveness of cognitive-behavior therapy ( CBT ) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder ( GAD ) patients by using a nonspecific therapy control group . Sixty-one patients who had used benzodiazepines for more than 12 months were r and omly assigned to the experimental conditions . Nearly 75 % of patients in the CBT condition completely ceased benzodiazepine intake , as compared with 37 % in the control condition . Results of the 3- , 6- , and 12-month follow-ups confirmed the maintenance of complete cessation . Discontinuation rates remained twice as high in the CBT condition . The number of patients who no longer met GAD criteria was also greater in the CBT condition . The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD BACKGROUND Benzodiazepine withdrawal programmes have never been experimentally compared with a nonintervention control condition . AIMS To evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use in general practice , and to evaluate the value of additional group cognitive-behavioural therapy ( CBT ) . METHOD A 3-month r and omised , 3-month controlled trial was conducted in which 180 people attempting to discontinue long-term benzodiazepine use were assigned to tapering off plus group CBT , tapering off alone or usual care . RESULTS Tapering off led to a significantly higher proportion of successful discontinuations than usual care ( 62 % nu . 21 % ) . Adding group CBT did not increase the success rate ( 58 % v. 62 % ) . Neither successful discontinuation nor intervention type affected psychological functioning . Both tapering strategies showed good feasibilityin general practice . CONCLUSIONS Tapering off is a feasible and effective way of discontinuing long-term benzodiazepine use in general practice . The addition of group CBT is of limited value BACKGROUND Many patients with depression take benzodiazepine drugs long term despite the absence of continuing therapeutic value . AIMS To evaluate a treatment programme involving gradual discontinuation with or without simultaneous selective serotonin reuptake inhibitor ( SSRI ) prescribing and to determine the long-term outcome after benzodiazepine withdrawal . METHOD Patients went through three phases - change to an equivalent dose of diazepam ; subsequent r and omisation to either 20 mg of paroxetine or placebo ; and gradual reduction of diazepam in depression-free patients - with a follow-up after 2 or 3 years . RESULTS A total of 230 patients were recruited and 75 % in the paroxetine group and 61 % in the placebo group were successfully treated after 6 weeks ( P:=0.067 ) . After 2 or 3 years 13 % of patients were still benzodiazepine free : 26 % of those who had successfully tapered off benzodiazepine and 6 % of the total group . CONCLUSIONS Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use . The addition of SSRI treatment is of limited value Twenty four long-term benzodiazepine users were allocated r and omly to treatment with either buspirone ( mean dose 25 mg/day ) or placebo , prior to tapering off the benzodiazepine over 6 weeks . In both groups , six out of 12 patients successfully completed withdrawal . However , buspirone-treated patients tended to have lower anxiety levels than placebo-treated patients . The amount of previous benzodiazepine usage predicted outcome Recognizing the need to offer alternative methods of brief interventions , this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact . One hundred and twenty-one problem drinkers were recruited by media advertisements and were r and omly allocated to a full cognitive-behavioural treatment programme ( CBT ) or to a minimal intervention condition ( MI ) that gave information regarding alcohol misuse and instructions to record drinking++ . As predicted , CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period . CBT produced a 50 % fall in consumption , bringing the average intake of subjects within recommended maximum levels . Treatment gains at 6 months were well maintained to 12 months . High levels of consumer satisfaction , a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment . However , some drinking occasions still involved high intake for a significant subgroup of subjects , and this issue will be addressed in future programmes . The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas This study investigated 2 methods of disseminating a cognitive-behavioral intervention for panic disorder ( PD ) . Thirty-six Ss who met diagnostic criteria for PD according to the Anxiety Disorders Interview Schedule-Revised were r and omly assigned to 1 of 3 conditions : bibliotherapy ( BT ) , group therapy ( GT ) , or a waiting-list control ( WL ) condition . Interventions lasted 8 weeks and were followed by a posttest , along with 3- and 6-month follow-up assessment s. Results indicated that both the BT and GT treatments were more effective than the WL condition in reducing frequency of panic attacks , severity of physical panic symptoms , catastrophic cognitions , agoraphobic avoidance , and depression and that the BT and GT treatments were more effective in increasing self-efficacy . Both interventions maintained their effects throughout the follow-up periods and produced clinical ly significant levels of change among the majority of treated Ss Abstract Recent uncontrolled research suggested that trazodone and sodium valproate may be helpful in benzodiazepine ( BZ ) discontinuation . We therefore undertook a double-blind study to assess whether trazodone and valproate , as compared to placebo , would attenuate withdrawal and facilitate discontinuation in BZ-dependent patients with a minimum of 1 year daily BZ use . Seventy-eight patients , taking a mean dose of 19 ± 17 mg/day of diazepam ( or its equivalent ) , were stabilized for several weeks on their BZ ( 16 diazepam , 25 lorazepam , 37 alprazolam ) and then for 1–2 weeks , pretreated with trazodone , sodium valproate or placebo before being tapered at 25 % per week . All treatments were continued for 5 weeks post-taper . BZ-free status was assessed after 5 and 12 weeks post-taper . Neither trazodone nor valproate had any significant effect on withdrawal severity . Peak physician withdrawal checklist change from baseline to peak severity was 16.4 for trazodone , 18.04 sodium valproate and 18.24 placebo ( F = 0.10 ; NS ) . Taper success rates were significantly effected by both active agents at the 5-week , but not 12-week , assessment . At 5 weeks post-taper , 79 % of sodium valproate and 67 % of trazodone , but only 31 % of placebo patients were BZ-free ( χ2 = 7.34 ; df 2 ; P < 0.03 ) . Major adverse events for trazodone  were sedation and dry mouth , and for valproate , diarrhea , nausea and headaches A multicenter , double-blind , placebo-controlled study was conducted to determine the safety of concurrently using buspirone with alprazolam before and during a gradual tapering of the alprazolam dose . Thirty-six patients received placebo t.i.d . and 36 received buspirone 5 mg . t.i.d . Findings included significantly greater anxiety ( as measured by the Hamilton Rating Scale for Anxiety ) in the placebo group and significantly reduced manifestations of abstinence ( as measured by the Abstinence Rating Scale ) in the buspirone group . Buspirone and alprazolam may be used together safely , and buspirone may be started early in the alprazolam tapering process The present study examined a relapse prevention ( RP ) program delivered via bibliotherapy in the treatment of individuals with panic attacks . Compared with a wait list control group , individuals receiving RP exhibited significant reductions on measures of frequency of panic attacks , panic cognitions , anticipatory anxiety , avoidance , and depression . In addition , individuals in the RP group were more likely to attain a " clinical ly significant change " in status on both panic-free status and level of avoidance more frequently than individuals in the control group . When compared with treatment effects evaluated in two prior phases of the study , the obtained results appear to be the product of a synchronous effect of bibliotherapy and minimal phone contact during the 6-month follow-up period . The results reflect the importance of brief therapist contact in increasing motivation for active participation in bibliotherapy interventions This study aim ed to assess the efficacy of a minimal intervention focusing on hypnotic discontinuation and cognitive-behavioral treatment ( CBT ) for  insomnia . Fifty-three adult chronic users of hypnotics were r and omly assigned to an 8-week hypnotic taper program , used alone or combined with a self-help CBT .  Weekly hypnotic use decreased in both conditions , from a nearly nightly use at baseline to less than once a week at posttreatment . Nightly dosage ( in lorazepam equivalent ) decreased from 1.67 mg to 0.12 mg . Participants who received CBT improved their sleep efficiency by 8 % , whereas those who did not remained stable . Total wake time decreased by 52 min among CBT participants and increased by 13 min among those receiving the taper schedule alone . Total sleep time remained stable throughout withdrawal in both CBT and taper conditions . The present findings suggest that a systematic withdrawal schedule might be sufficient in helping chronic users stop their hypnotic medication . The addition of a self-help treatment focusing on insomnia , a readily available and cost-effective alternative to individual psychotherapy , produced greater sleep improvement AIMS To evaluate whether gradual benzodiazepine taper combined with cognitive-behavioural treatment is more effective than st and ard treatment for patients with dependence in out-patient clinics . DESIGN A r and omized , controlled clinical trial , using st and ard question naires and serum and urine tests . SETTING S Four public-sector out-patient clinics for alcohol and drug abusers in Helsinki . PARTICIPANTS Seventy-six patients with benzodiazepine dependence ( DSM-III-R ) . Patients taking high doses of the drug or with alcohol use disorders were included to obtain a subject group representative of usual clinical practice . INTERVENTION Subjects received gradual benzodiazepine taper combined with cognitive-behavioural therapy ( experimental group ) or st and ard withdrawal treatment not scheduled by the research ers ( control group ) . MEASUREMENTS The outcome was measured in terms of attaining a state of abstinence or by a decrease in the dosage during the study period of up to 12 months ' duration . FINDINGS No statistically significant differences in the outcomes were observed between the groups . A total of 13 % of the experimental group and 27 % of the control group were able to discontinue drug use . In addition 67 % of the experimental group and 57 % of the control group were able to decrease the dose . CONCLUSIONS The search continues for improved methods of helping patients with complicated benzodiazepine dependence Buspirone is a new antianxiety compound of a totally new type which may avoid the dependence problems of its predecessors . This study was design ed to evaluate any possible cross-tolerance to the benzodiazepines . Twenty-four out patients on long-term therapeutic dose benzodiazepine treatment , who wished to discontinue treatment , were allocated r and omly to placebo substitution or buspirone substitution and then withdrawal over a total of 10 weeks . Assessment s were made at weekly intervals . Of the 24 patients entered into the trial , 13 received buspirone and 11 placebo . Only 
    Output:
    
Providing an intervention is more effective than routine care .
Psychological interventions may improve discontinuation above GDR alone .
While some substitutive pharmacotherapies may have promise , current evidence is insufficient to support their use