In Flanders, about 13% – more than one in 10 – of the population uses benzodiazepines. The number of users increases in the older age groups, and many more women than men are being prescribed the medications.
Do we have so much more problems with insomnia and anxiety than in our neighbouring countries? Probably not. Research puts the number of those who have trouble sleeping at about one-third of the adult population, comparable to other countries in Western Europe.
But in the Netherlands, for example, only 2.6% of the population goes to sleep with a pill, and in Norway the use of benzodiazepines is five times less than in Flanders. Only the French figures come remotely close. So there is a much higher prevalence here for doctors to prescribe these medications, although there are serious, well-known drawbacks.
Benzodiazepines, commonly known as benzos, were first prescribed in the 1960s; Valium was the first-ever prescription benzo prescribed and is still one of the most popular. Doctors prescribe them in cases of insomnia and anxiety (although for such complaints the use of antidepressants is on the rise).
Benzos have some nasty disadvantages. Although they are prescribed for insomnia, they reduce the quality of sleep. Alertness and concentration also diminish. But the biggest problem is that they are addictive.
“It is more accurate to call it dependence, rather than addiction,” corrects Professor Thierry Christiaens from the Department of Family Medicine at Ghent University. “It is not heroin or a drug like that. But we see that people who start with sleep medication sometimes use it for decades.”
It is partly, he continues, a psychological dependence. “Taking a sleeping pill becomes something like brushing your teeth before going to bed – a ritual without which someone cannot fall asleep.”
Considering this dependence, why do doctors prescribe benzos so often? It is due to an interplay between the role of the physician and patient expectations, explains professor Christiaens. “The patient has often waited a long time before going to the doctor, making it clear that there is a big problem and that he or she expects a quick and customised solution from the doctor. The doctor sees the seriousness of the problem and wants to help because that's just his role. Such assistance often takes the form of a pill.”
There are also a number of more sociological explanations. “The pressure on people is particularly high in our society,” says Christiaens. “And too often we push mental problems into a medical frame and seize the medication.” But that only takes away the symptoms, not the cause. “There is still a big taboo around mental health care and therapy.”
What is most striking about the figures on benzodiazepines are their use among the elderly, particularly in nursing homes. This is due to “a combination of factors,” says Christiaens. “It is often underestimated, but going into a home for the elderly is a mourning process. People leave their whole lives behind. And there is less physical independence in a nursing home.”
And nursing home medical staff, again, with the best intentions, turn to benzos. “Just like doctors, they see complaints about insomnia and anxiety too much as something that has to be resolved with medication,” says Christiaens. “The fact that nursing homes are understaffed plays a role. The elderly in nursing homes sometimes have too little physical stimulation, so they’re just not tired in the evening.”
Awareness is growing that benzodiazepines are not so innocent. In the training for general practitioners, more attention is being given to possible alternatives and increased communication between doctors and patients. The Flemish government is also working to educate the public about the dangers of sedatives and tranquillisers through media campaigns. For doctors and pharmacists, there is a wide range of information and training, both on avoiding the prescription of benzos and supporting patients who want to stop taking them.
“Some of these alternatives are quite simple; improving your sleeping habits can help a lot,” explains Christiaens. “Sometimes a more profound approach is needed, especially with persistent feelings of anxiety. In those cases patients benefit more from therapy, which attempts to discover the ‘why’ of anxiety. But for a lot of people, going to a therapists is too big of a step to take. Still, it is better to avoid starting with benzodiazepines because the willingness to stop in long-term users is very small.”
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