Brief report: a retrospective chart review of benzodiazepine prescription patterns, discontinuation, and return-to-use over a decade in a community outpatient substance use treatment program

Benzodiazepines are widely prescribed, yet their long-term use among patients with substance-use disorders (SUDs) remains poorly understood. This study examined benzodiazepines in a substance use treatment program. This study aims to describe prescribing patterns, tapering and discontinuation characteristics, and return to use rates in SUD patients receiving benzodiazepines in a community-based outpatient substance use treatment program. In this single-site, retrospective chart review study, electronic health records of 51 patients, prescribed benzodiazepines between FY 2014-2024, in a community-based outpatient substance use treatment program were analyzed. Demographics, psychiatric and SUD diagnoses, benzodiazepine half-life, dose, taper duration, discontinuation status, and return to use were examined descriptively. Intermediate-acting BZDs were the most commonly prescribed (68.6%), with limited attempts to switch to longer-acting agents. BZD prescriptions were discontinued in only 25.4% of cases, and 38.4% of those who discontinued returned to use. Patients who successfully tapered had longer down-titration durations compared to those who returned to use. (5.4 months vs. 2.2 months in return to use cases). Among patients with benzodiazepine use disorder, return to use occurred in 50.0% of those who discontinued. The patient population demonstrated notably high rates of psychiatric comorbidities and previous psychiatric hospitalizations. In patients with SUDs, benzodiazepine discontinuation is uncommon and frequently followed by return to use. Brief tapers show little benefit. Our data support that successful BZD tapering may require prolonged, structured tapering within integrated mental-health and substance use care to minimize return to use.