Objectives: Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia ...despite their documented side effects over time.
Method: We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis.
Results: Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individual's perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed.
Conclusion: We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.
Over the years, psychotropic drugs have been prescribed for symptoms of anxiety and/or insomnia. Elderly women are especially at risk of chronic use and ensuing side-effects. We examined psychosocial ...processes associated with long-term psychotropic drug use. We conducted in-depth interviews with 21 frail elderly women in a home care program and 14 of their primary caregivers. Results yielded a descriptive model of chronic use that takes into account antecedents of use, initial and subsequent prescription processes, individual contextual circumstances, the effect of the social context, and the women's cognitive strategies employed to make prolonged use coherent with their self-image.
Résumé
Cet article examine le soutien parental présent dans le réseau social des mères en contexte de vulnérabilité : mères ayant un enfant âgé entre 2 à 6 ans et cumulant au moins deux des facteurs ...de risque retenus (pauvreté, sous-scolarisation et jeune âge à la naissance du premier enfant). Les données recueillies par le biais d’entrevues semi-structurées effectuées auprès du groupe de mères considérées à risque (groupe cible, n = 49) ont été comparées à celles obtenues auprès d’un groupe de mères jugées peu à risque (groupe normatif, n = 43). Les résultats rapportent le point de vue des mères participantes concernant les membres de leur réseau social (par exemple, les personnes perçues comme étant les plus aidantes ou les plus nuisibles dans l’exercice de leur rôle parental). Les formes de soutien ou de stress attribuées à certaines figures perçues comme centrales par les mères (grands-mères maternelles, conjoints et ex-conjoints) sont également décrites. Certaines pistes d’intervention prenant appui sur les ressources du réseau informel sont suggérées.
Résumé
L’objectif de cette étude qualitative est de mettre en parallèle les attitudes envers les benzodiazépines (Bz) et les intentions de sevrage de personnes âgées de 50 ans et plus, utilisatrices ...à long terme dans le but de contrer des symptômes d’anxiété et d’insomnie. À cet effet, 23 utilisateurs (14 femmes et neuf hommes) ont été rencontrés lors d’entretiens en profondeur. Les analyses ont fait ressortir trois styles de consommateurs, soit : le style « sans-souci », le style « réaliste » et le style « pragmatique ». Les consommateurs du premier groupe n’ont pas de réticence à utiliser la substance qui est, selon eux, un médicament prescrit à bon escient. Les consommateurs du deuxième groupe estiment que la substance est une drogue dangereuse et certains vont même, avec beaucoup d’inconfort, tenter de cesser toute consommation par eux-mêmes, sans supervision médicale. Pour le dernier groupe, la Bz est considérée comme mi-drogue, mi-médicament, avec ses dangers mais également ses avantages. La motivation d’entamer un sevrage ou de réduire la consommation varie grandement d’une personne à l’autre. Les deux derniers groupes de consommateurs étaient les plus ouverts à un changement de comportement. Les attitudes envers la molécule, tantôt vue comme un médicament, tantôt comme une drogue, ou bien les deux, doivent être prises en compte dans une intervention de sevrage. Trois cas cliniques illustrent les résultats.
The objective of this qualitative study was to contrast attitudes towards benzodiazepine (Bz) use stemming from long-term users, aged 50 & up, with their intent to undergo a weaning process. Use ...aimed at counteracting symptoms of anxiety & insomnia. Twenty-three users (14 women & 9 men) underwent in-depth interviews. Analyses brought-out three types of users that is, the "carefree" style; the "realist" style; the "pragmatic" style. The first group had no qualms with regard to the substance. To their eyes, it was a wisely prescribed medication. For the second group, the substance represented a dangerous drug. Some tried, at their own risk to stop usage without medical supervision. For the last group, the Bz is perceived as half-drug, half-medication, with its own dangers & advantages. All respondents are drug users; however motivation to engage in a weaning process or at least to reduce usage varied greatly, the last two groups being the most open to behavioral change. Attitudes towards the substance, which alternate between medication & drugs, or a combination of both, must be taken into account in an intervention program. Three clinical portraits illustrate these results. Tables, References. Adapted from the source document.
The present study focuses on informal social networks and the people who give parental support to at-risk mothers (i.e., mothers who display at least two of the following risk factors : low SES, low ...education, and under 21 years at the birth of their first child). A sample of 49 such mothers, who had children between the ages of 2 and 6 years, participated in semi structured interviews. The group was then matched with a group of low risk mothers (n = 43). Results present mothers' perspectives on the people in their social network they see as being most helpful or most stressful, as far as parenting is concerned. They also describe the roles played by key members of their immediate environment (maternal grandmothers, spouse or ex-spouse). Practical guidelines towards a network-oriented approach in parental support are outlined.
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