Excessive use of benzodiazepines: between self-medication, abuse, and limited access to psychotherapeutic interventions

Abstract

Benzodiazepines are commonly prescribed for anxiety, insomnia, and psychosomatic complaints. In the Republic of Moldova, chronic use is rising due to high accessibility, self-medication, and prescriptions by various specialists, often without adequate psychiatric supervision or awareness of long-term risks. Analysis of factors contributing to excessive BZD use among adults in the Republic of Moldova: self-medication, inappropriate prescribing and limited access to psychotherapeutic interventions. A cross-sectional descriptive study was conducted including 152 adult patients from urban and rural areas. The methodology involved a semi-structured questionnaire on BZD use history, assessment of withdrawal symptoms and dependence, identification of psychiatric comorbidities, and analysis of prescriptions from outpatient cards. 61% of participants reported daily benzodiazepine use for more than 12 weeks, with self-medication identified in 38% of cases, underscoring a significant problem related to the unsupervised use of these substances. The primary indications were anxiety disorders 74% and chronic insomnia 58%. Despite this high prevalence, only 22% of participants received adjunctive psychotherapy. Withdrawal symptoms and tolerance were reported in 35% of cases, indicating the presence of physical dependence. Benzodiazepine use significantly impaired cognitive and social functioning, resulting in a negative impact on patients ‘quality of life and social adaptation. Excessive benzodiazepine use highlights gaps in the healthcare system and prescribing policies. Implementation of strict prescribing protocols, expanded access to psychotherapeutic interventions, and ongoing professional training are needed to prevent misuse and associated adverse effects.