A Mixed-Methods Study of Motives for Benzodiazepine Misuse Among Adults Receiving Substance Use Disorder Treatment

Benzodiazepine misuse is common among individuals with substance use disorders (SUDs) and is associated with poorer clinical outcomes. As benzodiazepines have heterogeneous effects, standard measures of substance use motives may overlook key reasons for misuse. Understanding motives better can inform intervention development. Our overarching objective was to characterize motives for benzodiazepine misuse among individuals with SUDs and develop a preliminary measure of these motives. We used a two-study, mixed methods design. Participants were recruited from a continuum of SUD treatment programs at a private psychiatric hospital. Study 1 participants (<i>N</i> = 10, 5 women) completed a semi-structured interview regarding motives and triggers for benzodiazepine misuse, and notes from interviews underwent inductive thematic analysis. Results from Study 1 were used to develop the Benzodiazepine Use Motives Questionnaire (BUMQ), which was administered to 38 participants (13 women) in Study 2. Qualitative analysis from Study 1 revealed six themes reflecting motives subtypes for benzodiazepine misuse, including (1) coping, (2) other substance (i.e., non-benzodiazepine) related, (3) sleep, (4) recreational, (5) benzodiazepine withdrawal and habit, and (6) social contextual. Results from Study 2 further supported the misuse of benzodiazepines to cope with negative affect, modulate the effects of non-benzodiazepine drugs, and improve sleep. This study revealed a broad range of benzodiazepine misuse motives in adults with SUDs, spanning misuse for drug-indicated reasons (e.g., anxiety, sleep), compensatory or synergistic effects with other drugs, physiological dependence, and recreational and social reasons. Treatments for benzodiazepine misuse may need to target multiple, varied motivators for misuse.