Response to ‘benzodiazepine use and aggressive behaviour’

To the Editor

We thank Dervaux and Laqueille (2015) for their interest in our systematic review, which concluded that benzodiazepine dose and individual factors may be involved in the expression of benzodiazepine-related aggression. We agree that given the current state of the literature, our ability to draw firm conclusions and provide clear practice guidelines regarding the prescription of benzodiazepines in high-risk groups is limited. Clinical and anecdotal evidence suggests that individuals who engage in high levels of drug and alcohol consumption, have a history of aggression and/or have impulsive/sensation-seeking tendencies may be more likely to experience aggression following the use of benzodiazepines. Indeed, there is some evidence to suggest that the combination of alcohol with benzodiazepines can increase the likelihood of aggressive behaviour occurring (e.g. Bond and Silveira, 1993; Lundholm et al., 2013). However, conclusions are often formed on the basis of methodologically disparate studies, animal studies or single case reports. Further empirical, systematic investigation is needed to extend and strengthen our understanding of this response, with a deliberate focus on the potential role of benzodiazepine type and dose, other substance use patterns, psychological distress and contextual factors.

We take this opportunity to make some recommendations regarding future research in this area. Larger sample sizes are critical in order to provide sufficient statistical power to consider the independent contribution of various benzodiazepines and other substances on subsequent aggressive behaviour. Enhanced specificity could also be afforded through interview or data collection protocols which require specific detail regarding the type, dose and pattern of use per substance. Objective confirmation of drug use (i.e. urinalysis) would enable greater confidence in the conclusions drawn. The use of appropriate comparison groups would also accentuate any conclusions made (i.e. non-violent or non-benzodiazepine using subgroups). It is hoped that further research adhering to such recommendations may strengthen any empirical conclusions made and provide clear practice guidelines regarding prescribing benzodiazepines.