Correlates of Dependence and Beliefs About the Use of Hypnotics Among Zolpidem and Zopiclone Users

Abstract

Background: Zolpidem and zopiclone are the two most commonly prescribed Z-drugs approved to treat insomnia. Objectives: To examine the demographic and clinical correlates of dependence and beliefs about hypnotic use among long-term zolpidem and zopiclone users in psychiatric treatment for insomnia. Methods: A total of 392 psychiatric outpatients who received zolpidem or zopiclone treatment for at least 3 months for insomnia were studied. Participants’ severity of hypnotic dependence and beliefs about the use of hypnotics to treat sleep problems were assessed. The correlation of dependence and beliefs about zolpidem and zopiclone treatment with demographic characteristics, hypnotic-using behaviors, co-use of addictive substances, and depressive symptoms were analyzed using multiple regression analysis models. Results: Zolpidem users reported more severe dependence and a lower level of necessity regarding the use of hypnotics than zopiclone users did. High equivalent doses of hypnotics and long duration of use were significantly associated with severe dependence and a low level of necessity. Severe depressive symptoms were signiciantly associated with severe dependence, a low level of necessity, and a low level of concern. Educational level was also associated with the levels of concern and necessity. Conclusions/Importance: There were differences in the level of dependence and belief about hypnotic use between zolpidem and zopiclone users. The correlates of dependence and belief identified in this study can serve as the basis for prevention and intervention programs.

Keywords :

• Belief
• Z-drugs
• dependence
• zolpidem
• zopiclone

THE AUTHORS

Cheng-Fang Yen, M.D., Ph.D., is a professor of Psychiatry at Kaohsiung Medical University and is an attending doctor at Department of Psychiatry at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. His main research interests are substance use and mental health of children and adolescents.

Chia-Nan Yen, M.D., M.S., is a lecturer at National Tainan Junior College of Nursing and is an attending physician in the Department of Psychiatry at Tainan Hospital of Ministry of Health and Welfare, Taiwan. His main research interests are substance use and geriatric mental illness.

Chih-Hung Ko, M.D., Ph.D., received his Ph.D. degree in Graduate Institute of Medicine, Kaohsiung Medical University and is the director of Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital in Kaohsiung, Taiwan. His main research interests are Internet gaming disorder.

Tzung-Jeng Hwang, M.D., Ph.D., is an assistant professor of psychiatry at the College of Medicine, National Taiwan University and is the attending psychiatrist of the Department of Psychiatry at National Taiwan University Hospital. His main research interests focus on psychopharmacology and dementia.

Cheng-Sheng Chen, M.D., Ph.D., is the professor of psychiatry at Kaohsiung Medical University and is the attending psychiatrist in the Department of Psychiatry at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. His main research interests are mood disorder and geriatric psychiatry.

Tzu-Ting Chen, M.D., M.S., received her master degree in Graduate Institute of Behavior Sciences from the Kaohsiung Medical University and is the attending doctor of Department of Psychiatry at National Taiwan University Hospital Yun-Lin Branch in Yunlin, Taiwan. Her main research interests are clinical psychopharmacology and mental health.

Po-Wen Su, M.D., M.S., is a PhD graduate student in the Institute of Health Policy and Management, College of Public Health, National Taiwan University and is an attending physician in the Department of Psychiatry at Puzi Hospital, Ministry of Health and Welfare. His main research interests are health behavior, substance use, and mental health of the sexual minority.

Shao-Tsu Chen, M.D., M.S., is a lecturer of Buddhist Tzu Chi University and attending psychiatrist of Buddhist Tzu Chi General Hospital in Hualien, Taiwan. His main research is neuropsychopharmacology and addiction.

Jin-Jia Lin, M.D., is an assistant professor of psychiatry at Taipei Medical University, and is an attending psychiatrist and director in the department of Psychiatry at Chi-Mei Medical Center in Tainan, Taiwan. His main research interests are suicide epidemiology and community mental health.

GLOSSARY

• Z-drugs: A group of hypnotic compounds that are structurally different from benzodiazepines (BZDs), but act on the same binding sites as gamma-aminobutyric acid type A (GABA-A) receptors do.