Benzodiazepine dependence counselling — CASC communication station

Station brief

Format. Communication and shared decision-making station, approximately 7–10 minutes after reading time. You are the psychiatry registrar in outpatient clinic. [1]

Candidate instructions. Explain physiological dependence without stigma, why stopping this weekend is unsafe, outline a gradual taper in plain language, address alcohol, offer alternatives for sleep and anxiety, involve the partner’s seizure fears accurately, and agree follow-up. Do not invent statute numbers. [2][3]

Candidate scenario

Patient: “I need these out of my system before the wedding — cold turkey, two days, done.” Partner: “His uncle had fits coming off tablets — should we take him to ED and stop them there all at once?” Current dose stable; no seizure yet; drinks nightly. [1]

Marking domains

• Non-stigmatising explanation of tolerance and withdrawal
• Clear warning: abrupt stop after years of daily use can cause severe anxiety, insomnia, and seizures
• Gradual reduction plan in plain language (pace individualised; slower if symptoms)
• Alcohol: increases sedation and risks; needs its own honest plan
• Alternatives: sleep schedule/CBT-I principles, anxiety treatment without indefinite BZD escalation
• Partner engagement; safety-net symptoms (seizure, confusion) → emergency care
• Collaborative written plan and follow-up; no false promise of zero symptoms