A Critique of the Article: High-Dose Benzodiazepine Dependence: A Qualitative Study of Patients’ Perceptions on Initiation, Reasons for Use, and Obtainment
Recruitment and Sampling
The study participants involved 41 adult patients who met the high-dose dependence criteria of BZD (Liebrenz et al., 2015), as characterized by the International Classification of Disease (ICD-10) (Dilling & Organization, 1994). The setting for this study was the Psychiatric University Hospital, Zurich, and took place between March 2011 and November 2012, and incorporated a mixture of methods of purposeful and principles of saturation sampling. Study participants were sampled from the general treatment setting and the specialized treatment units of drug-use problems (p. 3), and this achieved diversity of motives and themes. Also, the sample population was diverse in relation to age, gender, occupational status, time of using high-dose benzodiazepine, and previous clinical comorbidity and experience (p.3). The exclusion criteria were based on acute intoxication and insufficient language skills. Moreover, the researchers were given the authorization to access the hospital by the local committee of ethics “Cantonal Ethikkommission Zurich” before they carried out the research (p. 5).
Data was collected using single, unstructured, in-depth interviews which ranged between one hour to one and a half hours (p. 4). Data collection was meant to confirm the perceptions and experiences of the participants in regards to issues which surrounded their use of BZD and why they began and continued using BZDs (Costa & Guidotti, 1979). Gender balance was observed among the interviewers as they were conducted by one male and one female researcher, who during the study period, were either associated or employed by the Psychiatric University Hospital of Zurich (p. 4). Interviews were conducted outside the mainstream treatment environment to create a surrounding that motivated the respondents to fully share their perceptions and views. Also, the participants were promised that no personally identifying information obtained from the interviews would be shared with third parties, psychologists, and treating psychiatrists (p.4). Additionally, during the interviews, the only people that were in the room included the interviewer and the interviewee.
The interviewers had enough understanding of the topic as the male interviewer was a medical student in the final year of study while the female interviewer had a master’s in psychology (p. 4). Also, the interviewers were adequately trained on conducting out the interviews effectively. The interviews started with narrative opening queries and inquired about the reason for using BZDs using probes (p.4). The interviewers summarized and paraphrased the main points shared by the respondents during the data collection process (p. 4).
Ethical Consideration
The respondents were verbally informed about the purpose or objective of the study and were given a letter to opt-out in case they wanted. This was evident as the team of researchers had initially contacted sixty respondents and nineteen of them chose not to take part in the research, leaving the study with 41 participants. The main reason for these refusals was due to the potential respondents citing that they felt too ashamed to talk about the topic (Nakao, Takeuchi & Yano, 2007). Among the nineteen potential participants who declined to participate in the study, two of them refused because they considered the honorarium amount to be insufficient. Also, three potential respondents withdrew their consent to participate because they felt less interested in the subject (p. 4). The 41 participants who agreed to take part in the study, put in writing their informed consent and gave their views and perceptions on the subject matter during the interviews (p. 4). Additionally, the researchers obtained authorization to conduct the research from the regional commission of ethics “Cantonal Ethikkommission Zurich” (p. 5). Moreover, all respondents were promised that the information shared during the interviews would be kept confidential.
Data Analysis
The interviews were recorded digitally and later transcribed from Swiss German to Standard German. Coding and analysis of data was conducted manually using Microsoft Word. A code number was assigned to any personally identifying data. Evaluation of findings was done using the qualitative content analysis (Mayring, 2000). The technique was important as it preserved the importance of quantitative content analysis as established in the science of communication and further developing it to interpretive analysis steps (Mayring, 2000; Mayring & Fenzi, 2014). Additionally, the inductive qualitative process was used to code materials, and the obtained categories were communicated among the team of researchers to confirm whether the ratings were accurate as well as reach an agreement (p. 5). Translation to English and proofreading by a native English speaker was done before submission (p. 5). The translated English transcripts were later presented to the team to confirm for accuracy and making changes where necessary.
Findings
The participants who completed the interviews were 41 and most of them were men, representing 31 of the total participants. The respondents’ average age was 39.5 years. During the data collection session, respondents reported to have used BZDs for an average period of 8.2 years. The study found out that many reasons resulted to the use of BZDs, which includes psychological discomfort as well as mental problems such as somatic illness and/or drug use, social and recreational reasons (p. 17). The respondents were found to have formed explanations to support what prompted them into using BZDs. Participants who had a prior record of abuse and use of several substances, mostly considered BZDs to be less harmful and justified their use of BZDs to harm-reduction measures and not social reasons or for recreational purposes (p. 18). Moreover, most respondents reported that they obtained BZDs through legal and illegal means (p. 18), and mostly relied on the black market when their treatment is terminated.
Trustworthiness
Recording the interviews digitally using dictamus for iOS meant that the information collected was credible. The use of inductive qualitative process to code materials and communication among the team of researchers to confirm the accuracy of the ratings as well as reach an agreement ensured the data was accurate. The technique of assigning code numbers to personally-identifying information ensured confidentiality was maintained. Sampling of study respondents from the general treatment setting and specialized treatment units of drug-use problems achieved diversity of motives and themes. Assuring the respondents that that no individual identifying information obtained from data collection process would be shared with third parties, psychologists, and treating psychiatrists was appropriate and sufficient to achieve trustworthiness.
