Assessment of Benzodiazepine Withdrawal Syndrome: French Psychometric Validation of the Clinical Institute Withdrawal Assessment-Benzodiazepines (CIWA-B) Scale

Abstract

Background. Benzodiazepines (BZs) use is common in the treatment of insomnia. Discontinuation induces withdrawal symptoms, notably rebound insomnia and anxiety, which contribute to resumption of use, despite medical advice, and ultimately, long-term dependence. The Clinical Institute Withdrawal Assessment-Benzodiazepines (CIWA-B), derived from the CIWA-Ar for alcohol withdrawal, was adapted by Busto et al. (1989) to assess the severity of BZs withdrawal.
Objective. This study aimed to conduct the French cross-cultural validation of the CIWA-B and to evaluate its psychometric properties in the context of hypnotic benzodiazepine use.
Methods. One hundred and seven chronic users of hypnotic BZS enrolled in a withdrawal protocol participated in the study. Construct validity, internal consistency, test-retest reliability, as well as divergent, convergent, and discriminant validity were assessed.
Results. Exploratory factor analysis revealed a three-factor structure comprising anxiety, physiological symptoms, and sleep. Internal consistency, test-retest reliability, and convergent, divergent, and discriminant validity were good. The sensitivity of the scale could not be evaluated in this study.
Conclusion. The 20-item French version of the CIWA-B demonstrates satisfactory psychometric properties and represents a relevant tool for assessing benzodiazepine withdrawal syndrome. Further validation in populations using BZs for anxiolytic purposes and in less gradual withdrawal contexts is warranted.