Sedative, Hypnotic, or Anxiolytic Use Disorders

Substance Abuse: Sedative, Hypnotic, or Anxiolytic Use Disorders

Sedative–hypnotics and anxiolytics include prescription sleeping medications and most medications used for the treatment of anxiety. Pharmacologically alcohol is appropriately included among sedative–hypnotics; however, it is generally considered separately as it is in DSM-IV-TR (American Psychiatric Association, 2000). The medications usually included in the category of sedative– hypnotics are listed in Table 44.1.

Sedative–hypnotics are among the most commonly pre-scribed medications. They are also often misused and abused and can produce severe, life-threatening dependence. With the ex-ception of the benzodiazepines and newer hypnotics (e.g., eszop-piclone, zaleplon, zopiclone and zolpidem), overdose with seda-tive–hypnotics can be lethal. Benzodiazepines and the newer hypnotics are rarely lethal if taken alone; in combination with alcohol or other drugs, however, they can be lethal.

When the benzodiazepines were introduced into clinical medicine in the early 1960s, their lack of lethality in overdose led physicians to believe that they were without harmful effects. Over time, it was recognized that the benzodiazepines could produce severe physiological dependence and could be drugs of abuse. Nonetheless, their medical utility in treatment of disabling anxiety, episodic sleep disturbances and seizures has made them indispensable to medical practice.

Considerations of sedative–hypnotic use disorders should reflect a sensible balance between their medical utility, side ef-fects, and abuse and dependence. Some abuse and dependence that inevitably occur must be accepted to keep them available in clinical practice.