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.
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