Substance-related Disorders of Sedative–Hypnotics

Substance-related Disorders of Sedative–Hypnotics

The term “misuse” is commonly applied to prescription seda-tive–hypnotics, but the DSM-IV-TR does not provide explicit criteria for misuse as it does for abuse and dependence. When medications are taken in higher doses or more frequently than prescribed, or by someone other than the person for whom the medication was prescribed, or for reasons other than what would normally be considered medical use, the behavior is generally considered misuse of the medication.

DSM-IV-TR defines abuse and dependence in terms of be-havioral and physiological consequences to the person taking themedication. The criteria for abuse and dependence are intended to apply as uniformly as possible across classes of drugs, and the criteria do not distinguish the source of the medication or the intended purpose for which it was taken. Further, when most people, including physicians speak of drug dependence, they are referring to physical dependence. DSM-IV-TR uses the term de-pendence to denote a more severe form of substance use disorder than abuse, and it uses the specifier “with or without physiologi-cal dependence” to indicate whether the patient has significant physical dependence. Physiological dependence is not necessar-ily required for a diagnosis of drug dependence. A diagnosis of substance dependence is made only when a patient has dysfunc-tional behaviors that are a result of the drug use.

The qualification that the dysfunctional behavior is the “result” of drug use is extremely important, and observation of the patient over time in a medication-free state may be necessary to determine which is driving which. The patient, the patient’s family members and the treating psychiatrist may disagree about what is causing symptoms or behavioral dysfunction. Likewise, the underlying motivation for “drug-seeking” behavior may vary. For example, a patient whose panic attacks are ameliorated by a medication may exhibit what may be interpreted as drug-seek-ing behavior if access to the medication is threatened. The terms anxiolytic and minor tranquilizer are also frequently sources of confusion. In classic pharmacology sedative–hypnotics are drugs or medications that produce a dose-related depression of consciousness. Drug classes are formed by combining drugs or medications that have similar pharmacological profiles.