![]() ![]() Accident risk is greatest in the first weeks of benzodiazepine use or with increasing dosage or use of long-half-life agents. Relatively small doses may cause drowsiness, motor impairment and impaired judgement. Patients prescribed high doses of sedative-hypnotic agents or treated for more than 1 month are at risk for dependence, especially with a past history of alcohol or prescription drug abuse, and family history of alcoholism may confer a genetic predisposition to benzodiazepine dependence.In the absence of dose escalation or deliberate use of the prescription to produce euphoria, however, there is not necessarily a link between chronic benzodiazepine use and use disorder (Stern, Fricchione, Cassem, Jellinek & Rosenbaum, 2010). There are two broad categories of patients who become dependent upon sedative-hypnotic or anxiolytic medications: those who take them for symptomatic treatment of a neurologic or psychiatric disorder and those who use them in non-medical settings, sometimes for self-medication for psychiatric symptoms but also to enhance euphoria or curb withdrawal from other drugs. Symptoms of Sedative,Hypnotic and Anxiolytic Use Disorderīarbiturates have been more stringently controlled in the United States, and benzodiazepines are more frequently abused because of perceived greater safety and more frequent prescribing for sleep or anxiety problems. These changes have elicited both accolades and criticism (Edwards, 2012). Internet gaming and overconsumption of caffeine have been placed in Section III of the Manual, for further study and possible later inclusion as diagnoses. A single disorder (gambling) has been placed in a new category of behavioral addictions because of similarities between gambling addiction and substance use disorders in clinical features, psychiatric comorbidity, physiology, brain origin and response to treatment. Drug craving has been added to the list of symptoms because this occurs frequently, but the requirement for drug-related legal problems has been removed because this often does not occur. More symptoms of problematic substance use have been added to the criteria and a diagnosis of mild use disorder now requires 2 or 3 of these rather than a single manifestation for substance abuse. The not-infrequent “polysubstance addiction” is addressed as separate substance use disorders, although the overarching criteria are the same for most substances. Recent revisions of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) have combined substance abuse and substance dependence into Substance Use Disorder, in which substance use results in distress or functional impairment, specified by drug and graded on a continuum from mild to severe. In addition, “dependence” and “addiction” have often been used interchangeably, and dependence upon a drug does not necessarily mean addiction, a situation exemplified by insulin, anticonvulsants and sometimes chronic pain regimens. This is not always the case, and abuse of a substance can be severe while some individuals dependent upon a drug to function may not misuse it as severely or have withdrawal symptoms. The distinction between “abuse” and “dependence” was based on the concept of abuse as an early or mild phase of abnormal substance use and dependence as a later and more severe manifestation. The syndrome of substance abuse has recently involved the consumption of drugs in a way that is harmful to the user of others, while substance dependence has meant the compulsive need to use drugs in order to function normally, with withdrawal symptoms if the drug(s) cannot be obtained. The problem of compulsive and maladaptive use of these drugs, as with other psychoactive substances, has been divided into 2 categories, substance abuse and substance dependence (American Psychiatric Association, 2000). Barbiturates were synthesized in 1903, meprobamate in 1950 and the benzodiazepine chlordiazepoxide in 1959, setting the stage for the great proliferation of sedative-hypnotic drugs and anxiety medications that has continued to the present day (Lader, 2011). Alcohol, opium and the two in combination (laudanum) were among the first widely used and frequently misused sedative and anxiolytic drugs, and bromide salts, paraldehyde and chloral hydrate were in medical use by the end of the 19th century. ![]() Self-medication or pharmaceutical treatment for anxiety and insomnia has taken place throughout history, and the problems these can cause have been recognized since ancient times. ![]() DSM-5 Category: Substance-Related and Addictive Disorders Introduction ![]()
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