Disorders due to Substance Use: Sedatives, Hypnotics, and Anxiolytics

The use of sedative–hypnotic medications, particularly benzodiazepines, is common. In most cases, the use does not lead to a use disorder. In the US general population, the 12-month prevalence of sedative, hypnotic, or anxiolytic use disorder is estimated to be 0.3%, although physiological dependence, including tolerance, is much more common. The risk of anxiolytic use disorder is increased in younger individuals and those with a co-occurring psychiatric disorder (particularly another substance use disorder). Onset is generally during adolescence or early adult life. There are two major pathways toward its development. The most common pathway is an escalation of recreational use. A second pathway involves individuals who originally obtained the medication by prescription from a clinician, usually for the treatment of anxiety or insomnia, but gradually increase the dose and frequency of administration, rather than taking the medication as prescribed. There are no FDA-approved medications approved for the treatment of anxiolytic use disorder and the evidence base for the treatment is limited, beyond medications to treat co-occurring disorders or symptomatic treatment of withdrawal symptoms. Tapering, when needed, should be done gradually, to minimize the risk of withdrawal and relapse. Psychotherapeutic interventions should be targeted at increasing motivation to stop use, facilitate the withdrawal itself, and promote abstinence.