Sedative, hypnotic, or anxiolytic use disorder is often associated with other substance use dis- orders (e.g., alcohol, cannabis, opioid, stimulant use disorders). Sedatives are often used to al- leviate the unwanted effects of these other substances. With repeated use of the substance, tolerance develops to the sedative effects, and a progressively higher dose is used. However, tolerance to brain stem depressant effects develops much more slowly, and as the individual takes more substance to achieve euphoria or other desired effects, there may be a sudden onset of respiratory depression and hypotension, which may result in death. Intense or repeated sedative, hypnotic, or anxiolytic intoxication may be associated with severe depression that, although temporary, can lead to suicide attempt and completed suicide.
The 12-month prevalences of DSM-IV sedative, hypnotic, or anxiolytic use disorder are es- timated to be 0.3% among 12- to 17-year-olds and 0.2% among adults age 18 years and older. Rates of DSM-IV sedative, hypnotic, or anxiolytic use disorder are slightly greater among adult males (0.3%) than among adult females, but for 12- to 17-year-olds, the rate for females (0.4%) exceeds that for males (0.2%). The 12-month prevalence of DSM-IV sedative, hypnotic, or anxiolytic use disorder decreases as a function of age and is great- est among 18- to 29-year-olds (0.5%) and lowest among individuals 65 years and older (0.04%).
Twelve-month prevalence of sedative, hypnotic, or anxiolytic use disorder varies across racial/ethnic subgroups of the US. population. For 12- to 17-year-olds, rates are greatest among whites (0.3%) relative to African Americans (0.2%), Hispanics (0.2%), Native Amer- icans (0.1%), and Asian Americans and Pacific Islanders (0.1%). Among adults, 12—month prevalence is greatest among Native Americans and Alaska Natives (0.8%), with rates of approximately 0.2% among African Americans, whites, and Hispanics and 0.1% among
Asian Americans and Pacific Islanders.
The usual course of sedative, hypnotic, or anxiolytic use disorder involves individuals in their teens or 205 who escalate their occasional use of sedative, hypnotic, or anxiolytic agents to the point at which they develop problems that meet criteria for a diagnosis. This ders (e.g., alcohol, opioids, stimulants). An initial pattern of intermittent use socially (e.g., at parties) can lead to daily use and high levels of tolerance. Once this occurs, an increasing level of interpersonal difficulties, as well as increasingly severe episodes of cognitive dys- fimction and physiological withdrawal, can be expected.
The second and less frequently observed clinical course begins with an individual who originally obtained the medication by prescription from a physician, usually for the treat- ment of anxiety, insomnia, or somatic complaints. As either tolerance or a need for higher doses of the medication develops, there is a gradual increase in the dose and frequency of self—administration. The individual is likely to continue to justify use on the basis of his or her original symptoms of anxiety or insomnia, but substance—seeking behavior becomes more prominent, and the individual may seek out multiple physicians to obtain sufficient supplies of the medication. Tolerance can reach high levels, and withdrawal (including seizures and withdrawal delirium) may occur.