As with many substance use disorders, sedative, hypnotic, or anxiolytic use disorder gen- erally has an onset during adolescence or early adult life. There is an increased risk for misuse and problems from many psychoactive substances as individuals age. In particular, cognitive impairment increases as a side effect with age, and the metabolism of sedatives, hypnotics, or anxiolytics decreases with age among older individuals. Both acute and chronic toxic effects of these substances, especially effects on cognition, memory, and motor coordination, are likely to increase with age as a consequence of pharmacodynamic and pharmacokinetic age- related changes. Individuals with major neurocognitive disorder (dementia) are more likely to develop intoxication and impaired physiological functioning at lower doses.
Deliberate intoxication to achieve a ”high" is most likely to be observed in teenagers and individuals in their 205. Problems associated with sedatives, hypnotics, or anxiolytics are also seen in individuals in their 403 and older who escalate the dose of prescribed med- ications. In older individuals, intoxication can resemble a progressive dementia.
Temperamental. Impulsivity and novelty seeking are individual temperaments that re- late to the propensity to develop a substance use disorder but may themselves be geneti- cally determined.
Environmental. Since sedatives, hypnotics, or anxiolytics are all pharmaceuticals, a key risk factor relates to availability of the substances. In the United States, the historical pat- terns of sedative, hypnotic, or anxiolytic misuse relate to the broad prescribing patterns.
For instance, a marked decrease in prescription of barbiturates was associated with an in- crease in benzodiazepine prescribing. Peer factors may relate to genetic predisposition in terms of how individuals select their environment. Other individuals at heightened risk might include those with alcohol use disorder who may receive repeated prescriptions in response to their complaints of alcohol-related anxiety or insomnia.
Genetic and physiological. As for other substance use disorders, the risk for sedative, hypnotic, or anxiolytic use disorder can be related to individual, family, peer, social, and environmental factors. Within these domains, genetic factors play a particularly important role both directly and indirectly. Overall, across development, genetic factors seem to play a larger role in the onset of sedative, hypnotic, or anxiolytic use disorder as individuals age through puberty into adult life.
Course modifiers. Early onset of use is associated with greater likelihood for develop- ing a sedative, hypnotic, or anxiolytic use disorder.
There are marked variations in prescription patterns (and availability) of this class of sub- stances in different countries, which may lead to variations in prevalence of sedative, hyp- notic, or anxiolytic use disorders.
Females may be at higher risk than males for prescription drug misuse of sedative, hyp- notic, or anxiolytic substances.
Almost all sedative, hypnotic, or anxiolytic substances can be identified through labora- tory evaluations of urine or blood (the latter of which can quantify the amounts of these
Sedative, Hypnotic, or Anxiolytic Use Disorder 555 agents in the body). Urine tests are likely to remain positive for up to approximately 1 week after the use of long-acting substances, such as diazepam or ﬂurazepam.
Sedative, Hypnotic, or Anxioiytic Use Disorder