Like alcohol, these agents are brain depressants and can produce similar substance/ medication-induced and substance use disorders. Sedative, hypnotic, or anxiolytic sub- stances are available both by prescription and illegally. Some individuals who obtain these substances by prescription will develop a sedative, hypnotic, or anxiolytic use disorder, use disorder. In particular, sedatives, hypnotics, or anxiolytics with rapid onset and / or short to intermediate lengths of action may be taken for intoxication purposes, although longer acting substances in this class may be taken for intoxication as well.
Craving (Criterion A4), either while using or during a period of abstinence, is a typical feature of sedative, hypnotic, or anxiolytic use disorder. Misuse of substances from this class may occur on its own or in conjunction with use of other substances. For example, in- dividuals may use intoxicating doses of sedatives or benzodiazepines to "come down” from cocaine or amphetamines or use high doses of benzodiazepines in combination with methadone to ”boost” its effects.
Repeated absences or poor work performance, school absences, suspensions or expul- sions, and neglect of children or household (Criterion A5) may be related to sedative, hyp- notic, or anxiolytic use disorder, as may the continued use of the substances despite arguments with a spouse about consequences of intoxication or despite physical fights (Criterion A6). Limiting contact with family or friends, avoiding work or school, or stop- ping participation in hobbies, sports, or games (Criterion A7) and recurrent sedative, hypnotic, or anxiolytic use when driving an automobile or operating a machine when im- paired by sedative, hypnotic, or anxiolytic use (Criterion A8) are also seen in sedative, hypnotic, or anxiolytic use disorder.
Very significant levels of tolerance and withdrawal can develop to the sedative, hyp- notic, or anxiolytic. There may be evidence of tolerance and withdrawal in the absence of a diagnosis of a sedative, hypnotic, or anxiolytic use disorder in an individual who has abruptly discontinued use of benzodiazepines that were taken for long periods of time at prescribed and therapeutic doses. In these cases, an additional diagnosis of sedative, hyp— notic, or anxiolytic use disorder is made only if other criteria are met. That is, sedative, hypnotic, or anxiolytic medications may be prescribed for appropriate medical purposes, and depending on the dose regimen, these drugs may then produce tolerance and with-
Sedative, Hypnotic, or Anxiolytic Use Disorder 553 drawal. If these drugs are prescribed or recommended for appropriate medical purposes, and if they are used as prescribed, the resulting tolerance or withdrawal does not meet the criteria for diagnosing a substance use disorder. However, it is necessary to determine whether the drugs were appropriately prescribed and used (e.g., falsifying medical symp- toms to obtain the medication; using more medication than prescribed; obtaining the med— ication from several doctors without informing them of the others’ involvement).
Given the unidimensional nature of the symptoms of sedative, hypnotic, or anxiolytic use disorder, severity is based on the number of criteria endorsed.