Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

220 III. SUBSTANCES OF ABUSEcoadministered with other agents that suppress respiration. The benzodiazepinescan be antagonized by specific agents that do not block the effects ofother sedatives. The benzodiazepine antagonists do not produce significanteffects in the absence of the benzodiazepines. These properties distinguish thebenzodiazepines from the other sedatives and produce a margin of safety thathas led to the widespread use of benzodiazepines (Charney, Minie, & Harris,2001).The National Comorbidity Survey (NCS) found that 17.2% of the populationhad an anxiety disorder in the past 12 months, and 24.9% had a lifetimehistory of anxiety disorder (DuPont, Dupont, & Rice, 2002; Kessler et al.,1994). These studies establish that the anxiety disorders are the most prevalentclass of mental disorders over a 12-month period of time (DuPont, 1995). Usingthe standard human capital approach to estimate the social costs of illnesses in1994, the anxiety disorders produced a total social cost of $65 billion (DuPontet al., 2002). Of this total, the cost of all treatments was only $15 billion,whereas $50 billion was due to lost productivity as a result of the often seriouslydisabling nature of the anxiety disorders. For comparison, using the same methodology,the costs of all mental illnesses in 1994 was $204 billion, of which themood disorders—including depression and bipolar disorders—totaled $42 billionand schizophrenia totaled $45 billion.The benzodiazepines were introduced in 1960s as comparatively problemfreecompared to the barbiturates, which they rapidly replaced. Their popularityreached unprecedented levels in the early 1970s. However, a powerful backlash,labeled the “social issues,” emerged, which caused a drop in the use of benzodiazepinesduring the 1980s, even though there was a rise in the prevalence ofthe disorders for which they are used (DuPont, 1986, 1988).As the benzodiazepines became more controversial, and as various regulatoryapproaches were employed to limit their use in medical practice, there wasa danger that clinicians would revert to the older and generally more toxic sedativesand hypnotics, which, in the era of the benzodiazepines, had becomeunfamiliar (Juergens & Cowley, 2003). Thus, there is more than historicalinterest in looking at these earlier sedatives, because for some younger medicalpractitioners, they are new medicines. The use of sedatives and hypnotics forthe treatment of anxiety and insomnia in patients with addiction to alcoholand other drugs entails additional risks, especially when benzodiazepines areused (Handelsman, 2002).For more than three decades, the federal government has tracked the ratesof self-reported, nonmedical use of a variety of drugs within the United States,primarily in two surveys—one of high school seniors (Monitoring the Future[MTF]), and the other of Americans 12 years of age and older (National HouseholdSurvey on Drug Abuse [NHSDA]) (U.S. Department of Health andHuman Services, 2001, 2002). The NHSDA separately tracks the use of “tran-