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

10. Sedatives/Hypnotics and Benzodiazepines 221quilizers” and “sedatives” while the MTF survey tracks “tranquilizers” and “barbiturates.”Neither survey identifies “benzodiazepines” specifically. In general,the trends over this extended period of time show a steady rise in nonmedicaluse, peaking in the late 1970s, followed by a low point in the early 1990s. Thiswas followed by a subsequent upturn in the levels of use that continued into2001. In 2000, the NHSDA estimated the total number of use Americans, 12years of age and older, who had used a tranquilizer nonmedically during theprior 30 days as 788,000, down from 950,000 the prior year (U.S. Departmentof Health and Human Services, 2001). Most of the people who had used abenzodiazepine nonmedically had done so only a few times in their lifetimes.Nonmedical benzodiazepine use, which is different from, and far less commonthan medical use of the benzodiazepines, is a small but significant part of theoverall nonmedical drug problem in the nation.DISTINGUISHING MEDICAL AND NONMEDICALUSE OF BENZODIAZEPINESA series of national surveys tracking the medical use of the benzodiazepinesshowed that their use peaked in 1976 and by the late 1980s had fallen about25% off that peak rate (DuPont, 1988). A 1979 survey of medical use of thebenzodiazepines (near the peak of benzodiazepine use in the United States),showed that 89% of Americans ages 18 years and older had not used a benzodiazepinewithin the previous 12 months. Of those who had used a benzodiazepine,most (9.5% of all adults) had used the benzodiazepine either less thanevery day or for less than 12 months, or both, whereas a minority (1.6% of theadult population) had used a benzodiazepine on a daily basis for 12 months orlonger. This long-term user group was two-thirds female; 71% were age 50 orolder, and most had chronic medical problems, as well as anxiety (DuPont,1988).Of those with anxiety disorders in a large community sample, three-fourthswere receiving no treatment at all, including not using a benzodiazepine. The1.6% of the population who are chronic benzodiazepine users can be comparedto the 17% of the population suffering from anxiety disorders at any 12-monthperiod. This statistic led many observers to conclude that not only are benzodiazepinesnot overprescribed but they also may actually be underprescribed,because of the reluctance of both physician and patients to use these medicines(Mellinger & Balter, 1981).To understand the place of the benzodiazepines in contemporary medicalpractice, it is important to separate appropriate medical use from inappropriate,nonmedical use. Five characteristics distinguish medical from nonmedical useof all controlled substances, including the benzodiazepines.