Use Of Psychotherapeutic Drugs Research Articles

Prescription Psychotherapeutic Drug Use and Nicotine Use among Young People in the United States

Background: While prescription psychotherapeutic drug use (PPDU) and nicotine use pose substantial problems in isolation, they pose an increased risk in combination. This study aimed to estimate the prevalence of PPDU for young people, stratified by nicotine use status. A trend analysis was used to examine changes in PPDU and nicotine use over time. Methods: We used a cross-sectional population-based sample of young people aged 16–25 years (n = 10,454) from the National Health and Nutrition Examination Survey (NHANES, 2003–2018). For each data cycle, the prevalence of self-reported PPDU and nicotine including pain relievers, sedatives, stimulants, and tranquilizers was estimated. Using Joinpoint regression, we tested for significant changes in trends using a log-linear model and permutation test approach and produced the average data cycle percentage change (ADCPC). Results: From 2003 to 2018, 6.7% of young people had PPDU and 27.3% used nicotine. The prevalence of cigarette smoking decreased while other nicotine product use increased (p’s < 0.001). Those who used nicotine were more likely to have PPDU (8.2%; 95% CI = 6.5%, 9.8%) vs. non-nicotine use (6.1%; 95% CI = 5.1%, 7.0%; p = 0.01). Results indicated a decreasing trend for nicotine use (ADCPC = −3.8, 95% CI = −7.2, −0.3; p = 0.04), but not for PPDU (ADCPC = 1.3; 95% CI = −4.7, 7.8; p = 0.61). On further examination, opioid use decreased, sedative use remained stable, and stimulant and tranquilizer use increased over time. Conclusions: From 2003 to 2018, young people who used nicotine had a higher prevalence of PPDU than those who did not. Clinicians should communicate the association between nicotine use and prescription drugs when prescribing or managing young patients’ medications.

Examination of Veteran Fathers' Parenting and Their Adolescent Children's Substance Use in the United States

ABSTRACTBackground: Adolescent children of U.S. military veterans may be at increased risk for engaging in substance use; however, this has yet to be examined using nationally representative data. Parental involvement and communication are potential protective factors to target with prevention efforts, but veterans' parenting has not been studied in general, nonclinical populations. Objectives: This study presents data on parenting characteristics among fathers who are veterans of the U.S. military and the substance use behaviors of their adolescent children. Methods: Data were analyzed from approximately 2,200 veteran fathers, 13,100 nonveteran fathers, and their children aged 12 to 17 who participated in the National Survey on Drug Use and Health from 2004 to 2013. Parenting characteristics and adolescent substance use were compared by fathers' veteran status. Results: Compared with nonveteran fathers, veteran fathers were less likely to have talked with their children about the dangers of substance use, were more likely to believe that their children used substances, and were just as likely to be parentally involved. Higher percentages of adolescent children of veterans than those of nonveterans engaged in tobacco use and nonmedical use of psychotherapeutic drugs. Parental involvement and father-child communication about the dangers of substance use did not explain differences in substance use among adolescents with veteran versus nonveteran fathers. Conclusions/Importance: Adolescent children of veterans appear to be a group in particular need of substance use prevention services. Parental involvement and father-child communication may be appropriate protective factors to address in prevention efforts.

CDC to Clinicians: Be Alert for Children With Poliolike Illness

noncancerpain inolderadults,Solomonsaid. Heledastudythatusedhealthcareutilization dataforMedicarebeneficiariesstartingopioid therapy for noncancer pain to try to help answerthatquestion(SolomonDHetal.ArchInternMed. 2010;170[22]:1979-1986). Thestudy,publishedin2010,wasdevised “somewhat inresponsetotheAGSguideline,” Solomonsaid.Granted,hesaid, researchhad raised concerns about the safety of NSAIDs, butAGS“movedtoofar,perhaps, toembrace thepotential benefits of opioids.” Solomon’s study found that the ratesof adverseeventsvaried,dependingontheopioid and the duration of treatment. For example, the risk of cardiovascular events increased for codeine users after 180 days of use.And the risk of death fromall causes increasedafteronly30daysforusersofoxycodone or codeine. “This study’s findings do not agree with a commonly held belief that all opioids are associated with similar risk,” Solomon and his coauthors wrote. As the baby boomers age—the oldest arenowaged68years, the youngest nearly 50 years—overuse of opioids is expected to increase.With their historyof experimentationwithdrugs, thebabyboomersasagroup may be more likely to seek and abuse opioids thanmembersof their parents’ generation, Trevisan said. WestleyClark,MD, JD,MPH,directorof the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, cited a 2006 report, coauthored by Compton, that projected the number of elderly individuals usingdrugs fornonmedical reasons in2020 (ColliverJDetal.AnnEpidemiol. 2006;16[4]: 257-265). By 2020, the nonmedical use of psychotherapeutic drugs, which includes opioid painkillers, was expected to reach 2.4%, nearly 2.7million, among thepopulation of US individuals 50 years or older, Compton and his coauthors wrote. That compares with 1.2%, or 911 000 people, in that age demographic in 2006. AlthoughtheAHRQstatisticalbriefcan’t prove thatopioidoveruseplayeda substantial role in the increase in US hospitalizations amongolder individuals, Clark said, he views the document as a “cautionary tale.” “I see it as opening the door for greater inquiries,” he said. “It is consistent with a number of other observations being made about the use of prescription opioids.”

A Prospective Evaluation of Psychotherapeutic and Illicit Drug Use in Patients Presenting with Chronic Pain at the Time of Initial Evaluation

Background: Reports of chronic pain and associated opioid use, abuse, and fatalities continue to increase at an alarming rate, not only in the United States but also across the globe. In light of the many resultant fatalities, multiple authors and authorities have cautioned against the excessive use of opioids. Consequently, the Food and Drug Administration, Drug Enforcement Administration, and multiple state authorities have been proposing and implementing a plethora of regulations to curb opioid overuse and abuse. In the majority of cases, pain physicians have been portrayed as the perpetrators responsible for escalating use and abuse and resultant fatalities. Objectives: To assess the patterns of psychotherapeutic drug use and illicit drug use at the time of initial evaluation. Study Design: A prospective evaluation. Setting: A private, specialty referral interventional pain management clinic in the United States. Methods: Participants were all new patients presenting to interventional pain management evaluated by one physician. Inclusion criteria was patients over 18 years of age with chronic spinal pain of at least one year duration. Results: The results of this evaluation indicate that 94% of patients were on long-term opioids prior to presenting to interventional pain management. Illicit drug use is also common, although it has declined significantly. While a large proportion of individuals (45.7%) have used illicit drugs at some point in the past, current illicit drug use is present in only 7.9% of patients, both past and current use are similar to that of the general population. More importantly, a significant proportion of patients have been on opioids (high doses of more than 40 mg equivalents of morphine 48.8%) on a long-term basis, initiated and maintained by primary care physicians, prior to presenting to interventional pain management. Further, 35% were on benzodiazepines, and 9.2% on carisoprodol prior to presenting to interventional pain management. Limitations: The limitations of this evaluation include that it is a prospective, single center evaluation by one physician that is partially dependent on subjective recall of the patient. Conclusion: This study shows an overwhelming majority of patients were initiated and maintained with opioids in managing chronic noncancer pain. They were frequently on high doses over a long period of time with multiple drug combinations prescribed by primary care physicians. Key Words: Chronic pain, persistent pain, noncancer pain, controlled substances, substance abuse, prescription drug abuse, opioids, prescriptions, urine drug testing, fatalities, regulations

Opioid Epidemic in the United States

Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain. Key words: Opioid abuse, opioid misuse, nonmedical use of psychotherapeutic drugs, nonmedical use of opioids, National Survey on Drug Use and Health, opioid guidelines.

C-B1-01: Psychotherapeutic Prescription Patterns Across Health Plans in the Mental Health Research Network

Background The need for effectiveness and dissemination research is at least as great in mental health as in other areas of health care. The Mental Health Research Network aims to use the VDW for multi-site studies of mental disorder epidemiology, treatment patterns, or treatment effectiveness. We expect that the existing infrastructure is satisfactory in some areas, while others will need improvement or expansion. We present early results from validation studies of enrollment and pharmacy data on patterns of psychotherapeutic drug use.

Therapeutic Use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective

The treatment of chronic pain, therapeutic opioid use and abuse, and the nonmedical use of prescription drugs have been topics of intense focus and debate. After the liberalization of laws governing opioid prescribing for the treatment of chronic non-cancer pain by state medical boards in the late 1990s, and with the introduction of new pain management standards implemented by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2000, opioids, in general, and the most potent forms of opioids including Schedule II drugs, in particular, have dramatically increased. Despite the escalating use and abuse of therapeutic opioids, nearly 15 to 20 years later the scientific evidence for the effectiveness of opioids for chronic non-cancer pain remains unclear. Concerns continue regarding efficacy; problematic physiologic effects such as hyperalgesia, hypogonadism and sexual dysfunction; and adverse side effects - especially the potential for misuse and abuse - and the increase in opioid-related deaths. Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world's illegal drugs. Retail sales of commonly used opioid medications (including methadone, oxycodone, fentanyl base, hydromorphone, hydrocodone, morphine, meperidine, and codeine) have increased from a total of 50.7 million grams in 1997 to 126.5 million grams in 2007. This is an overall increase of 149% with increases ranging from 222% for morphine, 280% for hydrocodone, 319% for hydromorphone, 525% for fentanyl base, 866% for oxycodone, to 1,293% for methadone. Average sales of opioids per person have increased from 74 milligrams in 1997 to 369 milligrams in 2007, a 402% increase. Surveys of nonprescription drug abuse, emergency department visits for prescription controlled drugs, unintentional deaths due to prescription controlled substances, therapeutic use of opioids, and opioid abuse have been steadily rising. This manuscript provides an updated 10-year perspective on therapeutic use, abuse, and non-medical use of opioids and their consequences.

National Drug Control Policy and Prescription Drug Abuse: Facts and Fallacies

In a recent press release Joseph A. Califano, Jr., Chairman and President of the National Center on Addiction and Substance Abuse at Columbia University called for a major shift in American attitudes about substance abuse and addiction and a top to bottom overhaul in the nation's healthcare, criminal justice, social service, and eduction systems to curtail the rise in illegal drug use and other substance abuse. Califano, in 2005, also noted that while America has been congratulating itself on curbing increases in alcohol and illicit drug use and in the decline in teen smoking, abuse and addition of controlled prescription drugs-opioids, central nervous system depressants and stimulants-have been stealthily, but sharply rising. All the statistics continue to show that prescription drug abuse is escalating with increasing emergency department visits and unintentional deaths due to prescription controlled substances. While the problem of drug prescriptions for controlled substances continues to soar, so are the arguments of undertreatment of pain. The present state of affairs show that there were 6.4 million or 2.6% Americans using prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 4.7 million used pain relievers. Current nonmedical use of prescription-type drugs among young adults aged 18-25 increased from 5.4% in 2002 to 6.3% in 2005. The past year, nonmedical use of psychotherapeutic drugs has increased to 6.2% in the population of 12 years or older with 15.172 million persons, second only to marijuana use and three times the use of cocaine. Parallel to opioid supply and nonmedical prescription drug use, the epidemic of medical drug use is also escalating with Americans using 80% of world's supply of all opioids and 99% of hydrocodone. Opioids are used extensively despite a lack of evidence of their effectiveness in improving pain or functional status with potential side effects of hyperalgesia, negative hormonal and immune effects, addiction and abuse. The multiple reasons for continued escalation of prescription drug abuse and overuse are lack of education among all segments including physicians, pharmacists, and the public; ineffective and incoherent prescription monitoring programs with lack of funding for a national prescription monitoring program NASPER; and a reactive approach on behalf of numerous agencies. This review focuses on the problem of prescription drug abuse with a discussion of facts and fallacies, along with proposed solutions.

Improving our Brains?

Our brains are the substrate of all thought, emotion and behavior. Because our brains are the most complex objects of human inquiry, brain science is still at a relatively early stage of its development. Nonetheless, success in influencing brain function is already raising significant social, ethical and policy issues. Here, I highlight concerns related to one aspect of clinical neuroscience: the use of psychotherapeutic drugs, originally developed to treat illness, for individuals who are not ill. I focus on this issue, sometimes described as the use of drugs for ‘enhancement’ of normal function, because it is already upon us even as science is focused on the development of safer and more effective drugs for an expanding list of indications related to alertness, mood and cognition.

Projecting Drug Use Among Aging Baby Boomers in 2020

Greater rates of lifetime drug use among the baby-boom generation, combined with the size of that generation, suggest that the number of elderly persons using drugs will increase in the next two decades. Given the potential public health demands implied by increasing numbers of elderly drug users, the goal is to project the numbers of current drug users aged 50 years and older in 2020. Using the modeling and projection methods of Gfroerer et al (2003) applied to data from the 1999 to 2001 National Household Surveys on Drug Abuse, projections were developed for the use of marijuana, nonmedical use of any prescription-type psychotherapeutic drug, and any illicit drug use. From 1999 to 2001 to 2020, past-year marijuana use in persons 50 years and older is forecast to increase from 1.0% to 2.9%. The number of users is expected to increase from 719,000 to almost 3.3 million, reflecting the combined effects of the increase in rate of use and a projected 51.9% increase in the civilian noninstitutionalized population in this age group. Use of any illicit drug will increase from 2.2% (1.6 million) to 3.1% (3.5 million), and nonmedical use of psychotherapeutic drugs will increase from 1.2% (911,000) to 2.4% (almost 2.7 million). These projections call attention to changes to be considered in planning and to the need for improved knowledge of the biomedical and psychosocial effects of nonmedical drug use on aging and elderly individuals.

Factors associated with Ecstasy use in Turkish students.

The purpose of this study was to establish the factors associated with Ecstasy use in secondary school students in Turkey. This is a survey of a representative sample drawn from cities in different geographical regions in Turkey in 1998 and 2001. The questionnaire was administered to a total of 18,556 and 11,911 10th-grade students in 1998 and 2001, respectively. The questionnaire administered in the study was adapted from the questionnaires used in 'Monitoring the Future' study in the United States and ESPAD (the European School Survey Project on Alcohol and Other Drugs). It included questions about demographic characteristics, family characteristics, school life, social contacts and use of substances. While the percentage of those who used Ecstasy at least once in their life-times was 2.65% in 1998, the figure reached 3.31% in 2001. Male gender, older age, use of alcohol, cannabis, heroin and cocaine, non-medical use of psychotherapeutic drugs and participation in a meeting concerning the adverse effects of substance use were found to be significant variables predicting 'ever use' of Ecstasy in both years by logistic regression analysis. Ecstasy use, while low in Turkey, appears to be on the increase and follows a pattern in terms of correlates that is similar to other illicit drugs. Whatever the causes behind the rise in Ecstasy use, creative, personalized and informative educational programmes should be conducted in all educational institutions to curb Ecstasy use.

Incidence and risk factors in fractures of the proximal femur due to osteoporosis

Every year more than one million fractures of the proximal femur occur in the world, especially in older persons. Given the continuous aging experienced by populations, such fractures will become more frequent from year to year and will constitute a growing public health problem. The largest increase is expected to occur in countries of Latin America around the year 2050. Since nearly 70% of all atraumatic fractures in persons over 45 are due to osteoporosis, a case-control study was conducted in the city of Mar del Plata, Argentina, for the purpose of investigating the incidence of and the risk factors associated with proximal femur fractures due to osteoporosis. Between 1 August 1992 and 31 July 1993, a record was kept of all fractures of the proximal femur due to osteoporosis in persons over 50 years of age that visited any of the city's 30 public and private health centers. A total of 246 cases was recorded. The incidence rate per 100,000 inhabitants in the above-50 population was 259 among women and 92 among men, for a ratio of 2.8:1. The incidence was consistently higher in the older age groups, especially in persons over 75. Factors associated with a statistically significant increased risk of fracture of the proximal femur were: a history of neurologic disorders, psychotherapeutic drug use, alcohol consumption, previous fractures, cardiovascular disease, and a decreased intake of milk products. There were no observed differences between cases and controls with respect to age at menopause, weight, height, previous activity, smoking habits, or sun exposure, nor were such differences detected in terms of the percentage of women who had undergone oophorectomy.

Activity Limitation and Psychotherapeutic Drug Use Among Community-Residing Elderly Women

This cross-sectional case-comparison study assessed the risk of activity limitation among community-dwelling older women (aged 55 and older) exposed to psychotherapeutic drugs. The data are taken from the National Institute of Mental Health Epidemiologic Catchment Area program. Exposures to short-elimination (≤24 hours) and long-elimination (≥24 hours) half-life psychotherapeutic drugs were assessed, as were the presence of functional disabilities (measured by limitations as defined in the Instrumental Activities of Daily Living and Activities of Daily Living scales). Women who reported the use of long-life sedative hypnotic drugs had a significantly higher risk of having an activity limitation; this relationship remained significant in a multiple regression model that controlled for other factors related to activity limitation, such as age, race, number of chronic health conditions, and presence of psychiatric distress. These results suggest the possibility that psychotherapeutic drug use is implicated in activity limitation. Health care providers should be aware of this possibility when treating older patients and be alert to the autonomic and sedating effects of these and other drugs when prescribing medications to the elderly. There is a need for prospective studies examining the possible trajectories of activity limitation in relation to drug use.

Clinical variables in pharmacoepidemiology

Pharmacoepidemiology traditionally concerns itself with the rates at which drugs are prescribed and used in the general population. Interpretations of these data frequently assume that the rates—for psychotropic drugs—reflect primarily the reinforcing properties of the drugs. This paper, in contrast, focuses on the influence of certain clinical characteristics of consumers on patterns of psychotherapeutic drug use. The data are from a nationwide (US) probability sample of 3, 161 persons aged 18–79 years surveyed in 1979. One-year prevalence rates of use and the longest period of regular daily use serve as indices of drug consumption. Scores on a 43-item checklist of psychological symptoms were used to compute two clinical descriptors of the respondents—a quantitative index of the level of psychic distress and a qualitative syndromal classification including depression, agoraphobia/panic, other phobias, and generalized anxiety. The data showed that, although anxiolytics and antidepressants have characteristic patterns of prevalence and duration of use, the clinical characteristics of users (severity and pattern of symptoms) strongly influence these patterns. Prevalence and duration of drug use alone do not suffice to illuminate the social functions and significance of psychotherapeutic agents, to provide a basis for value judgements about the use of such compounds, and to guide medical decision-making. Since clinical variables play such a major role in the consumption of these agents, it is crucial to include information about these variables in the analysis and interpretation of patterns of psychotherapeutic drug use.

Appropriate Use and Regulatory Control of Benzodiazepines

Appropriate Use and Regulatory Control of Benzodiazepines

Mental Retardation and Psychiatric Disorders

Estimates of the prevalence of comorbidity of psychiatric disorders and mental retardation in community and clinical populations range from 14.3 to 67.3 percent. A wide variety of disorders have been reported in this population, including schizophrenia, depression, and, commonly, conduct disorder. The incidence of specific disorders appears to be related to the level of retardation and the concomitant presence of seizure disorder. Accurate assessment of psychiatric disorders in this population is difficult because mentally retarded patients have poor communication skills and because most diagnostic instruments were developed for persons of normal intellectual functioning. Treatment includes educational, behavioral, and pharmacological interventions, but guidelines for safe use of psychotherapeutic drugs are needed.

Changes in popular attitudes and beliefs about tranquilizers. 1970-1979.

In nationwide surveys of the extent and nature of psychotherapeutic drug use conducted in 1970 and 1979, respondents were also questioned about their knowledge of tranquilizers and attitudes toward the use of these medications in general and in specific situations. In both 1970 and 1979, most Americans believed that tranquilizers were effective; by 1979, however, we found a sharp increase in the proportion of respondents who believed that these medications were overprescribed. Reservations about the effects of tranquilizers on health, mood, and behavior had also become more widespread by 1979. In both 1970 and 1979, however, respondents were generally more accepting of tranquilizer use when presented with practical situations pitting benefit against risk. A majority condoned the use of tranquilizers in situations involving pronounced impairment.

The nontherapeutic use of psychotherapeutic drugs among the college age group: the sedatives and tranquilizers.

Abstract The sedatives and minor tranquilizers comprise two large groups of prescription drugs widely used without medical supervision by the college age group. Within the sedative group, the barbiturates and methaqualone are currently the most popular. An estimated nine million Americans have used sedatives without medical supervision, approximately five and one-half million of whom are within the college age group. The appeal of barbiturates to college students is that these drugs produce a “high” similar to that of alcohol, relieve feelings of stress, and produce a temporary sense of well-being. Tolerance and dependence develop quickly; high doses impair motor coordination and judgment. Barbiturates are frequently implicated in auto accidents and in suicides. Methaqualone continues to be popular among students because of its purported aphrodisiac effects and because it is frequently used to bring the cocaine user “down.” Its increase in use has therefore paralleled the increase in use of cocaine. The use of tranquilizers has doubled between 1972 and 1982. Valium, the most popular of tranquilizers, continues to be widely used among students because of its ability to be absorbed rapidly into the bloodstream and to produce its effects of euphoria and acute intoxication quickly. Though Valium is considered to be a relatively safe drug, it can be fatal if taken in large doses with alcohol. Tolerance and both psychological dependence and physiological addiction may occur and cause students to use increasing doses of the drug. A detailed knowledge of the adverse psychological and biological effects of the sedatives and tranquilizers will prove helpful to all those working within the college health facilities.

Anti-anxiety agents: duration of use and characteristics of users in the U.S.A.

A national survey of psychotherapeutic drug use was carried out in the U.S.A. in 1979. Data were obtained from a probability sample (n = 3161) of adults in the general population, using a clinically-oriented interview lasting an average of 90 minutes. The data provide estimates of the prevalence of using anxiolytic and other psychotherapeutic medications. Among users they also provide detailed descriptions of patterns of use and characteristics associated with various patterns of use. The study found that 11% of American adults used an anxiolytic during the 12 months prior to the survey. Benzodiazepines accounted for 84% of the anxiolytics mentioned. The analyses compared (i) users of anxiolytics with non-users and (ii) three groups of anxiolytic users classified according to pattern (frequency and regularity) of use. The results were generally consistent with an illness treatment model of psychotherapeutic drug use, and they raise interesting questions about short-term single-occasion use.

Anxiety disorders: prevalence and treatment.

A method is reported for classifying survey respondents according to syndromes resembling some of the anxiety disorders as defined by DSM III, using responses to a standard clinical symptom checklist administered on a large scale in the U.S.A. by trained survey interviewers in the 1979 National Survey of Psychotherapeutic Drug Use. These syndromes ('agoraphobia/panic', 'other phobia', and 'generalized anxiety') have several characteristics consistent with their DSM III diagnostic counterparts. They show 1-year prevalence rates of 1.2%, 2.3%, and 6.4%, respectively, roughly in accord with the limited relevant epidemiological data available. The prevalence of these anxiety syndromes is lower than clinical lore suggests. The very low prevalence of use of antidepressants (8%) and the much higher rate of use of anti-anxiety agents (55%) among agoraphobics are surprising. The infrequent use of anti-anxiety agents among respondents with generalized anxiety (27%) also is noteworthy. These findings suggest that the majority of persons with serious anxiety disorders still do not receive treatment or the most appropriate treatment, although other possible interpretations of the data also are considered.