In DSM-III, this disorder is called Barbiturate or Similarly Acting Sedative or Hypnotic Dependence
Either tolerance or withdrawal:
- Tolerance: need for markedly increased amounts of the substance to achieve the desired effect, or markedly diminished effect with regular use of the same amount.
- Withdrawal: development of Barbiturate or Similarly Acting Sedative or Hypnotic Withdrawal after cessation of or reduction in substance use.
For more information, see Substance Dependence
Very significant levels of physiological dependence, marked by both tolerance and withdrawal, can develop to the sedatives, hypnotics, and anxiolytics. The timing and severity of the withdrawal syndrome will differ depending on the specific substance and its pharmacokinetics and pharmacodynamics. For example, withdrawal from shorter-acting substances that are rapidly absorbed and that have no active metabolites (e.g., triazolam) can begin within hours after the substance is stopped; withdrawal from substances with long-acting metabolites (e.g., diazepam) may not begin for 1-2 days or longer. The withdrawal syndrome produced by substances in this class may be characterized by the development of a delirium that can be life threatening. There may be evidence of tolerance and withdrawal in the absence of a diagnosis of Substance Dependence in an individual who has abruptly discontinued benzodiazepines that were taken for long periods of time at prescribed and therapeutic doses. A diagnosis of Substance Dependence should be considered only when, in addition to having physiological dependence, the individual using the substance shows evidence of a range of problems (e.g., an individual who has developed drug-seeking behavior to the extent that important activities are given up or reduced to obtain the substance).
The following specifiers may be applied to a diagnosis of Sedative, Hypnotic, or Anxiolytic Dependence:
- With Physiological Dependence
- Without Physiological Dependence
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- On Agonist Therapy
- In a Controlled Environment