ALPRAZOLAM AND BENZODIAZEPINE DEPENDENCE

The incidence of nonmedical use of alprazolam is very low relative to its widespread legitimate medical use; in fact, given the millions of patients who have received this medication, the incidence is remarkabl y small. In particular, among patients with anxiety disorders, depende nce does not appear to be a clinically important problem. Alprazolam a buse and dependence represent only a small fraction of the large and s erious nonmedical use problem in the United States, and when they occu r, are among individuals who abuse other drugs. For example, a serious problem of alprazolam abuse may exist among patients in methadone mai ntenance treatment. A similar problem exists with diazepam. Alcohol ab users and alcohol-dependent individuals are another group among whom c oncern about benzodiazepine and alprazolam abuse exists. However, more and better information about the extent and nature of this use is nee ded. Many patients with alcohol or drug abuse also have anxiety disord ers for whom effective pharmacotherapy may be needed. In the interim, caution but not prohibition to use should prevail in prescribing alpra zolam to such patients. To the extent that nonmedical alprazolam use e xists, evidence suggests that the vast majority of such use is the con sequence of the inappropriate prescribing of the medication by a small number of physicians. One way to reduce the inappropriate use of benz odiazepines in methadone programs is to drug test the methadone-mainte nance patients and to link positive urine tests to contingency-managem ent strategies. The available data provide some support to the idea th at alprazolam and diazepam have more abuse liability than other benzod iazepines.