SOCIAL PHARMACOLOGY - UNRESOLVED CRITICAL ISSUES

This article describes and analyzes decision-making by patients, physi cians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors dete rmining both patient and physician behavior. The individual's psycholo gical functioning is seen as a continuous reciprocal interaction betwe en behavioral, cognitive, and environmental influences; i.e., an inter actional paradigm is applied. The importance of research models includ ing cognitive and situation variables to guide the search for appropri ate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, responden ts should be asked to describe their reactions to specific medical sit uations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often sele cted are: message comprehension, receiver satisfaction, changes in kno wledge, attitudes, and drug behavior, as well as health effects. More re search is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for and use of new drug information. A different set of factors influence the patien t's decision to start a medicinal or drug treatment than the factors t hat influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpret ation of physiological signs. More cognitive-oriented research about d rug compliance must be undertaken. In such studies the mediating syste ms of a group of patients could be considered before and after interve ntion. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one are a but irrationally in another. Face-to-face education of physicians ha s been shown to be effective in reducing inappropriate prescribing in a number of studies. ''Overprescribing'' of benzodiazepine has been an issue of intensive professional debate during the last decades. The t wo groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction betw een mind and brain as well as making different value assumptions regar ding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined wi th an information-processing and a normative perspective. The benzodia zepines dependency problem has provoked lively discussion among profes sionals and the general public. Long-term benzodiazepine use and perso nality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dep endency. A great need exists for detailed studies of the cognitive and interactional processes of how benzodiazepine users start, continue, detect dependency, and eventually stop taking the drug.