Treatment regimen and hypnotic self-administration

Rationale and objectives: Previous studies have shown that insomniacs self- administer hypnotics at high nightly rates. This study determined whether p rior experience with different treatment regimens (i.e., instructions and c apsule availability) would alter the previously observed high hypnotic self -administration rates. Methods: Sixty-four healthy men and women with (n=32 ) and without (n=32) insomnia, 21-55 years, self administered placebo or tr iazolam (0.25 mg) after different prior treat ment regimens. They received one of three different treatment regimens enforced for 11 nights: a capsule each night, a capsule as needed, or a capsule every third night. On 14 sub sequent nights they choose to self administer a capsule or not, placebo dur ing 1 week and triazolam (0.25 mg) the other (counterbalanced in order). Re sults: Insomniacs self-administered more capsules than normals and triazola m was self-administered more than placebo. For both groups, treatment regim en had a minimal effect on capsule self-administration. During the treatmen t phase, triazolam improved self-ratings of sleep relative to placebo. Duri ng the choice phase, nightly variations in self-rated sleep predicted self- administration of a capsule on the following night, regardless of whether t he capsule was active drug or placebo. Conclusions: The data of this study are consistent with the view that hypnotic self-administration by insomniac s is therapy-seeking behavior and not drug abuse.