risk factor relates to availability of the substances. In the United States, the historical pat-
terns of sedative, hypn otic, or anxiolytic misuse relate to the broad prescribing patterns.
For instance, a marked decrease in prescription  of barbiturates was associated with an in-
crease in benzodiazepine pres cribing. Peer factors may rela te to genetic predisposition in
terms of how individuals select  their environment. Other individuals at heightened risk
might include those with alcohol use disorder who may receive repeated prescriptions in
response to their complaints of al cohol-related anxiety or insomnia.
Genetic and physiological. As for other substance use diso rders, the risk for sedative,
hypnotic, or anxiolytic use disorder can be re lated to individual, family, peer, social, and
environmental factors. Within these domains, genetic factors play a particularly important
role both directly and indirectly. Overall, ac ross development, genetic factors seem to play
a larger role in the onset of sedative, hypnotic,  or anxiolytic use disorder as individuals age
through puberty into adult life. 
Course modifiers. Early onset of use is associated with greater likelihood for develop-
ing a sedative, hypnotic, or anxiolytic use disorder.
Culture-Related Diagnostic Issues
There are marked variations in prescription patt erns (and availability) of this class of sub-
stances in different countries, which may lead to variations in prevalence of sedative, hyp-
notic, or anxiolytic use disorders.
Gender-Related Diagnostic Issues
Females may be at higher risk than males for prescription drug mi suse of sedative, hyp-
notic, or anxiolytic substances.
Diagnostic Markers