pattern may be especially likely among indi viduals who have other substance use disor-
ders (e.g., alcohol, opioids, stimulants). An in itial pattern of intermit tent use socially (e.g.,
at parties) can lead to daily use and high leve ls of tolerance. Once this occurs, an increasing
level of interpersonal difficulties, as well as increasingly severe episodes of cognitive dys-
function and physiological wi thdrawal, can be expected.
The second and less frequently  observed clinical course begins with an individual who
originally obtained the medication by prescrip tion from a physician, usually for the treat-
ment of anxiety, insomnia, or somatic complain ts. As either tolerance or a need for higher
doses of the medication develops, there is a gr adual increase in the dose and frequency of