Sedative, Hypnotic, or Anxiolytic Use Disorder 553
drawal. If these drugs are prescribed or recommended for appropriate medical purposes,
and if they are used as prescribed, the result ing tolerance or withdrawal does not meet the
criteria for diagnosing a substance use disord er. However, it is necessary to determine
whether the drugs were appropriately prescribed and used (e.g., falsifying medical symp-
toms to obtain the medication; using more medication than prescribed; obtaining the med-
ication from several doctors without info rming them of the others’ involvement). 
Given the unidimensional nature of the symp toms of sedative, hypnotic, or anxiolytic
use disorder, severity is based on the number of criteria endorsed.
Associated Features Supporting Diagnosis
Sedative, hypnotic, or anxiolytic use disorder is often associated with other substance use dis-
orders (e.g., alcohol, cannabis, opioid, stimulant use disorders). Sedatives are often used to al-
leviate the unwanted effects of these other substances. With repeated use of the substance,
tolerance develops to the sedative effects, an d a progressively higher dose is used. However,
tolerance to brain stem depressa nt effects develops much more slowly, and as the individual
takes more substance to achieve euphoria or other desired effects, there may be a sudden onset
of respiratory depression and hypotension, which may result in death. Intense or repeated
sedative, hypnotic, or anxiolytic  intoxication may be associated  with severe de pression that,
although temporary, can lead to suicide attempt and completed suicide. 
Prevalence
The 12-month prevalences of DS M-IV sedative, hypnotic, or an xiolytic use disorder are es-