Anxiety and substance use disorders: the treatment of high-risk patients.
Primary care physicians routinely treat patients with various anxiety disorders. These patients may have a substance use disorder or may be at high risk for abuse or addiction. Routine treatment of anxiety disorders with psychoactive drugs is successful in many patients, but it can lead to iatrogenic dependence in high-risk patients. This article describes addiction risk factors, drug pharmacodynamics, environment and environmental cues, and genetics. With these addiction risk factors in mind, the physician can apply a stepwise treatment protocol described in three progressive levels: conservative, nonpharmacological approaches; nonpsychoactive pharmacotherapy; and psychoactive pharmacotherapy. In addition, proper prescribing practices for high-risk patients are described in terms of diagnosis, dosage, duration, discontinuation, dependence, and documentation.
Landry
M J
MJ
Haight Ashbury Training and Education Project, San Francisco, CA 94117.
Smith
D E
DE
McDuff
D R
DR
Baughman
O L
OL
D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D002985:Clinical Protocols / Q000592:standards; D005194:Family Practice / Q000379:methods*; D006801:Humans; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000628:therapy*
D011619:Psychotropic Drugs