The term addictive as used by the popular press frequently confuses the more precise concepts of acute and chronic tolerance, physical dependence and withdrawal, and psychologic dependence. Serious physical dependence on
psychoactive drugs is rare and is easily managed. In contrast, psychologic dependence, the most important reason for persistent
drug use, is much more common and is difficult to treat. Some tactics are available - for example, confrontation and discussion with the patient about how a
drug is not going to be effective over long periods. Treating the symptom of a complex problem should, of course, not be expected to solve the problem. The most important tactic is to prescribe dependence-associated drugs only when clearly indicated, when the problem is responsive to
drug therapy and for the shortest period necessary, without the option for renewing the prescription. Many problems related to
drug use long after the period of expected benefit is past can be avoided by far more restrictive
drug prescribing.
Barbiturates and nonbarbiturate
sedative hypnotics (e.g.,
ethchlorvynol,
glutethimide,
meprobamate,
methaqualone and
methyprylon) should not be prescribed for
insomnia, acute reactive anxiety, chronic anxiety neurosis or depressive illnesses, since the safer and equally effective
benzodiazepines, which are less associated with dependence, are available.