Alprazolam-reinforced medication use in outpatients with anxiety

• Published in: Drug and alcohol dependence Vol. 45; no. 3; pp. 143 - 155
• Main Authors: Roache, J.D., Stanley, M.A., Creson, D.R., Shah, N.N., Meisch, R.A.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 02.05.1997; Elsevier Science
• Subjects: Adult; Alprazolam; Alprazolam - therapeutic use; Analysis of Variance; Anti-Anxiety Agents - therapeutic use; Anxiety; Anxiety Disorders - drug therapy; Behavior, Addictive; Benzodiazepines; Biological and medical sciences; Choice Behavior; Circadian Rhythm; Double-Blind Method; Female; Follow-Up Studies; Humans; Individuality; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neuropharmacology; Panic; Panic Disorder - drug therapy; Pharmacology. Drug treatments; Placebos; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Reinforcement; Reinforcement (Psychology); Self Administration - psychology; Self-administration; Self-medication; Treatment Outcome; Alprazolam; Self-administration; Panic; Reinforcement; Anxiety; Self-medication; Benzodiazepines; Human; Chemotherapy; Treatment; Tranquillizer; Generalized anxiety disorder; Psychotropic; Anxiety disorder; Benzodiazepine derivatives; Self administration
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/S0376-8716(97)01354-9

The reinforcing effects of alprazolam were investigated in 14 patients who had generalized anxiety or panic disorder, but were not current users/abusers of other psychoactive substances. Using a double-blind outpatient choice procedure, color-coded alprazolam (0.5 mg) and placebo capsules were provided to patients for use ‘as needed’ in the treatment of anxiety symptoms. Comparisons of alprazolam and placebo during a 2 week sampling period in which placebo and alprazolam were available sequentially revealed no significant differences on measures of medication usage or anxiety levels, although alprazolam did increase subjective ratings of drug effects/side effects. During a 4 week choice period, alprazolam was strongly preferred over placebo in 11 out of 14 patients indicating that alprazolam functioned as a reinforcer. Medication usage ranged from zero to 4.0 mg alprazolam in a day. Variations in daily medication-use were positively correlated with anxiety level fluctuations for a majority of patients. For a majority of patients, the results indicate that alprazolam functioned as a reinforcer without accompanying signs of abuse or addiction.