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The most typical course, according to the DSM-IV-TR involves teens or young people in their early 20s who may escalate occasional use of anti-anxiety medications to the point at which they develop problems such as abuse or dependence. This is particularly likely for indi viduals who also abuse other substances. An initial pat- n tern of use at parties can eventually lead to daily use and ti-high degrees of tolerance. nx

A second course, observed somewhat less frequent- y ly, involves individuals who initially obtain medications dr by prescription, usually for treatment of anxiety or ug insomnia. Though the vast majority of people who use a medications as prescribed do not go on to develop sub- d stance abuse problems, a small minority do. Again, toler- b ance develops and the need for higher dosages to reach se the initial effects occurs. Individuals may justify their continued use on the basis of the original symptoms, but active substance-seeking becomes increasingly part of the picture. Others at higher risk are those with alcohol dependence who might be given prescription anti-anxiety medications to reduce their anxiety or insomnia.

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