This application seeks four years of continued funding to expand our research and development of a novel procedure to examine the self-medication behavior of outpatients with anxiety disorder. Whereas benzodiazepines remain one of the most effective medications for anxiety, fears regarding risks of prescription drug dependence often prevent their rational use. Seven experiments will employ a drug vs. placebo choice paradigm to expand our knowledge of risk factors for addictive behavior in therapeutic populations self-medicating with benzodiazepines. This will be achieved by examining different procedures, drugs, doses, and patient populations than have been studied previously; and doing so in a way permitting examination of the demographic, psychological, and psychiatric variables that predict individual and population differences in medication use behavior. Specifically, we will: 1) expand the database on self-medication behavior in anxious patients without drug abuse or significant medication use histories by examining varying doses of alprazolam or other benzodiazepines (clonazepam and oxazepam) having minimal potentials for abuse; 2) further develop the procedure by examining self-medication behavior involving regular divided daily dosing patterns rather than irregular usage """"""""as needed;"""""""" 3) utilize the procedures to examine a great range of patient populations so as to expand the generality of findings; 4) better characterize factors increasing risks of benzodiazepine dependence, and 5) further examine the effectiveness of cognitive behavior therapy to lessen the need for medication and its attendant risks. This research is important to NIDA because of its development of a procedure to study issues regarding prescription drug dependence. Moreover, it provides basic data regarding distinctions between self-medication and addictive behavior and increases our understanding of the role of psychotherapy in the treatment of co-morbid psychiatric disorders to affect change in drug taking behavior.
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