Prescription drug abuse.

Misuse and abuse of prescription medication can be a difficult clinical area for physicians. Prior to prescribing any mood-altering medication, the physician should screen for patients at risk for abuse by asking about an individual or family history of alcohol or other drug abuse. When prescribing a psychoactive medication, the clinician should be sure that there is a clear clinical indication and should identify a therapeutic end-point and time limit. Nonpharmacologic interventions should be emphasized when appropriate. When misuse rather than abuse is suspected, the intervention may be one of education and simplification or clarification of the therapeutic contract. Physicians should recognize apparent drug-seeking behaviors and feel comfortable questioning for possible alcohol or other drug-related problems so that drug abuse can be identified as an additional problem requiring attention. Physicians should be comfortable with assertively denying drugs to drug-seeking patients when appropriate. Although sometimes difficult, to do otherwise would be to facilitate the continuation of a potentially serious problem. The potential frustration and aggravation of dealing with prescription drug abuse can be minimized by thoughtful attention to prevention, the development of a rational style of prescribing, and the appropriate use of intervention.