[Epidemiology of the use of anxiolytic and hypnotic drugs in France and in the world].

A higher anxiolytic and hypnotic consumption has been evidenced in France by recent international and national surveys. In an effort to counteract this pattern French Health authorities have enforced limitation to the prescription of these drugs. Understanding the causes of this overuse needs a careful analysis of the pattern of use of this medicine but also of the associated morbidity factors. In the last ten years several studies have attempted to address these issues. In the general population there were 25 to 30% of occasional or regular users with between 5 and 7% chronic users making french anxiolytic users two to three time superior to most industrialised countries. This high level of consumption is not the privilege of anxiolytic since the same pattern of use is observed for all medicine. Studies in primary care, in medical inpatients and psychiatric inpatients show as expected that anxiolytic use increase with the psychiatric morbidity and also with somatic disorder. The main risk factors for anxiolytic use are female sex, old age and psychic and somatic morbidity. Age seems to play a major role in subjects over 65: 17% are chronic users. Multiple factors might play a role in benzodiazepine use as medical care system, physician type of practice, cultural specific aspects but no proper simple explanation is available to explain the mechanism of the french high anxiolytic use. Given the poor global recognition of mental disorder observed in most countries it is suggested to privilege primary care physician training in psychiatry to optimize psychotropic drug use.