To the Editor.—
The article by Schenck et al1 made no mention of alcohol or other drug abuse in their sample of patients with sleep behavior disorder. Response to clonazepam in these patients is consistent with possible alcohol-sedative abuse. This symptom, often reported by alcohol and other drug abusers and by their families, usually resolves with abstinence and recovery from substance abuse in such patients. Future investigators of this phenomenon should consider data collection for substance abuse disorders (eg, via γ-glutamyltransferase assays, urine drug screens, the Michigan Alcoholism Screening Test, and collateral sources). For patients with sleep behavior disorder who engage in substance abuse, it is important that treatment be primary whenever possible (ie, recovery from substance abuse), especially when symptomatic therapy (eg, benzodiazepines) may exacerbate the primary condition.
Westermeyer J. Alcohol and Other Drug Abuse and Sleep Behavior Disorder. JAMA. 1987;258(3):323. doi:10.1001/jama.1987.03400030039016