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November 5, 1982

Treatment of Anxiety

Author Affiliations

University of North Dakota School of Medicine Fargo

JAMA. 1982;248(17):2115. doi:10.1001/jama.1982.03330170023016

To the Editor.—  In a recent letter that reacted to the report by Hasday and Karch entitled "Benzodiazepine Prescribing in a Family Medicine Center" (1981;246:1321), Walter Strauser urged us to gather more data on the use of pro re nata prescriptions for benzodiazepines, since only 3.4% were prescribed in this manner (1982; 247:1936). We noted that the low rate is salutary; there is hazard in the pro re nata prescribing, as evidenced by the data gathered in substance abuse and pain treatment areas. The problem is understandable from principles of operant conditioning. Benzodiazepines are often reinforcing because they decrease aversive conditions, eg, fear and anxiety, and may also have positive reinforcing properties. They are especially powerful reinforcers because the effects are immediate. These drug effects may, therefore, reinforce intake behavior. Administering such drugs on a pro re nata schedule may tend to increase, not decrease, the frequency or intensity of