I think in the real and present world a considerable amount of prescription drug abuse/addiction occurs and no one really has a good handle on it because there is no good agreement on who needs meds and who does not (and there is not likely ever to be good agreement on it). In the late 1800's early 1900's cocaine was considered relatively harmless and was in many OTC patent medicines. I guess I think in the year 2002 I think there is more habituation to anti-anxiety agents (valium, librium etc) and some of the habituating psychotropics. www.nida.nih.gov
did a Research Report on this very topic.
I think many people become accustomed to medicating uncomfortable feelings instead of working through them (...with either alcohol or psychotropics). Working through them is not quick, can be uncomfortable and carries no guarantee of success. Like you, I would never want to be construed as saying no one ever needs a psychotropic, but they can short circuit the working through process. I guess I also believe that they can be used effectively in conjunction with talk therapy to allow people to calm down sufficiently to think or talk about the uncomfortable idea and they may help folks cope until such time as they are ready to doing the working through process, but for a certain number of people, they come to substitute for working through. But, like most nurses, I grew tired of fighting constantly with clients who were accustomed to taking horse sized doses of medicines and wanted us to be their "candy man" in the hospital.
In my work in drug prevention in the school I have come to accept that most people are not going to change their substance abuse/addiction patterns in response to the first (or maybe even second, third or fourth) person who voices a concern about their chemical use. But there has to be a first person who gently and lovingly says, "Gee, I am worried about this." To be effective, confrontation has to come from someone they care about and that is why nurse confrontation may or may not be effective. (Some times people respond to a "concerned" authority figure.)
When I confront kids about chemical use, unless they've been caught red handed (smoking pot in school or drunk at a school event), I am very plain with them that I don't "know them well enough" to say that drugs are a problem and I spend a lot of time relationship building with them and trying to find out about their function in as many other domains as possible (academics, attendance, behavior, legal, getting along with family). Many times parents are very enabling of their teens chemical use and getting them to state their concerns can be hard (they may be in considerable denial). Sometimes parents are chemical abusers too and to be concerned about their kid would mean they have to look at their own usage, too. They don't want to. Helping a patient admit to concern about their chemical use will be very difficult unless a family member is willing to get on board and say they are worried, too.
Though I have only been in this field about 3 1/2 years, addictions has kind of grabbed me; it's interesting.