Sedatives, also known as sedative hypnotics, are a diverse group of medications that get their name because they produce sedation in the form of sleepiness or reduced anxiety levels. Doctors and public health officials also refer to these medications as tranquilizers. Anyone who consumes a sedative for extended periods of time (with or without a prescription) can develop a state of physical dependence. If not monitored and addressed by a physician, this dependent state can lead to sedative addiction.
What are Sedatives?
All sedatives produce their therapeutic effects by increasing brain levels of gamma-aminobutyric acid (GABA), a neurotransmitting chemical that helps limit the amount of communication between nerve cells called neurons. When GABA levels rise, activity levels inside the brain and spinal cord (i.e., the central nervous system) decline. In turn, reduced activity in the brain and spinal cord leads to reduced activity in the peripheral nervous system, which includes all nerves not located in the central nervous system. Under the influence of this general slowdown, organs throughout the body function at a decreased pace. The end result is sedation. Due to their effects on the brain and body, sedatives are also known as depressants.
There are two main groups of sedatives: barbiturates and benzodiazepines.
Pharmaceutical researchers created the first barbiturates in the 1800s, and their use as medications began in the early 1900s. In the 1950s, doctors and researchers began to realize that use of barbiturate medications comes with a serious risk for damaging side effects, up to and including accidental overdoses. Once these risks became apparent, the use of benzodiazepine sedatives began in earnest. These newer medications have the same basic therapeutic benefits as barbiturates, but come with substantially smaller chances for an overdose when taken in prescribed amounts.
Today, benzodiazepines are much more widely used than barbiturates. When they do prescribe barbiturates for their patients, doctors sometimes employ them as seizure treatments or anesthetics, not as sedatives. However, the switch from barbiturates to benzodiazepines does not indicate a complete lack of risk from benzodiazepine use. In fact, while not as potentially deadly as barbiturates, these medications can trigger overdoses and symptoms of dependence and addiction, just like their older counterparts.
The list of sedative drugs produced today includes the barbiturates phenobarbital (Luminal, Gardenal) barbital (Veronal, Malonal), pentobarbital (Nembutal), allobarbital (Dialog), cyclobarbital (Cyclodorm) and secobarbital (Seconal, Tuinal). Not all of these medications are available in the U.S. The list of benzodiazepines used to calm anxiety includes such well-known medications as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), chlordiazepoxide (Librium) and lorazepam (Ativan).
Benzodiazepine prescription sedatives used largely for their ability to produce sleepiness include triazolam (Halcion) and midazolam (Versed). Another sleep-inducing member of this medication family, flunitrazepam (Rohypnol) is outlawed in the U.S. due to its recognized role as a “date rape” drug that helps facilitate sexual assault.
Symptoms and Diagnosis of Sedative Addiction
For someone with a legitimate prescription, abuse or misuse of a sedative (or any other medication) is defined as taking that medication more often than instructed and/or in larger amounts than instructed. For a person who doesn’t hold a legitimate prescription, abuse occurs when any amount of consumption takes place. In some cases, people in both groups participate in misuse/abuse out of a desire to experience the euphoric effects produced by a barbiturate or benzodiazepine that rapidly dissolves in the bloodstream. However, in other cases, abuse is a result of a sincere (if misguided) desire to feel or increase the therapeutic benefits of sedatives as anti-anxiety medications or sleep aids.
The human brain adjusts relatively quickly to the altered GABA levels triggered by barbiturates and benzodiazepines. Within a matter of weeks or months, it will start to view the presence of these medications as an expected situation. When this brain switch occurs, the affected person may be developing sedative dependence.
Dependence differs from addiction and can appear even in people who closely follow their doctor’s instructions. When doctors recognize this state, they can manage it and prevent it from progressing to addiction. However, in a person who consumes a sedative without the proper medical oversight, addiction is an ever-present possibility.
Two of the symptoms of sedative addiction overlap with the symptoms of sedative dependence are:
- The need to take increasing amounts of a barbiturate or benzodiazepine in order to feel its effects
- The onset of withdrawal symptoms when intake of a barbiturate or benzodiazepine does not meet the brain’s established expectations
Specific withdrawal symptoms that may appear in a dependent or addicted individual include:
- An anxious mental state
- Abdominal cramping
- Convulsions (i.e., seizures)
- Appetite loss
- Disturbed sleep
- Sensory hallucinations
- Muscle tremors or weakness
- Body temperature elevation
- Blood pressure elevation
- Heart rate elevation
Additional problems found in cases where addiction is also present include an inability to set limits on the amount of barbiturate or benzodiazepine consumed on a given day, and an inability to set limits on how often medication consumption occurs on a given day.
Whether related to barbiturate use or benzodiazepine use, sedative addiction forms part of a larger condition known as sedative, hypnotic, or anxiolytic use disorder. This condition, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), also includes symptoms of non-addicted sedative abuse that are prominent enough to interfere with the ability to lead a functional life. These symptoms can include such things as:
- Establishment of sedative use as a top priority in daily life
- An unwillingness to stop taking sedatives even when intake leads to obvious problems in close, personal interactions
- Recurring use of a barbiturate or benzodiazepine in situations where this use poses a significant physical risk to self or others
In any given person, sedative, hypnotic, or anxiolytic use disorder may exclusively include symptoms of addiction or exclusively include symptoms of abuse. However, the condition’s inclusive definition was established because many affected individuals experience combined symptoms of abuse and addiction.
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Sedative overdoses occur when there is enough barbiturate or benzodiazepine in the bloodstream to depress central nervous system activity below its minimum sustainable threshold. Overdose indicators include:
- Excessive sleepiness
- An inability to think clearly
- Inadequate lung function (excessively slow, irregular, or shallow breathing)
- An inability to speak clearly
- Sensory hallucinations
- An involuntary eye movement called nystagmus
- Uncoordinated or non-responsive muscles
- Unsustainably low blood pressure
- Hypovolemic shock
- Kidney failure
Potential severe consequences of a sedative overdose can include coma and death.
Barbiturates are particularly likely to trigger an overdose. That’s true because of the relatively small difference between therapeutic doses of these medications and the amount necessary to begin shutting down the central nervous system. On their own, barbiturates also kill more often than benzodiazepines. However, in the U.S., significant numbers of people combine the use of a benzodiazepine with an opioid street drug or an opioid medication. Since opioids also depress the central nervous system, their consumption boosts overdose and fatality risks for benzodiazepine users.
Sedative Addiction Treatment and Prognosis
Effective treatment is available for people affected by sedative abuse and/or sedative addiction. The first step in the treatment process is medically supervised detoxification (detox). Anyone who rapidly halts the use of a barbiturate or benzodiazepine can develop serious or severe seizures. For this reason, sedative detox takes a gradual approach and centers on the use of controlled, diminishing doses of appropriate detox medications.
The time needed to complete detoxification is determined largely by the type of sedative responsible for producing abuse/addiction. Some barbiturates and benzodiazepines are eliminated from the bloodstream relatively quickly. On the other hand, the body takes longer to eliminate certain medications in both families of substances.
Active recovery from sedative, hypnotic, or anxiolytic use disorder often includes individual and/or group psychotherapy. Forms of therapy with demonstrated usefulness in the recovery process include:
- Motivation-based therapy
- Cognitive behavioral therapy (CBT)
Psychoeducation helps affected individuals and their families improve their knowledge of addiction-related issues. It also:
- Gives program participants a format to air their grievances
- Provides support for other phases of treatment
- Facilitates a self-empowered approach to treatment
People taking part in motivation-based therapies may be encouraged to clarify their reasons for seeking treatment. Cognitive behavioral therapy participants learn what motivated their involvement in substance abuse. In addition, they learn how to recognize and successfully cope with situations and settings that increased the odds of abuse in the past.
Only a doctor or addiction specialist can definitively determine the extent of sedative-related problems. Residential treatment is common for people moderately or severely affected by sedative abuse/addiction. That’s true, in part, because of the risks associated with the detoxification process for these individuals. People mildly affected by their condition may successfully get all the help they need from an outpatient program.
For anyone suffering from a sedative use disorder who also has co-occurring alcoholism or mental health conditions, integrated treatment in a residential setting is suggested. If programs run according to accepted principles and guidelines, the needs of the individual set the standard for treatment from the first day of enrollment to the eventual return to daily life.