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SEDATIVE HYPNOTIC USE DISORDER

SEDATIVE HYPNOTIC USE DISORDER

Our Experience

Our experience with sedative-hypnotic disorder is that it is a severely debilitating disorder. This is because many benzodiazepines are highly addictive and people can become dependent on these medications relatively quickly if they are not taken by prescription. It is also noteworthy that these substances often have high comorbidity with generalized anxiety disorder (GAD) and insomnia.

WHAT IS SEDATIVE HYPNOTIC USE DISORDER?

Sedative, Hypnotic, or Anxiolytic Use Disorder is a substance use disorder characterized by repeated use of substances including benzodiazepines, benzodiazepine-like drugs (e.g., zolpidem, zaleplon), carbamates (e.g., glutethimide, meprobamate), barbiturates (e.g., phenobarbital, secobarbital), and barbiturate-like hypnotics (e.g., glutethimide, methaqualone) despite significant problems associated with their use. This class also includes all prescription sleeping medications and almost all prescription anti-anxiety medications.

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The development of this disorder typically follows one of two trajectories:

  1. Early age of onset: This occurs during the teenage years to mid-20s when the use of the substance is associated with other substances and social use (e.g., at parties).

  2. Prescription-related: Less common but equally important, an individual may be given a prescription from a physician, usually for anxiety, insomnia, or somatic complaints. In these cases, the individual may develop tolerance or a need for higher doses of the medication, resulting in a gradual increase in the dose and frequency of self-administration. Some individuals may even seek multiple physicians to prescribe supplies of the medication.

 

The prognosis for individuals with this disorder can be severe. Similar to alcohol, significant tolerance and withdrawal can develop to substances in this class. As users take more substance to achieve the same euphoria or desired effect, there can be a sudden onset of respiratory depression and hypotension, which can cause death.

 

The social and functional consequences of a sedative, hypnotic, or anxiolytic use disorder are similar to those of alcohol use disorder. Additionally, significant use of substances in this class can lead to a substance-induced depressive disorder, which in severe cases can result in suicide attempts and deaths.

 

The risk for acute and chronic toxic effects (e.g., cognition, memory, falls, confusion) of these substances increases with age. Misuse of substances in this class may also be comorbid with other substances (e.g., alcohol, cannabis, opioid, and stimulant use disorders).

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Treatment for this disorder often involves medical detoxification and psychotherapy. It’s crucial to address the misuse of these substances promptly to prevent serious health complications.

WHAT ARE THE SYMPTOMS OF SEDATIVE HYPNOTIC USE DISORDER?

Dependence on sedative, hypnotic, or anxiolytic drugs can have significant effects on a person’s well-being. Here are the symptoms associated with this type of dependence:

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  1. Craving for the Drug: Individuals experience an intense desire or urge to use the drug. Despite attempts to reduce or quit, the craving persists.​

  2. Physical Dependence: When someone becomes physically dependent on these drugs, they develop withdrawal symptoms when they stop taking them. These symptoms can include tremors, sweating, anxiety, and other discomforts.​

  3. Continued Need: Despite negative consequences related to drug use (such as impaired relationships, psychological issues, or physical health problems), the person continues to feel a need for the drug.

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WHAT ARE BENZODIAZEPINES?

Benzodiazepines, commonly referred to as “benzos,” belong to a class of agents that affect the central nervous system and are used for various medical conditions. These medications act on specific receptors in the brain known as gamma-aminobutyric acid-A (GABA-A) receptors. By attaching to these receptors, benzodiazepines make the nerves in the brain less sensitive to stimulation, resulting in a calming effect.

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Here are some key points about benzodiazepines:

  1. Uses: Benzodiazepines may be prescribed for the following purposes:

  2. Variety: Different benzodiazepines have varying properties. Some are more potent or have longer durations of action than others. Here are a few common benzodiazepines available in the U.S.:

  3. Safety: When taken as prescribed by a doctor and for short periods (such as the day of surgery or for less than two weeks to aid sleep), benzodiazepines are considered safe. However, they are classified as DEA scheduled IV controlled substances, which means they have the potential for abuse, addiction, and diversion 

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EFFECTS OF BENZODIAZEPINES

Benzodiazepines, a class of medications commonly used to manage anxiety and sleep disorders, indeed come with a range of potential side effects. Let’s delve into these effects:

  1. Slowed Reaction Times: Benzodiazepines can impair cognitive processing speed, leading to delayed responses.

  2. Loss of Motor Control: These drugs may affect coordination and fine motor skills, resulting in clumsiness or unsteadiness.

  3. Slurred Speech: Benzodiazepines can cause speech difficulties, making words sound muddled or unclear.

  4. Dizziness: Some individuals experience dizziness or lightheadedness while taking these medications.

  5. Drowsiness: A common side effect, benzodiazepines can induce significant drowsiness.

  6. Constipation: These drugs may slow down bowel movements, leading to constipation.

  7. Memory Problems: Benzodiazepines can impact memory and concentration, especially at higher doses.

  8. Restlessness: Paradoxically, some people may experience restlessness or agitation.

  9. Delirium: In susceptible individuals, benzodiazepines can contribute to delirium, characterized by confusion and altered perception.

  10. Aggression: Although rare, aggressive behavior has been reported in some cases.

  11. Depression: Prolonged use of benzodiazepines may exacerbate depressive symptoms.

  12. Hallucinations: Uncommonly, these drugs can lead to hallucinations, where individuals perceive things that aren’t present.

  13. Paranoia: Feelings of extreme suspicion or distrust may occur.

 

Additionally, benzodiazepine overdose can have severe consequences:

  1. Slurred Speech: Overdose can intensify the slurred speech associated with regular use.

  2. Confusion/Impaired Mental Status: Individuals may become disoriented, confused, or experience altered consciousness.

  3. Coma and Respiratory Depression: In large doses, benzodiazepines can depress the central nervous system, potentially leading to coma and respiratory failure.

  4. Death: When combined with other respiratory depressants (such as alcohol or opioids), benzodiazepine overdose can be fatal.

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BENZODIAZEPINE

WITHDRAWAL SYNDROME

General:

  • Headache

  • Palpitations

  • Sweating

 

Musculoskeletal:

  • Tremor and fasciculations

  • Muscle pain, stiffness, and aches (in limbs, back, neck, and jaw)

 

Neurological:

  • Dizziness and light-headedness

  • Paraesthesia (shooting pains in neck and spine)

  • Visual disturbances (blurred vision, diplopia, photophobia, vision lags behind eye movements)

  • Tinnitus

  • Faintness and dizziness, with a sense of unsteadiness

  • Confusion and disorientation (which may be intermittent) – a common cause of confusion in older patients

  • Delirium (in the absence of autonomic hyperactivity), particularly in older patients

  • Delusions and paranoia

  • Hallucinations (visual and auditory)

  • Grand mal seizures occurring 1–12 days after discontinuing benzodiazepines

 

Gastrointestinal:

  • Nausea

  • Anorexia

  • Diarrhea (which may resemble irritable bowel syndrome)

 

Psychological:

  • Rebound insomnia and nightmares

  • Anxiety and panic attacks

  • Irritability, restlessness, and agitation

  • Poor memory and concentration

  • Perceptual distortions – sensory hypersensitivity (light, sound, touch, taste) and abnormal sensations (e.g., ‘cotton wool’ sensations)

  • Metallic taste

  • Distortions of body image

  • Feelings of unreality, depersonalization, and derealization

  • Depression and dysphoria

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