Sedative-Hypnotic / BDZ Dependence

Sedative-Hypnotic / BDZ Dependence

Sedative-Hypnotic / BDZ Dependence

BDZ dependence develops with long-term use of benzodiazepines (BDZ), psychoactive drugs that act as sedatives or minor tranquilizers.

BDZs act on receptors on the central nervous system (CNS) and have calming, hypnotic, anti-anxiety, anti-seizure, and muscle relaxant properties. These effects make BDZs useful for the short-term treatment of anxiety, panic, agitation, insomnia, seizures, and muscle spasms.

BDZs are usually taken in pill form, but they can also be taken by injection, intravenously, or as a suppository.

Prevalence

According to the National Surveys on Drug Use and Health, 30.6 million adults used benzodiazepines in 2015 – 2016. Approximately twice as many women as men are prescribed BDZ. It is hypothesized that this is largely because men usually turn to alcohol to cope with struggles whereas women resort to taking prescription drugs such as BDZ.

Symptoms of dependence on sedative, hypnotic or anxiolytic drugs:

BDZ dependence is a maladaptive pattern of BDZ use leading to clinically significant impairment or distress that is manifested by three or more of the following, occurring at any time in the same 12-month period:

  • Tolerance to increasing amounts of the drug
  • Withdrawal symptoms:

    • Sleep disturbance
    • Irritability, agitation
    • Increased tension and anxiety, panic attacks, psychosis, depression, depersonalization, derealization
    • Hand tremor, shaking, seizures, muscular pain and stiffness
    • Sweating
    • Difficulty with concentration, confusion and cognitive difficulty, memory problems
    • Dry retching and nausea, weight loss
    • Palpitations
    • Headache
    • Hallucinations
  • Repeated use of BDZ to relieve or avoid withdrawal symptoms
  • Taking the substance often in larger amounts or over a longer period than was intended
  • Having a persistent desire to cut down on control substance use with unsuccessful efforts

Therapeutic dose dependence is the largest category of people dependent on BDZ. These individuals typically do not escalate their doses to high levels or abuse their medication. Smaller groups include patients escalating their dosage to higher levels and people who use BDZ recreationally.

Risk factors of dependence on sedative, hypnotic or anxiolytic drugs:

A minority of people, such as the elderly, can have disturbing reactions to BDZ such as worsened agitation or panic. When combined with other CNS depressants such as alcoholic drinks and opioids like codeine, morphine, and heroin, the potential for fatal overdose increases due to the ways they interact.

BDZ should only be taken for 2 to 4 weeks as taking it over longer periods leads to dependence, which can cause impairment of social, occupational, and academic functioning and can lead to interpersonal problems. It also carries the risk of cancer and dementia.

Treatment for dependence on Sedative, Hypnotic or Anxiolytic drugs:

Management of BDZ dependence includes medication and psychological interventions because of the high rebound and withdrawal risks of discontinuing use abruptly.

  • Medication – gradual reduction is the usual clinical course in weaning people off BDZ over a period of four weeks to even years; and withdrawal rates should be under the patient’s control. As the dose is reduced, the patient’s tolerance to the drug drops too and dependence is lessened. Sometimes the course of action is to switch the patient to a longer-acting BDZ.

    Flumazenil is the antidote of choice for BDZ toxicity. Other drugs can help ease the withdrawal symptoms of headaches, nausea, etc.

  • Psychological interventions – cognitive-behavioral therapy and group or one-on-one therapy support the patient during and after withdrawal. Aftercare is important in preventing relapse.
  • Hospitalization – inpatient or outpatient detox may be required if withdrawal symptoms are severe and/or in the case of overdose.

Symptoms of dependence on sedative, hypnotic or anxiolytic drugs:

BDZ dependence is a maladaptive pattern of BDZ use leading to clinically significant impairment or distress that is manifested by three or more of the following, occurring at any time in the same 12-month period:

  • Tolerance to increasing amounts of the drug
  • Withdrawal symptoms:

    • Sleep disturbance
    • Irritability, agitation
    • Increased tension and anxiety, panic attacks, psychosis, depression, depersonalization, derealization
    • Hand tremor, shaking, seizures, muscular pain and stiffness
    • Sweating
    • Difficulty with concentration, confusion and cognitive difficulty, memory problems
    • Dry retching and nausea, weight loss
    • Palpitations
    • Headache
    • Hallucinations
  • Repeated use of BDZ to relieve or avoid withdrawal symptoms
  • Taking the substance often in larger amounts or over a longer period than was intended
  • Having a persistent desire to cut down on control substance use with unsuccessful efforts

Therapeutic dose dependence is the largest category of people dependent on BDZ. These individuals typically do not escalate their doses to high levels or abuse their medication. Smaller groups include patients escalating their dosage to higher levels and people who use BDZ recreationally.

Risk factors of dependence on sedative, hypnotic or anxiolytic drugs:

A minority of people, such as the elderly, can have disturbing reactions to BDZ such as worsened agitation or panic. When combined with other CNS depressants such as alcoholic drinks and opioids like codeine, morphine, and heroin, the potential for fatal overdose increases due to the ways they interact.

BDZ should only be taken for 2 to 4 weeks as taking it over longer periods leads to dependence, which can cause impairment of social, occupational, and academic functioning and can lead to interpersonal problems. It also carries the risk of cancer and dementia.

Treatment for dependence on Sedative, Hypnotic or Anxiolytic drugs:

Management of BDZ dependence includes medication and psychological interventions because of the high rebound and withdrawal risks of discontinuing use abruptly.

  • Medication – gradual reduction is the usual clinical course in weaning people off BDZ over a period of four weeks to even years; and withdrawal rates should be under the patient’s control. As the dose is reduced, the patient’s tolerance to the drug drops too and dependence is lessened. Sometimes the course of action is to switch the patient to a longer-acting BDZ.

    Flumazenil is the antidote of choice for BDZ toxicity. Other drugs can help ease the withdrawal symptoms of headaches, nausea, etc.

  • Psychological interventions – cognitive-behavioral therapy and group or one-on-one therapy support the patient during and after withdrawal. Aftercare is important in preventing relapse.
  • Hospitalization – inpatient or outpatient detox may be required if withdrawal symptoms are severe and/or in the case of overdose.
Sources NIH – Benzodiazepine Dependence Treatment | OPUSTREATMENT – Benzodiazepine Addiction: Dangers | Withdrawal | Treatment | DRUGREHAB – Benzodiazepine Addiction