Sage Prairie

Sedative/Benzo Use Disorder

Sedative or Benzodiazepine Use

What is considered Sedative Use Disorder?

Sedative-hypnotic drugs, and anti-anxiety drugs slow down the activity of the brain. Benzodiazepines (Ativan, Halcion, Librium, Valium, Xanax, and Rohypnol) are the best known drugs in this category. Prior to use of anti-anxiety drugs, barbiturates (Amytal, Nembutal, Seconal, and phenobarbital) were used commonly for similar purposes. 

Other drugs in this group include chloral hydrate (which when mixed with alcohol was once known as “knockout drops” or a “Mickey Finn”), glutethimide, methaqualone (Quaalude, Sopor, “ludes”) and meprobamate (Equanil, Miltown and other brand names). Regular use of these drugs often lead to “drug tolerance.” That is, the body adjusts to them and it takes a higher and higher dose to achieve the desired effect. Dependence also can develop, meaning withdrawal symptoms will occur if the drug is suddenly stopped.

Many of these drugs have legitimate uses. Benzodiazepines are a good treatment for anxiety and are also useful in sleep disorders. Barbiturates are used to treat seizures and for anesthesia during major surgery.

• A craving for the drug, often with unsuccessful attempts to cut down on its use
• Physical dependence (development of physical withdrawal symptoms when a person stops taking the depressant)
• A continued need to take the drug despite drug-related psychological, interpersonal or physical problems 

There is no absolute dose or number of pills per day that indicates a person is dependent on sedative, hypnotic or anxiolytic drugs. People with dependence eventually develop physical tolerance (the gradual need for greater amounts of the drug to feel the same effects). Addiction to these medication implies that the person is also craving the drug’s effect or relying on the drug for a reason other than the intended therapeutic uses of the drug.

A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:
• Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use.
• A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects.
• Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic.
• Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g. – repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic-, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household).
• Continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g. -arguments with a spouse about consequences of intoxication; physical fights).
• Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use.
• Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g. – driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use).
• Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic.
• Tolerance, as defined by either of the following;
– A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve
intoxication or desired effect.
– A markedly diminished effect with continued use of the same amount of the sedative, hypnotic,
or anxiolytic.
• Withdrawal, as manifested by either of the following:
– The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal).
– Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as alcohol) are taken to relieve or avoid withdrawal symptoms.

Tolerance is not considered for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.

• Gender (women are more likely than men are to use sedatives)
• Availability of sedatives.
• Early exposure to sedative abuse.
• Family history of substance abuse.
• Alcohol use disorder.
• Novelty seeking.
• Impulsivity.
• Associating with individuals who use or abuse sedatives.

Similar to alcohol, sedative, hypnotic or anxiolytic drugs can cause severe symptoms during intoxication. These symptoms can include slurred speech, problems with coordination or walking, inattention, and memory difficulties. In extreme cases, the person may lapse into a stupor or coma.

• Cognitive impairment. Benzodiazepines cause acute adverse effects: drowsiness, increased reaction time, ataxia, motor incoordination, and anterograde amnesia. Additionally, a meta-analysis of studies looking at withdrawal from an average of 17 mg per day of diazepam (Valium) found that long-term use led to substantial cognitive decline that did not resolve three months after
• Motor vehicle crashes. The risk of driving while on benzodiazepines is about the same as the risk of driving with a blood alcohol level between 0.050% and 0.079% (an alcohol level greater than 0.08% is illegal in all states).
• Hip fracture. Benzodiazepines increase the risk of hip fracture in older persons by at least 50%.In a study of 43,343 persons, zolpidem increased the risk of hip fracture by 2.55 times in those older than 65 years.

The first goal of treatment is detoxification (withdrawal from the drug). Detoxification usually involves gradually reducing the dose of the drug or temporarily substituting a medication that has less serious withdrawal symptoms. The substitute medication, if used, also will be reduced gradually. Depending on the severity of the drug dependence and other factors (significant heart or lung disease, liver failure, high blood pressure, a person’s age and general health status), detoxification may need to take place in the hospital. 

All addictions are complex and have multiple causes. A drug use disorder is usually not an isolated problem. Commonly, people with sedative, hypnotic or anxiolytic drug addictions are also struggling with other mental disorders, such as anxiety or depression. Thus, treatment is best tailored to the multiple needs of the individual. This should begin with a comprehensive evaluation (medical, psychological and social) to identify the variety of troubles that are fueling the drug use. 

Counseling, behavioral therapies, and group programs (such as 12-step or rational recovery) can help a person address the addiction. Medications or psychotherapy can address craving or habits that could lead to relapse. They also are helpful for other symptoms or problems that are discovered in the course of evaluation and treatment.

These include 12-step groups, SMART recovery, Al-Anon Family groups, All Recovery groups, and others. Sage Prairie also has developed a partnership with local Recovery Community Organizations to offer other peer services. These programs are designed to offer participants active help and support for one another in their recovery

Sage Prairie has partnered with Recovery Properties to offer patient housing. In the housing, there are only current and former Sage Prairie patients. This helps patients to develop a community, which is supportive of recovery. 

Financial Assistance
A major barrier to recovery can be access to care. Sage Prairie has partnered with navigators to assist individuals to fund treatment and access other financial services available through Federal, State and local programs and scholarships. 

Physical Health
Patients are given a healthy meal each treatment day. Patients living in housing are offered a free local gym membership to improve their physical health.

Prior to the early 1800’s, alcohol and opium were the only drugs available that had sedative effects. The first substance introduced as a sedative/hypnotic was a liquid solution of bromide salts in the 1800s. Chloral hydrate, a derivative of ethyl alcohol, the second substance was introduced in 1869 as a synthetic sedative-hypnotic, used as “knock-out” drops. The third substance, Paraldehyde, was introduced into medicine in the 1880s and was closely followed by barbital in 1903. 

Phenobarbital became available in 1912 and was followed, during the next 20 years, by a long series of other barbiturates. Barbiturates were primarily used as sleeping pills during this time. However, they were also were used to reduce voluntary inhibition during psychiatric procedures. Among the most commonly prescribed were phenobarbital, secobarbital (Seconal), amobarbital (Amytal), and
pentobarbital (Nembutal). When individuals would take high-enough doses, these medications produce a deep unconsciousness that makes them useful as general anesthetics. In higher doses they depress the central nervous and respiratory systems to the point of coma, respiratory failure, and death. 

Early research found that prolonged use of barbiturates, for relief of insomnia, leads to tolerance, withdrawal and dependence. Symptoms included restlessness, anxiety, weakness, insomnia, nausea, and convulsions. Analysis of electroencephalographic (EEG) showed that some of these drugs produces sleep disruption. 

Not until the mid-20th century were new types of sedative-hypnotic, benzodiazepines, were introduced. Barbiturate use declined because benzodiazepines were found to be more effective in relieving anxiety than in inducing sleep, but they were superior to barbiturates because of the reduced dangers they present of tolerance and addiction and because they are much less likely to injuriously depress the central nervous system when used at high doses. They were also found to require a much smaller dosage than barbiturates to achieve their effects. 

The benzodiazepines include chlordiazepoxide (Librium), diazepam (Valium), alprazolam (Xanax), oxazepam (Serax), and triazolam
(Halcion). These were intended only for short- or medium-term use, since the body does develop a tolerance to them and withdrawal symptoms (anxiety, restlessness, and so on) develop even in those who have used the drugs for only four to six weeks. The benzodiazepines are thought to accomplish their effect within the brain by facilitating the action of the neurotransmitter gamma-aminobutyric acid, which is known to inhibit anxiety.