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Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Sedatives, Hypnotics, or Anxiolytics Use Disorder

The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to sedative-, hypnotic-, or anxiolytic use disorders.

pills spilling from bottleSedatives, hypnotics, and anxiolytics (SHA) substances include several drug types. These are:

1.1) Anxiolytics (anti-anxiety) drugs such as benzodiazepines (e.g., Valium, Librium, Ativan, Klonopin, Rohypnol);
2.2) Barbiturates (e.g., Amytal, Nembutal, Seconal, Phenobarbital);
3.3) Other antianxiety and sleeping medications.

These drugs act as central nervous system depressants (like alcohol). For this reason, they are deadly when taken at high doses. They are also fatal at lower doses when combined with alcohol. The SHAs may be overused by people of any age group. Females are at higher risk than males for abusing prescription drugs in this class.

These substances often lead to tolerance and withdrawal. The public is aware of the lethality of these drugs because of the premature deaths of many famous people. Marilynn Monroe, Judy Garland, Hank Williams, Heath Ledger, and Michael Jackson were all victims of these drugs.

SHA addiction often occurs together with other drugs of abuse. This usually reflects an effort to counteract the effects of those other drugs. For example, people may abuse benzodiazepines to help them "come down" from the high of cocaine.

Sedatives, Hypnotics or Anxiolytics Withdrawal

SHA withdrawal occurs after the abrupt cessation (or significant reduction) of prolonged use. SHA withdrawal may be particularly uncomfortable and quite dangerous. In general, long-term use, at higher doses, leads to more intense withdrawal. However, even at low doses of certain drugs, withdrawal symptoms have been reported.

The speed and severity of withdrawal largely depends on the half-life of the drug. The half-life of a drug refers to how quickly your body can clear the drug from your system. Drugs that remain in your system a long time have a long half-life. These are called long-acting drugs. Drugs are cleared fairly quickly have a short half-life. These drugs are called short-acting drugs. For short-acting drugs (e.g. lorazepam), withdrawal symptoms begin within 6-8 hours and typically last about a week. For long-acting drugs (e.g. diazepam), withdrawal symptoms may not be evident for a week. The intense withdrawal effects subside after 3-4 weeks. However, less intense symptoms may last much longer.

Withdrawal symptoms may interfere with people's ability to function well. People in withdrawal also experience physical changes. These may include sweating; increased pulse; hand tremor; insomnia; nausea/vomiting; anxiety; hallucinations; and even grand mal seizures. Consult with a medical professional before attempting to discontinue heavy and/or prolonged use of these drugs.

Effects of Sedatives, Hypnotics, or Anxiolytics: Intoxication

Sedative, Hypnotic, or Anxiolytic Intoxication is characterized by significant behavioral changes. These include aggression, mood swings, and impaired judgment. The disinhibiting effects of these drugs is similar to alcohol. This may contribute to social blunders, aggression, and even legal problems. Physical signs involve slurred speech; nystagmus; a lack of coordination; impaired memory; decreased blood pressure and pulse; and possibly coma. Serious injuries (due to falls or accidents) and overdoses (intentional or accidental) are not uncommon.