Benzodiazepine dependence

Benzodiazepines are a large group of drugs that have hypnotic, sedative and anti-anxiety effects. In addition, benzodiazepines can help relax muscles and prevent seizures. Medicines from the benzodiazepine group are prescribed to eliminate physiological and psychological manifestations of anxiety. Anxiety is a complex condition accompanied by pathological manifestations of the muscles (excessive tension, twitching, convulsions), vegetative symptoms (palpitations, excessive sweating, flushing, heaviness in the stomach, etc.), alertness (sleep disorders, increased attention, anxiety ), fears and anxieties.

Benzodiazepines, from Valium (aka “Mother’s Little Helper”), millions of tablets of which were prescribed in the 1960s to housewives suffering from stress and anxiety, to Xanax, a drug used today for recreational purposes and for self-medication by adolescents, has been used for generations. put people to sleep and often harm them.

In medical practice, benzodiazepines are used, the action of which is aimed at the following conditions:

  • Epilepsy.
  • Insomnia and other sleep disorders.
  • Anxiety and fears.
  • Muscle spasms.

The mechanism of action of benzodiazepines is such that they are often used to treat drug addicts who have used:

  • Opiates.
  • Amphetamines.
  • Hallucinogenic drugs.

Benzodiazepines are also used to reduce anxiety. It is worth noting that medicines of this group are used for drug addiction, although they themselves have a narcotic effect. Addicted people use drugs not for treatment, but to get euphoria and high from taking.

Benzodiazepine abuse – dependence on sleeping pills, sedatives and anti-anxiety drugs from the benzodiazepine group. It occurs quite often due to the widespread prevalence of benzodiazepines. It can occur both when uncontrolled use for the purpose of obtaining pleasure, and when taken for medical reasons. Symptoms resemble alcohol intoxication, disorientation, poor coordination, talkativeness, slurred speech, and decreased muscle tone. With constant long-term use, addiction may develop.

 

Dependence on benzodiazepines

Even using the drug for medicinal purposes, you can provide yourself with addiction. Moreover, benzodiazepine dependence is mental and physical. To avoid such an outcome, you should strictly adhere to the doctor’s prescription.

Taking too much of the medication can lead to overdose. Its symptoms are:

  • dilated pupils;
  • weakening of the pulse;
  • profuse sweating;
  • confusion of consciousness;
  • weak breathing.

In advanced situations, the patient may fall into a coma. If these symptoms appear, you need to call an ambulance. He provides treatment for addiction in specialized institutions. Qualified doctors will prescribe the appropriate therapy. Usually it includes a set of activities.

Benzodiazepines are addictive quickly, and if the patient abuses such pills, the symptoms will be as follows:

  • Failures in speech, it becomes incomprehensible.
  • Loss in space and time.
  • Dizziness.
  • Drowsiness.
  • Concentration failures.
  • Decreased appetite.
  • Nausea.
  • Visual impairment.
  • In rare cases, convulsions.
  • Rave.
  • Nightmares while sleeping.

 

Drug addiction

Drug dependence on medications is characterized by the following features:

  • Constant and irresistible attraction to medicine.
  • Inability to control the drug intake.
  • Decrease in the body’s sensitivity to the drug (tolerance), the need to take it in increasing doses to achieve the same effect.

The onset of a painful condition when the drug is discontinued. Disregard for the negative consequences of taking the drug.

The likelihood of developing dependence on benzodiazepines exists even with the recommended doses, but over a long period. Studies have shown that drugs of this series provoke the development of mental and physical dependence. Withdrawal is usually more unpleasant and lasts longer than withdrawal from drugs.

The dependence in patients develops approximately 4-6 months after taking therapeutic doses of the drug. But few of the patients become drug addicts if they do not have the goal of enjoying the use of the drug.

People who use higher doses of benzodiazepines become addicted to them within 2–3 months.

Cancellation of benzodiazepines should be gradual after 3 weeks of use, and with longer use, the dose should be reduced very slowly, for example, by 0.125 (1/8) doses every 2 weeks, while the entire withdrawal period may last 6-12 hours. The drug should be canceled more slowly when severe symptoms appear (minor symptoms can be stopped with beta-blockers). If a drug with a short t1 / 2 is discontinued, it can be replaced with a drug with a longer t1 / 2, such as diazepam, to reduce sudden fluctuations in plasma drug concentration. Cancellation of the last dose is especially difficult to tolerate. With a severe syndrome, withdrawal should be carried out with the parallel administration of a sedative antidepressant. Dependence may be minimal if small doses of drugs are given in short or intermittent courses. Only in exceptional cases can benzodiazepines be taken for several weeks.

The difficulty in assessing symptoms is shown in a study in which patients undergoing long-term diazepam therapy were asked to describe their condition; while they were told that the drug was canceled, in fact, in fact, the dose remained the same [Tyrer P. et al., Lancet].

The British National Pharmacology Guide recommends switching the patient to diazepam at the beginning of withdrawal and gives the following equivalents: 5 mg diazepam = 15 mg chlordiazepoxide, 0.5-1 mg loprazolam, 0.5 mg lorazepam, 0.5-1 mg lormetazepam, 5 mg nitrazepam, 15 mg oxazspam, 10 mg temazepam (250 mcg triazolam).

Withdrawal symptoms in drug addicts can develop due to sudden discontinuation of benzodiazepines. These include:

  • tides
  • rash
  • hyperhidrosis
  • muscle and head pain
  • excessive fatigue or excessive energy
  • heart palpitations
  • abdominal pain
  • gastrointestinal symptoms such as vomiting, diarrhea, constipation, decreased appetite
  • insomnia
  • hypersensitivity
  • sense of anxiety
  • irritability
  • aggression

All of these signs are most vividly manifested when using drugs and alcohol. At the same time, many patients and doctors understand by the term addiction – a painful condition as a result of drug withdrawal. This is a very important, but far from the only sign of drug dependence, which is not a specific sign only for psychotropic drugs. This condition can occur, for example, as a result of the abolition of beta-blockers in the treatment of hypertension (a sharp increase in blood pressure), increased attacks of bronchial asthma when hormones are canceled. But no one would think of calling these patients drug addicts!

 

Risk factors

Risk factors for benzodiazepine dependence are long-term use beyond four weeks, use of high doses, use of potent short-acting benzodiazepines, addicts and addiction to drug abuse. The use of short acting benzodiazepines results in repeated withdrawal effects, which are alleviated by the next dose, which reinforce the addiction in the person. Physical dependence develops more rapidly with higher potency benzodiazepines such as alprazolam (Xanax) than with lower potency benzodiazepines such as chlordiazepoxide (Librium).

The severity of the symptom is worse with the use of high doses, or with high potency benzodiazepines or short half-life. Other cross-tolerant sedative sleeping pills, such as barbiturates or alcohol, increase the risk of benzodiazepine dependence. Similar to the use of opiates for pain, the therapeutic use of benzodiazepines rarely results in substance abuse.

 

Poisoning and overdose

Benzodiazepines can lead to overdose, but when used as a monopreparation rarely cause death (no more than 3% of cases of acute poisoning). But the simultaneous use of alcohol or opiates seriously increases this probability, and this combination is very life-threatening. Also, benzidiazepine addiction is high in cocaine users, and this combination is also considered risky.

 

Treatment

Depending on the severity of symptoms, treatment can be carried out on an outpatient basis, in a narcological or psychiatric department. With a short experience of use, a one-time cancellation of the psychoactive drug is possible. With prolonged use and severe withdrawal symptoms, the drug is either canceled gradually, gradually reducing the dose, or replaced with another drug from the same group, and then the dose is also reduced. Treatment is carried out against the background of individual or group psychotherapy. Subsequently, the patient is under the supervision of a narcologist.

The prognosis for benzodiazepine dependence is quite favorable. A noticeable personality defect due to the use of drugs develops only in a small number of patients, in other cases, after the abolition of benzodiazepines, a gradual disappearance of symptoms and a complete or almost complete recovery are observed. As with other addictions, an important component of successful treatment is the patient’s willingness to stop substance abuse.

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