Sedative, Hypnotic, or Anxiolytic Related Use Disorder

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Sedative, Hypnotic, or Anxiolytic Use Disorder

Sedative, hypnotics, or anxiolytic use disorder is a misuse of sedative, hypnotics, or anxiolytic substances. Sedative, hypnotics, or anxiolytics can be obtained legally and illegally. The addiction of these substances 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. Sedative, hypnotics, or anxiolytic  dependence causes withdrawal symptoms, which makes it difficult to stop taking them, consequently developing an addiction. Commonly abused sedative, hypnotics, or anxiolytic include valium, ativan, ambien, sleep aids, barbiturates, etc. Sedative, hypnotics, or anxiolytic use disorder can begin at any age, but problems with sedative, hypnotics, or anxiolytic use are most commonly first observed in early 20's. 

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Sedative, Hypnotic, or Anxiolytic Use Disorder Defined

Sedative, hypnotics, or anxiolytic use disorder includes signs and symptoms that reflect compulsive, prolonged self-administration of sedative, hypnotics, or anxiolytic substances that are used for no legitimate medical purpose. Sedative, hypnotics, or anxiolytic substances include benzodiazepines, benzodiazepine like drugs (e.g., zolpidem, zaleplon), carbamates (e.g., gluethimide, methaqualone). This class of substances include all prescription sleeping medications and almost all anti anxiety medications. These substance are used for physical and psychological medical conditions. Sedative, hypnotics, or anxiolytics reduce arousal and stimulation in various areas of the brain. As a result, the user may experience a sense of calm or sedation, sleep, respiratory depression, or coma. Prolonged use of these medications can be addictive for some people and deadly at high doses. These medications have also been linked to problems with depression and memory. Sedative, hypnotics, or anxiolytic use disorder severity is specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met. While it can range from mild to severe, even a mild disorder can escalate and lead to serious problems, so early treatment is important. Very significant levels of tolerance and withdrawal can develop using sedative, hypnotics, or anxiolytic.

Different Types:

There are not separate types of sedative, hypnotics, or anxiolytic use disorders, but there are levels of severity. These levels are based on which criteria is met, which is listed under symptoms.

Mild: Presence of 2-3 symptoms.

Moderate: Presence of 4-5 symptoms.

Severe: Presence of 6 or more symptoms.

Sedative, Hypnotic, or Anxiolytic Use Disorder Causes:

There can be several causes to sedative, hypnotics, or anxiolytic use disorder. Various factors like temperament, environment, genetics, and physiology can all impact how taking sedative, hypnotics, or anxiolytic affects the body and behavior. For certain people taking sedative, hypnotics, or anxiolytic s has a different and stronger impact that can lead to sedative, hypnotics, or anxiolytic use disorder that it may not have on others. Since sedative, hypnotics, or anxiolytics are all pharmaceuticals, a key risk factor relates to availability of the substances. Many individuals with sedative, hypnotic, or anxiolytic use disorder have genetic behavioral disinhibition (a highly heritable tendency towards impulsivity, novelty-seeking, dangerous risk-taking and rule-breaking).

Sedative, Hypnotic, or Anxiolytic Use Disorder Symptoms:

To be diagnosed with an sedative, hypnotics, or anxiolytic related disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A problematic pattern of sedative, hypnotics, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

    1. Sedative, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended.
    2. There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotics, or anxiolytic use.
    3. A great deal of time is spent in activities necessary to obtain the sedative, hypnotics, or anxiolytic, use the sedative, hypnotics, or anxiolytic, or recover from its effects.
    4. Craving, or a strong desire or urge to use sedative, hypnotics, or anxiolytics.
    5. Recurrent sedative, hypnotics, or anxiolytic use, resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work to 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).
    6. Continued sedative, hypnotics, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedative, hypnotics, or anxiolytics (e.g., arguments with a spouse about consequences of intoxication; physical fights).
    7. Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotics, or anxiolytic use.
    8. Recurrent sedative, hypnotics, 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).
    9. Continued sedative, hypnotics, or anxiolytic use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substances.
    10. Tolerance, as defined by either of the following:
      • A. A need for markedly increased amounts of sedative, hypnotics, or anxiolytics to achieve intoxication or desired effect.
      • B. A markedly diminished effect with continued use of the same amount of sedative, hypnotics, or anxiolytics.
    11. Withdrawal, as manifested by either of the following:
      • A. The characteristic withdrawal syndrome for sedative, hypnotics, or anxiolytics.
      • B. Sedative, hypnotics, or anxiolytic (or a closely related substance, such as alcohol) is taken to relieve or avoid withdrawal symptoms.

Symptoms of Sedative, hypnotics, or anxiolytic use disorder can include:

  • Craving
  • Sweating
  • Euphoria or general discontent
  • Chronic constipation
  • Small pupils
  • Nausea
  • Reduced sex drive
  • Sensitivity to pain
  • Shallow breathing or slurred speech

If you are taking sedative, hypnotics, or anxiolytics solely under appropriate medical supervision, an individual does not meet this criteria. Sedative, hypnotics, or anxiolytic withdrawal causes brief, but severe, episodes of depression that can lead to suicide attempts and completed suicide. Accidental Sedative, hypnotics, or anxiolytic overdose is common, and should not be mistaken for a suicide attempt. Sedative, hypnotics, or anxiolytic use disorder can include periods of Sedative, hypnotics, or anxiolytic intoxication and symptoms of withdrawal.

Sedative, Hypnotics, or Anxiolytic Intoxication:

To be diagnosed with sedative, hypnotics, or anxiolytic intoxication, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A.Recent use of an sedative, hypnotics, or anxiolytic.
B.Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, sedative, hypnotics, or anxiolytic use.
C.One (or more) of the following signs or symptoms developing during, or shortly after, sedative, hypnotics, or anxiolytic use:

  1. Slurred speech.
  2. Incoordination.
  3. Unsteady gait.
  4. Nystagmus.
  5. Impairment in cognition (e.g., memory, attention).
  6. Coma or stupor.

D. The signs or symptoms are not attributable to another medical conditioning are not better explained by another mental disorder, including intoxication with another substance.

Sedative, Hypnotics, or Anxiolytic withdrawal:

To be diagnosed with sedative, hypnotics, or anxiolytic withdrawal, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Cessation of (or reduction in) sedative, hypnotics, or anxiolytic use that has been prolonged.

B. Two (or more) of the following, developing within several hours or a few days after the cessation of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A:

      1. Hand tremor.
      2. Autonomic hyperactivity (e.g, sweating or pulse rate greater than 100 bpm).
      3. Insomnia.
      4. Nausea or vomiting.
      5. Anxiety.
      6. Psychomotor agitation.
      7. Grand mal seizures.
      8. Transient visual, tactile, or auditory hallucinations or illusions.

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that is assumed or known to struggle with sedative, hypnotics, or anxiolytic use disorder. Many people with sedative, hypnotics, or anxiolytic use disorder hesitate to get treatment because they don't recognize they have a problem, so approaching them to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need professional help. If concerned about someone who may have a sedative, hypnotics, or anxiolytic use disorder, ask a professional experienced in drug addiction treatment for advice on how to approach that person. Do not force someone to seek professional care, but always offer support and encouragement. Even though prevention of a loved one from developing a sedative, hypnotics, or anxiolytic use disorder, talking with them about treatment options is important. For more information visit: https://www.samhsa.gov.

Types of Sedative, Hypnotics, or Anxiolytic Use Disorder Treatment:

The effectiveness of treatment for this disorder is unknown because there are no randomized controlled trials. The first step in treatment is being able to recognizing there is a sedative, hypnotics, or anxiolytic use problem, which can be difficult for most individuals. A key part of recovery for sedative, hypnotics, or anxiolytic use disorder is continued support. To stop taking sedative, hypnotics, or anxiolytic’s necessary lifestyle changes are important. Ensuring that family and friends are aware of the problem and lifestyle change to ensure the support system of friends and family. Distance from individuals that continue to take sedative, hypnotics, or anxiolytic may impact discontinued use of sedative, hypnotics, or anxiolytic. Finally, continuing to engage in other healthy habits is necessary for treatment. This can include managing stress in a healthy way, good sleep habits, maintaining a schedule, or regular physical activity can make it easier to recover from sedative, hypnotics, or anxiolytic use disorder.

Detox and withdrawal
The first step in treatment is enrolling in a program to begin detoxification or detox. People with mild withdrawal symptoms require social and psychological support to help them overcome a strong urge to begin using the drug again to stop the feelings of anxiety. People with severe withdrawal symptoms usually need to be treated in a hospital, sometimes in an intensive care unit, and be closely monitored. They are given low doses of the drug intravenously. Sometimes another similar drug that is easier to gradually withdraw is substituted. Even with the best treatment, people may not feel normal for a month or more.

Psychotherapy
Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, triggers, etc. that may impact individuals with sedative, hypnotics, or anxiolytic use disorder. In therapy, individuals learn skills and establishing treatment plans that usually involve drug treatment specialists. It may include goal setting, behavior change techniques and use of self-help manuals. In therapy or counseling, it may help individuals better understand their problem with sedative, hypnotics, or anxiolytic and maintain continued support. Sedative, hypnotics, or anxiolytic use disorder commonly occurs along with other mental health disorders, like depression and anxiety, which can be discussed in therapy.

Self- Help Groups
There are various self-help groups that are options for individuals to attend, such as Narcotics Anonymous. Some people find that talking with others who have an sedative, hypnotics, or anxiolytic use problem may be a helpful part of treatment. Through self-help groups, individuals find a forum of peer support, gaining strength as they share their feelings, and experiences with others who are facing the same obstacles as themselves.

Differences Between Common Disorders:

There are other possible causes of that resemble sedative, hypnotics, or anxiolytic use disorder but would not meet criteria for this disorder. These are common disorders but the differences between them and sedative, hypnotics, or anxiolytic use disorder.

  • Alcohol use disorder- Sedative, hypnotics, or anxiolytic must be differentiated from alcohol use disorder.
  • Clinically appropriate use of sedative, hypnotics, or anxiolytic medications- Individuals may continue to take benzodiazepine medication according to physician’s direction for legitimate medical needs even if physiological signs of tolerance and withdrawal manifest. These individuals do not develop symptoms of sedative, hypnotics, or anxiolytic disorder because they are not preoccupied with obtaining the substance and its use does not interfere with their performance of usual social or occupational roles.

Resources:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

O’Malley, G & O’Malley, R. (2017). Anti-anxiety and Sedative Drugs - Special Subjects. Retrieved from:

https://www.merckmanuals.com/home/special-subjects/recreational-drugs-and-intoxicants/antianxiety-and-sedative-drugs

Sedative, Hypnotic, and Anxiolytic-Related Disorders. (2017). Retrieved from: www.psychologytoday.com/us/conditions/sedative-hypnotic-and-anxiolytic-related-disorders

Sedative, Hypnotic, and Anxiolytic Use Disorder. (n.d.). Retrieved from: https://www.mentalhealth.com/home/dx/sedativedependence.html

Sedative, Hypnotic, Or Anxiolytic Related Disorders. (n.d.). Retrieved from: https://www.mentalhelp.net/articles/sedative-hypnotic-or-anxiolytic-related-disorders/

Substance Use Disorders. (2014). Retrieved from: https://www.samhsa.gov/disorders/substance-use

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