Sedative, hypnotics, or anxiolytic use disorder is a misuse of sedative, hypnotics, or anxiolytic substances. Sedatives, 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 sedatives, hypnotics, or anxiolytics include valium, Ativan, Ambien, sleep aids, barbiturates, etc.

Sedatives, 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., glutethimide, methaqualone). This class of substances includes all prescription sleeping medications and almost all anti-anxiety medications. These substances are used for physical and psychological medical conditions. Sedatives, 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 sedatives, hypnotics, or anxiolytics.

Sedative, Hypnotic, or Anxiolytic Use Disorder Causes

There can be several causes of sedative, hypnotics, or anxiolytic use disorder. Various factors like temperament, environment, genetics, and physiology can all impact how taking sedatives, hypnotics, or anxiolytics affects the body and behavior. For certain people taking sedatives, 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 sedatives, hypnotics, or anxiolytics are all pharmaceuticals, a key risk factor relates to the 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

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

Sedatives, Hypnotics, or Anxiolytic Intoxication:

A. Recent use of a 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:

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.

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 disorders 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.

Types of Sedatives, 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 recognize 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 sedatives, hypnotics, or anxiolytics’ 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 sedatives, hypnotics, or anxiolytics may impact discontinued use of sedatives, hypnotics, or anxiolytics. 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 the sedative, hypnotics, or anxiolytic use disorder.

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 the use of self-help manuals. In therapy or counseling, it may help individuals better understand their problem with sedatives, hypnotics, or anxiolytics 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 sedatives, hypnotics, or anxiolytic use problems 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 that resemble sedative, hypnotics, or anxiolytic use disorder but would not meet the 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 the 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