Sedatives are a class of drugs which are characterized by their tendency to induce relaxation and sleep. As such, plenty of drugs and substances can fit in this category, from alcohol to benzodiazepines. In this case, however, the word sedative will be used to refer to hypnotics which are nonbenzodiazepines, like Lunesta and Ambien. These drugs, when taken too frequently or in doses higher than prescribed can lead to addiction.
In American history, bromides were the first type of sedative which achieved widespread usage. These drugs, however, were found to build up in the body and produce dangerous toxicity. As a result, barbiturates became the go-to sedative in the early 20th century. Barbiturates had their own problems, however, as they were quickly linked with dependence, tolerance, and lethal overdoses.
Today, hypnotics are one of the most frequently prescribed drugs in the country and, while many experts will point out that they are significantly less dangerous than barbiturates and bromides, they are not without risk for dependency1.
The prevalence of past-year, non-medical use of sedatives is around 2.3%. Of these non-medical users, about 10% match the criteria for abuse and dependence. This makes sedative abuse a very common addiction in the United States.
Demographically speaking, sedative abuse is a pretty widespread issue in American society. Risk factors have been shown to include individuals who are older age, unmarried, and uneducated. Those with criminal histories also had a higher risk for sedative abuse. Women are also at a greater risk for sedative abuse than men, as are Caucasian people when compared with those of other races.
Like many other prescription drugs, the most common path to addiction is through mental health disturbances. A person may initially be diagnosed with a sleep disorder or mood disorder for which they are prescribed a sedative. After a time, the person may begin to abuse the medication by either taking it in higher quantities than medically indicated or using it after their prescription has ended2.
Many of the symptoms of sedative abuse are similar to alcohol abuse. Sedatives are fast-acting drugs which typically manifest symptoms of intoxication within 30 minutes. Like many benzodiazepines and other addictive drugs, it acts upon the areas of the brain responsible for producing and receiving the chemical GABA. This produces the hypnotic effect for which it is prescribed, but also produces other side effects3.
When an addict abuses hypnotics, they will manifest several outward symptoms. These symptoms include:
Many of these symptoms can be dangerous. Sedative addicts who are experiencing blackouts may remain partially ambulatory and can harm themselves and others, particularly if motor vehicles are involved or if they are mixing sedatives with other addictive drugs. Most E.R. cases involving sedatives result from addicts combining sedatives with other medications or drugs, which can be dangerous or lethal4.
As with most prescription drugs, the cost to an addict can vary greatly. For those who have a prescription, prices are substantially lower than those who are dealing with purchasing the drugs at street value. When hypnotics hit the street, their price can be marked up significantly and is subject to whatever criminal element is controlling the market. On average, however, sedatives on the street cost less than $5, which is significantly cheaper than most other prescription drugs on the street5.
While many prescription drugs, including benzodiazepines, present a strong correlation between crime and abuse, hypnotics typically do not. The effects of drugs like Ambien and Lunesta render most people unable to do much outside of sleeping and stumbling around. As such, there is no connection between nonbenzodiazepine sedative addicts and crime6.
That is not to say that sedative addicts do not suffer other costs not measured in legal terms or money. Many people who abuse sedatives suffer a great deal in their home life. For those who are parents or have a family, sedatives can often render them unavailable for those around them. They can become unfit parents and become so involved with sedative abuse that they are unable to work for extended periods of time. Many recovered addicts report that, while under the prolonged influence of sedatives, they essentially missed out on huge swaths of their own lives, existing essentially in a drug-induced fugue, drifting between blackouts7.
When taken as prescribed, sedatives and hypnotics put a person to sleep very quickly. When abused or taken in higher doses, a variety of harmful side effects can take place in addition to drowsiness. One of the most common effects reported by users taking high doses of hypnotics is something called a “blackout”. In this state, the addict retains motor and speech functions, although impaired, but is unable to recall anything which occurs. These episodes can be dangerous as users can get behind the wheel of an automobile or cause other forms of harm to themselves or others.
In other cases, taking higher doses than prescribed can lead to paranoia and suicidal thoughts. These cases are also dangerous since hypnotics already impair judgment, making the addict significantly more likely to take irrational action upon paranoid or suicidal thoughts.
As an addict develops a tolerance and begins to use more of these drugs over a longer period of time, they put themselves at risk for other, long-term effects. Long-term damage from sedatives includes depression, chronic fatigue, breathing difficulties, sexual problems, and chronic insomnia. Users will also frequently suffer from anxiety and even panic if they are unable to acquire their needed dose.
Physical problems with prolonged sedative use include high blood sugar, diabetes, and weight gain. Certain studies also suggest that sedatives can put addicts at an increased risk for heart problems, choking, liver failure, and suicide8.
Long-term sedative abuse can lead to addiction and a variety of issues which may become permanent or ongoing. Relapse rates among sedative abusers are estimated to be around 50% during the first 5 years. Additionally, those attempting to recover from sedative abuse have an extremely high risk for suicide, much higher than those recovering from other addictions9.
The reason most experts give for this increased risk of both relapse and suicide is the action of hypnotics upon the brain. As the brain becomes increasingly dependent upon drugs in order to monitor its natural rhythms, the disruption caused by sudden abstinence can take a long time to repair. The body has become accustomed to being sedated in order to sleep and perform other functions. Without it, addicts frequently fall victim to depression and insomnia. When the recovering addict suffers from both of these things, they will frequently turn to either relapse or suicide.
For this reason, medical supervision is highly recommended.
Depending upon which sedative an addict was using, withdrawal symptoms can vary, as can the time of onset. For short-acting hypnotics, an addict can expect withdrawal symptoms to being within 1-2 days and peak around 3 days. For longer-acting hypnotics, the timeframe can be extended, peaking after about 7 days. In either case, the withdrawal symptoms will be similar, including10:
Because of the potential for dangerous or even lethal effects of sudden withdrawal, it is almost always necessary for a person detoxing from sedatives to be placed under medical supervision. In this setting, they will often either be tapered off the drug they were abusing or be placed on a low-dose taper of benzodiazepines, which can prevent most dangerous withdrawal scenarios. Additionally, patients may receive medications which can aid with anxiety or sleeplessness11.
In many cases of sedative addiction, the addict may have channels by which to readily access the drugs, whether through drug dealers or more legal means like prescriptions. In almost all cases, the addict will need to readjust their lives in order to accommodate a new, substance-free lifestyle. This typically means changing social circles, avoiding old patterns and hangouts, and developing a support system for fellow recovering addicts.
In addition to these lifestyle changes, many addicts choose to enroll in rehab programs which are specially designed for easing this transition. They may also become involved with therapeutic solutions, which can include cognitive behavioral therapy, dialectical therapy, 12-step programs, or religious groups, all of which have been proven to be highly effective at combatting relapse12.
American Rehab Centers recommends Adult & Teen Challenge rehabs for recovery from addiction. Most other rehab programs are not able to give that as much time and attention to the addict or are too costing for most people to afford.
1News-Medical.Net. “What Are Sedatives?” Dr. Tomislav Mestrovic, M.D., Ph.D. November 23, 2015. https://www.news-medical.net/health/What-are-Sedatives.aspx
2U.S. National Library of Medicine. “Non-medical use, abuse, and dependence on sedatives and tranquilizers among U.S. adults: Psychiatric and socio-demographic correlates”. William C. Becker, David A. Fiellin, Rani A. Desai. June 1, 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745028/
3DrugBank. “Sedatives”. https://www.drugbank.ca/drugs/DB00425
4Yale Journal Of Biology and Medicine. “Prescription Sedative Misuse and Abuse”. Michael F. Weaver, M.D. September 3, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/
5U.S. National Library of Medicine. “The street value of prescription drugs”. Sajan, A., Corneil T., Grzybowski S. July 28, 1998. https://www.ncbi.nlm.nih.gov/pubmed/9700324
6Forbes. “Common Painkillers and Sedatives Linked to Increased Risk of Homicide, According to Study”. David DiSalvo. June 4, 2015. https://www.forbes.com/sites/daviddisalvo/2015/06/04/common-pain-killers-and-sedatives-linked-to-increased-risk-of-homicide-according-to-study/#4f6fbf471aef
7Narconon. “Effects of Sedatives”. http://www.narconon.org/drug-abuse/effects-of-sedatives.html
8Foundation for a Drug-Free World. “Depressants”. http://www.drugfreeworld.org/drugfacts/prescription/depressants.html
9DanHeadrickMD.com. “Sedatives Overview”. Dan Headrick, M.D. http://www.danheadrickmd.com/sedatives/
10Medscape. “Sedative, Hypnotic, Anxiolytic Use Disorders Clinical Presentation”. Stephen P. Erlach, J.D., M.D. February 10, 2017.
11DrugAbuse.com. “Sedative Detox and Withdrawal”. Lauren Brande, M.A. http://drugabuse.com/library/sedative-abuse-detox/
12Recovery.org. “Find the Best Residential Sedative Recovery Center”. Patrick Condron, M.Sc., M.A.C., A.D.C. June 13, 2013. http://www.recovery.org/topics/find-the-best-residential-sedative-recovery-center/