Benzodiazepine dependents with 3 medical treatment

Historically, the treatment of alcohol use disorders with medication has focused on the management of withdrawal from the alcohol. In recent years, medication has also been used in an attempt to prevent relapse in alcohol-dependent patients. The treatment of alcohol withdrawal, known as detoxification, by definition uses replacement medications that, like alcohol, act on the GABA receptor. These medications (i.e., barbiturates and benzodiazepines) are cross-tolerant with alcohol and therefore are useful for detoxification. By contrast, a wide variety of theoretical approaches have been used to reduce the likelihood of relapse. This includes aversion therapy and anticraving therapies using reward substitutes and interference approaches. Finally, medications to treat comorbid psychiatric illness, in particular, depression, have also been used in attempts to reduce the likelihood of relapse. 

The safety and efficacy of zolpidem for insomnia is similar to that of the benzodiazepines. As with other sedative medications, treatment optimally should not exceed 4 weeks to minimize tolerance and dependence. Zolpidem is less disruptive of sleep stages than benzodiazepines. The most common adverse effects include drowsiness, amnesia, dizziness, headache, and gastrointestinal complaints. Several cases of brief psychotic reactions have been reported in women. ... 

Control of early withdrawal symptoms, which prevents their progression to more serious symptoms, is the indication for which medications are most widely prescribed in the treatment of alcohol dependence. The most commonly used agents to treat alcohol withdrawal are the benzodiazepines, a class of drugs that, by virtue of their agonist activity at the GABA receptor complex, suppress the hyperexcitability associated with alcohol withdrawal. With widespread use of anticonvulsant medications for bipolar disorder and other disorders associated with behavioral disinhibition and CNS hyperexcitability, anticonvulsants have also been examined for use in the treatment of alcohol withdrawal. 

When treating anxiety one should of course first treat any reversible medical condition. When pharmacological treatment is necessary SSRI is most often drug of choice. Selective serotonin reuptake inhibitors are both effective and safe. Benzodiazepines that have been widely used are drugs with a relative high risk of adverse effects (see Chapter 4). Risks for dependence and abuse must always be considered for benzodiazepines. 

A second issue relating to long-term medication is the effect of withdrawing medication at the end of a period of treatment. Benzodiazepines are associated with discontinuation symptoms, and their repeated use may foster the development of true physiological dependence. In a study of discontinuation of treatment for panic disorder [Rickels et al. 1993) with either alprazolam [n = 27), imipramine [n = 11) or placebo [n = 10), a withdrawal syndrome was observed in almost all patients treated with alprazolam but in few pa-... 

Dependence. Both animal and human research has shown that brain receptors do change in character in response to chronic treatment with benzodiazepines and therefore will take time to return to premedication levels after cessation of medication. Features of withdrawal and dependence vary. Commonly there is a kind of psychological dependence based on the fact that the treatment works to... 

The atypical antianxiety medication buspirone has been used with some success with GAD patients. This medication offers the benefits of reduced rumination and worry, but without the problems of sedation and potential drug dependence seen with benzodiazepines. Buspirone is not addictive and thus provides a treatment option for GAD patients with substance abuse risk. 

These symptoms usually are not directly treated with psychotropic medications. Rather the primary medical disorder is treated, or the patient is referred for treatment of a chemical dependency problem (see chapter 12). When psychotropics are employed, they generally are used for short periods of time. Medications of choice are the benzodiazepines (although they should be used with extreme caution in patients with a substance abuse disorder). 

As with depression, those who are battling or have battled cancer sometimes report feelings of anxiousness that may also respond to medications. Benzodiazepines (BZs) are one class of drugs used in the treatment of anxiety and insomnia. Unlike antidepressants, they work almost immediately. The drugs include lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), chlordiazepoxide (Librium) and triazolam (Halcion). Some people do become dependent upon BZs, but the drugs are generally safe... 

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