Self-medication, insomnia

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

Lejoyeux et al. 1998). Similar to opioid-dependent persons, these patients reported that they use benzodiazepines to self-medicate anxiety, insomnia, and alcohol withdrawal and, less commonly, to enhance the effects of ethanol. Approximately l6%-25% of patients presenting for treatment of anxiety disorders abuse alcohol (Kushner et al. 1990 Otto et al. 1992). Controversy exists concerning appropriate benzodiazepine prescribing in this population (Cir-aulo and Nace 2000 Posternak and Mueller 2001). 

Alcohol. Along with several bromide preparations and paraldehyde, alcohol has often been used to relieve anxiety. Due to the marked untoward social and medical consequences of frequent use, alcohol has no place in the treatment of anxiety. Unfortunately, the inappropriate use of alcohol to self-medicate anxiety, depression, insomnia, or other symptoms often leads to alcoholism and therefore contributes to a signihcant public health problem. 

So how is insomnia treated Most commonly, people self-medicate their insomnia with over-the-counter medications such as Tylenol PM , Sominex , Unisom , or other drugs such as antihistamines (discussed in Chapter 3). Other people try natural remedies such as melatonin (see Chapter 4). When such medications don t work, people often ask their doctor for a prescription sleep aid, which is usually a type of medication called a benzodiazepine such as Halcion or a related type of drug such as Ambien or Sonata (see Chapter 6 for more on these types of drugs). 

The depressant effect of barbiturates is often sought by persons who are self-medicating for amdety-related problems or insomnia. Drugs of the benzodiazepine family (Librium, Valium, and Xanax) are also legitimately prescribed for the treatment of anxiety as well as muscle spasms or convulsions. However, doctors and patients must be careful because prolonged or excessive use can lead to dependence. Illegal use often involves forged prescriptions or the cooperation of illicit doctors. 

It can be seen in Table 3 that many common disease states are being treated by self-medication with nutraceuticals joint pain, particularly caused by rheumatoid arthritis or osteoarthritis (OA) is both widespread, and also often treated with glucosamine, chondroitin, and MSM by this population. Impotence and insomnia have high incidence amongst this population, and are treated with dehydroepiandrosterone (DHEA) and melatonin, respectively, but there is also a substantial incidence of degenerative eye conditions, often treated... 

A 27-year-old woman who had been taking huspirone 30 mg daily for over one month started to take St John s wort Hypericum 2000 Plus, Herb Valley, Australia) three tablets daily. After 2 months she complained of nervousness, aggression, hyperactivity, insomnia, confusion and disorientation, which was attributed to the serotonin syndrome. The St John s wort was stopped, the huspirone was increased to 50 mg daily and her symptoms resolved over a week. A 42-year-old woman who was taking fluoxetine 20 mg twice daily and huspirone 15 mg twice daily started to develop symptoms of anxiety, with episodes of over-sleeping and memory deficits. It was discovered that she had been self-medicating with St John s wort, ginkgQ biloba and melatonin. She was asked to stop the non-prescribed medication and her symptoms resolved. ... 

Does she self-medicate for psychosis, insomnia or boredom ... 

Alcohol. It may seem odd to list alcohol among the treatments for insomnia, bnt it has long been among the most common self-administered treatments for insomnia. Alcohol usually does help the person fall asleep, but it is otherwise an extremely poor treatment for insomnia. It can lead to fragmented sleep later in the night, not to mention the potential for hangover and tolerance. In fact, with repeated use, alcohol itself can produce insomnia. Even without taking the social and medical consequences of frequent alcohol use into account, alcohol has no place in the treatment of insomnia. 

Antihistamines. After alcohol, antihistamines are the most commonly self-administered sleep medications. Foremost among these is diphenhydramine (Benadryl), which is also available as a component in a variety of over-the-counter nighttime medications including Tylenol PM and Excedrin PM. Prescription antihistamines like hydroxyzine (Vistaril, Atarax) are also occasionally used to treat insomnia. Finally, it is the antihistamine effect of some antidepressants and anti-psychotics that contribute to their utility as sedative-hypnotics. 

Insomnia is a common symptom that is difficult to assess. The most common complaint is of insufficient and unsatisfying sleep. However, patients may feel tired during the day, and then blame insufficient sleep without convincing evidence. They then resort too easily to chemical remedies for their putative problem, in the form of self-administered or prescribed medication [1],... 

Despite the prevalence of insomnia, only 5% of individuals seek medical attention for management of their insomnia. Approximately 10% to 20% use nonprescription drugs or alcohol to self-treat. Of... 

Medically, stress can cause you to suffer high blood pressure, pain, breathing trouble, cancer, digestive disorders, insomnia, and fatigue. Psychologically, you may suffer frustration, irritability, anger, impatience, worry, a lack of self confidence, and poor listening. 

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