Substance abuse sedative-hypnotics

Comparable findings for lifetime prevalence of psychiatric disorders were obtained in another study of 133 persons, which also found that 47% received a concurrent DSM-III diagnosis of substance abuse or dependence (Khantzian and Treece 1985). The most frequently abused substances were sedative-hypnotics (23%), alcohol (14%), and cannabis (13%). Similar rates of psychiatric disorders were found in other studies of drug abusers (Mirin et al. 1986 Woody et al. 1983). Although such diagnoses do not imply causality, and, in many cases, opioid dependence causes or exacerbates psychiatric problems, some causal link seems likely (Regier et al. 1990). 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Taper oft antipsychotics, benzodiazepines, or sedative-hypnotic agents if possible Treat substance abuse... 

Anxiety disorders (e.g., generalized anxiety disorder, obsessive-compulsive disorder) Substance abuse (alcohol or sedative-hypnotic withdrawal)... 

Nevertheless, sedative-hypnotic agents often play a useful role in treatment. In particular, by providing a successful night s sleep, these medications can break the cycle of anxious anticipation and dread that afflicts the insomnia sufferer during the night. We generally prefer using zolpidem or zaleplon as a first-line treatment for early-to-middle insomnia. Late insomnia often responds well to trazodone or eszopiclone, and trazodone often is a first choice in the presence of substance abuse for all insomnias. 

Exposure to toxicants can vary, producing what is known as acute or chronic poisoning. Poisoning can also be classified according to the intent of use. Poisoning can either be suicidal (non-accidental) or accidental in nature. Recreational poisoning, such as substance abuse, can be a source of harmful intoxication and, in some cases, can lead to addiction and withdrawal symptoms. Intentional harm is observed when there is criminal doping with sedative-hypnotic medicines, often associated with robberies. 

Psychotic symptoms may also occur with the withdrawal of alcohol, sedatives, hypnotics, and anxiolytics The following symptoms may occur persecutory delusions, perceptual distortions, and vivid hallucinations in any modality, most classically visual and tactile hallucination of insects crawling under the skin (formication) Substance abuse history may be elicited from the history and confirmed by finding urinary metabolites Confirmation of schizophrenia can only be made if the psychotic symptoms persist for at least a month following drug withdrawal... 

Wesson, Donald R., D. E. Smith, and R. B. Seymour. 1992. "Sedative Hypnotics and Tricyclics." In Substance Abuse A Comprehensive Textbook, edited by Joyce H. Lowinson, Pedro Ruiz, Robert B. Millman, and J. G- Langrod. Baltimore Williams and Wilkins. 

Due to their high potential for abuse, most barbitu-rate-like substances have been replaced by newer, safer agents—such as the BZDs and non-BZD sedative-hypnotics—that exert a sedative-hypnotic effect. 

Glutethimide (Doriden), a highly lipid-soluble drug classified as a sedative-hypnotic, was introduced in 1954 as a safe barbiturate substitute. However, its addiction potential and the severity of withdrawal symptoms were similar to those of barbiturates. In 1991, glutethimide was classified as a Schedule II controlled substance in response to an upsurge in the prevalence of diversion, abuse, and overdose deaths. The drug is illegal in the United States and in several other countries. It is classified as a sedative-hypnotic. 

Although some sedative-hypnotics such as the nonbarbiturates glutethimide (Doriden) and methaqualone (Quaalude) were once legally prescribed drugs, these substances were banned from use in the United States because of their potential for addiction and abuse. Some sedative-hypnotics such as flunitrazepam (Rohypnol) are illegal in the United States but are legal in Europe and Latin America. 

May cause less dependence than some other sedative hypnotics, especially in those without a history of substance abuse... 

Diazepam is used primarily in the treatment of mental anxiety. In addition, it acts as a muscle relaxant for a variety of medical conditions. It may also be used as a sedative-hypnotic and anticonvulsant (e.g., for status epilepticus and drug-induced seizures). Diazepam may also be used to alleviate some of the symptoms associated with the following cholinesterase poisoning, substance abuse withdrawal, antihistamine overdose. Black Widow spider envenomation, and chloroquine overdose. As an anesthetic, diazepam may be used alone or in combination with other drugs for conscious sedation. 

Smith DE, Wesson DR. Benzodiazepines and other sedative-hypnotics. In Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment. Washington, American Psychiatric Press, 1994 179—186. 

The benzodiazepines form a group of over 40 substances, approximately half of which are available in Germany in proprietary medicines. All benzodiazepines have anticonvulsant, anxiolytic, muscle-relaxant and sedative/hypnotic properties, although the various substances differ from each other with respect to the strengths of these effects. Most substances are available as tranquilizers/ hypnotics and some as anticonvulsants or muscle relaxants. A habit-forming potential is common to all benzodiazepines, and a small number of these substances are abused extremely frequently. These are discussed further below. 

A generic term relating to psychological and/a physical dependence when one or mae psychoactive substances or classes of psychoaaive substances are abused (alcohol sedatives, hypnotics and anxiolytics cannabis opioids cocaine amphetamine and other sympathomimetics hallucinogens caffeine nicotine ... 

Barbiturates are derivatives of barbituric acid. These substances were once used extensively in clinical practices as sedatives-hynotics. Because of their abuse and physical dependence, their therapeutic application has diminished considerably. The sedative effects of barbiturates are similar to those of alcohol. Higher dosage can cause hypnosis and anesthesia. An intake of barbiturates 10-15 times that of the hypnotic dose can be toxic. Coma and death can result from overdose. 

---