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Benzodiazepine Abuse and Addiction

  • Annie UmbrichtEmail author
  • Martha L. Velez
Reference work entry

Abstract

Chlordiazepoxide’s sedative activity was serendipitously discovered by Sternbach in 1955 in Basel, Switzerland, and this first benzodiazepine (BZD) was introduced in 1960 for the treatment of anxiety and insomnia, followed shortly by diazepam in 1963. Given their lower toxicity, BZDs soon replaced barbiturates and other hypnotic drugs, and they became widely prescribed. Although generally considered effective and safe for short-term use for a wide range of conditions, the long-term use of BZDs is much more controversial as they lose efficacy and have been associated with adverse reactions. Problems associated with long-term use include rebound of the symptoms for which they were prescribed, alteration of sleep architecture with loss of sleep efficiency, nightmares, agitation, anterograde amnesia leading to cognitive impairment, confusion, depression, psychomotor compromise with increased risk of falls and motor vehicle accidents, withdrawal symptoms upon discontinuation, and risk of dependence and abuse in special populations. In the late 1980s and early 1990s, a new group of GABAA receptor agonists at the benzodiazepine receptor site, the Z-drugs, was introduced for the treatment of insomnia, the most common being zaleplon, zolpidem, zopiclone, and its s-enantiomer eszopiclone. Chemically distinct from the benzodiazepine group, they have been promoted to be safer than traditional BZDs and gained wide acceptance with the public and practitioners. However, given their site of action at the benzodiazepine site of the GABAAR, complications are expected to be similar. In fact, the FDA, on May 14, 2013, released a safety announcement recommending a dose reduction for zolpidem extended release as well as a warning not to operate a vehicle or machinery requiring complete mental alertness on the day following the use of zolpidem due to residual psychomotor impairment. Next day sedation, physical dependence and withdrawal, cognitive and psychomotor problems are found in patients receiving Z-drugs. Abuse of the Z-drugs is on the increase and studies suggest that Z-drugs may also increase the risk of depression.

Clinicians prescribing sedatives should ensure short-term use to maximize benefit while minimizing misuse and diversion. They can play a critical role in identifying patients at risk to misuse or divert prescription drugs. Several studies demonstrate that BZD discontinuation in patients with long-term use and dependence is associated with improved quality of life. The management of the patients with BDZ abuse and/or dependence and interventions for BZD detoxification will be described.

Keywords

Obstructive Sleep Apnea Anxiety Disorder Cognitive Behavioral Therapy Withdrawal Symptom Pathological Worry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  1. 1.Behavioral Pharmacology Research UnitThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA

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