Sedative, Hypnotic, and Anxiolytic-Related Disorders

Definition

Sedatives, hypnotics, and anxiolytics are often prescribed for a number of physical and psychological medical conditions. These substances that reduce arousal and stimulation in various areas of the brain. As a result, the user may experience a sense of calm or sedation, sleep, respiratory depression, or coma. This class of substances includes all prescription sleeping medications and almost all prescription anti-anxiety medications (tranquilizers). Sedative, hypnotic, or anxiolytic substances are available by prescription and can also be obtained illegally. Sedative-, hypnotic-, or anxiolytic- (SHA-) related disorders include SHA intoxication, SHA-use disorder and SHA withdrawal. Unfortunately, prolonged use of these medications can be addictive for some people. These medications have also been linked to problems with memory and depression, and some are under investigation for increasing the risk of dementia. 

Symptoms

SHA intoxication is diagnosed when recent exposure to these substances causes significant problematic behavioral or psychological changes. Symptoms may include sudden changes in mood, impaired judgment, inappropriate sexual or aggressive behavior, slurred speech, lack of coordination, unsteady walk, repetitive, uncontrolled eye movements, impaired attention and memory, and stupor or coma. Memory problems are common following SHA intoxication. People may not recall anything that happened while under the influence of the substance.

SHA-use disorder may be diagnosed if, for a period of more than 12 months, the individual has been taking these medications in larger amounts or over a longer period of time than was originally intended, having a strong craving or urge to use sedatives, hypnotics, or anxiolytics, having a strong desire to cut down on the use of these medications, or making unsuccessful efforts to do so, spending a lot of time obtaining, using, or recovering from the effects of the medication, continuing to use these medications despite problems caused by these drugs in major areas of life, using sedatives, hypnotics, or anxiolytics repeatedly despite its being physically hazardous (driving a car or operating machinery when drug-impaired), needing an increasing amount of medication to become intoxicated or reach the desired effect, and/or experiencing withdrawal symptoms when the use of medication is discontinued.

People experiencing SHA withdrawal may experience sweating, increased heart rate, hand tremor, insomnia, nausea or vomiting, visual, tactile, or auditory hallucinations, anxiety, and/or seizures.

Causes

When someone is prescribed SHAs for more than three months to treat post-traumatic stress disorder, anxiety, insomnia, or other conditions, or when they are used non-medically, there is always the possibility of addiction. Someone who is addicted to SHAs may regularly use only this class of substances to satisfy cravings for more. Others may use sedatives or benzodiazepines to “come down” from the intoxication of another drug or alcohol. SHA withdrawal can set in following reduction of use when there has been heavy and prolonged use of the medication for any reason.

Treatments

Recovery from SHA use disorder involves a one-month period of abstinence, along with behavioral counseling that includes instruction on stress management, relaxation, and coping techniques. Medication may be used to reduce withdrawal symptoms and help maintain abstinence. Self-help groups such as 12-step programs and other types of recovery programs can provide long-term support and help prevent relapse.

References

MD Guidelines. Sedative, Hypnotic or Anxiolytic Dependence. Accessed July 28, 2017.

Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer's disease: a case-control study. British Medical Journal. September 9, 2014;340. 

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

Arcoraci V and Spina E. Safety and tolerability of anxiolytics/sedative-hypnotics. Pharmacovigilance in Psychiatry. Published online December 8, 2015;191-207.

Last reviewed 09/20/2017