Substance Abuse (Depressants or Sedative-Hypnotic Drugs)

What Is It?

Sedative-hypnotic drugs, commonly called depressants, slow down or "depress" the activity of the brain. The most commonly abused of these are barbiturates (Amytal, Nembutal, Seconal, phenobarbital) and benzodiazepines (Ativan, Halcion, Librium, Valium, Xanax, Rohypnol). Other drugs in this group include chloral hydrate (which when mixed with alcohol was once known as "knockout drops" or a "Mickey Finn"), glutethimide (Doriden), methaqualone (Quaalude, Sopor, "ludes") and meprobamate (Equanil, Miltown and other brand names).

Although alcohol is also a depressant, alcohol is so common that health experts classify alcohol-related problems separately.

When someone continues to use these drugs, the person's body becomes tolerant to them. That is, the body adjusts to them and it takes a higher and higher dose to "get high." Dependence also can develop, meaning the person will have withdrawal symptoms if he or she suddenly stops taking the drugs.

Many of these sedative-hypnotic drugs have legitimate uses. Benzodiazepines are good for anxiety and sleep disorders. Barbiturates are used for seizure disorders and anesthesia. In therapeutic doses, they are effective. Using barbiturates to get "high" can be very dangerous. There is a relatively small difference between the desired dose and an overdose. A small miscalculation, easy to make, can lead to coma, respiratory distress (breathing slows or stops) and death. Withdrawal from barbiturates is similar to, and sometimes more severe than, alcohol withdrawal. Seizures are possible and can cause death.

Compared to barbiturates, benzodiazepines are safer drugs. They cause sedation but rarely stop a person's breathing or lead to death. They have the potential to be psychologically harmful by causing over-sedation, memory impairment, poor motor coordination and confusion. Withdrawal reactions can be extremely uncomfortable.

Combining any of these drugs, or using them with alcohol, can lead to dangerous effects. People often take these combinations to try to get higher or to counter unpleasant effects of other street drugs.

Symptoms

The symptoms of dependence on depressant drugs:

A craving for the drug, often with unsuccessful attempts to cut down on its use
Physical dependence (development of physical withdrawal symptoms when a person stops taking the depressant)
A continued need to take the drug despite drug-related psychological, interpersonal or physical problems

There is no absolute dose or number of pills per day that indicates a person is dependent on depressants. Dependent people eventually develop physical tolerance (the gradual need for greater amounts of the drug to feel the same effects). But addiction implies that the person is also relying on the drug emotionally.

If the person suddenly stops taking the drug, the body's accustomed internal environment changes drastically, causing symptoms of withdrawal: anxiety, tremors, nightmares, insomnia, poor appetite, rapid pulse, rapid breathing, blood pressure abnormalities, dangerously high fever and seizures. With short-acting medications pentobarbital (Nembutal), secobarbital (Seconal), alprazolam (Xanax), meprobamate (Miltown, Equanil), methaqualone (Quaalude) withdrawal symptoms begin 12 to 24 hours after the last dose and peak at 24 to 72 hours. With longer-acting medications phenobarbital, diazepam (Valium), chlordiazepoxide (Librium) withdrawal symptoms begin 24 to 48 hours after the last dose and peak within 5 to 8 days.

As with alcohol, depressants can cause symptoms during intoxication. These symptoms can include slurred speech, problems with coordination or walking, inattention, and memory difficulties. In extreme cases, the person may lapse into a stupor or coma.

Diagnosis

If your doctor suspects that you are addicted to depressants, he or she will ask you questions about the type of drugs you use, the amount you take, how often you use them, how long you've been using them and under what circumstances. Your doctor also will ask you about physical symptoms, psychological problems or behavioral difficulties (impaired work performance, problems in your personal relationships, criminal arrests) related to your drug use. If you are using any other substances (alcohol, heroin, amphetamines, cocaine, marijuana) in addition to depressants, it is helpful for your doctor to know this. Of course, many people using these substances are not sure they want to get help for the problem. It is difficult to talk frankly about substance use with your doctor or a counselor. However, an open accounting of drug use leads to more effective planning. The goal is not just to get through detoxification safely, but also to establish a treatment plan that helps to reduce craving for the drug and to solve the underlying problem that led to the addiction, such as anxiety, depression or stressful circumstances.

Your doctor can diagnose depressant dependence based on your history, including your pattern of drug use and its effect on your life and health. In some cases, especially if you have symptoms of intoxication or withdrawal, your doctor may find additional evidence for the diagnosis in your physical examination. Your urine or blood also may be screened.

Expected Duration

Depressant addiction can be a long-term problem that lasts for weeks, months or years.

Prevention

To help prevent problems, follow any prescription directions exactly and avoid taking more of the medication than your doctor ordered. The biological, psychological and social forces that lead to addiction, however, are difficult to prevent. If you feel that you need the medication for longer than prescribed, consult your doctor immediately. Never take medication that has been prescribed for anyone else.

Treatment

The first goal of treatment is detoxification (withdrawal from the drug). Detoxification usually involves gradually reducing the dose of the drug or temporarily substituting a medication that has less serious withdrawal symptoms. The substitute medication, if used, also will be reduced gradually. Depending on the severity of the drug dependence and other factors (significant heart or lung disease, liver failure, high blood pressure, age older than 65), detoxification may need to take place in the hospital.

Once a person has successfully withdrawn from depressants, he or she can begin counseling or psychotherapy to help identify emotional troubles that fueled the drug abuse or misuse. To prevent relapse, some patients may benefit from 12-step or other recovery programs.

Treatment is best tailored to the needs of the individual. In addition to counseling and psychotherapy, medications may be available to help reduce craving or treat depression, anxiety or any other mental disorder.

When To Call A Professional

It is best to seek help as soon as possible. Like alcoholism, depressant addiction is a real illness, not a sign of weakness or poor character.

Prognosis

Depressant dependence is difficult to shake without support and without treatment for the root causes of the addiciton. Withdrawal is likely to be safe when the substance is reduced gradually. People who require hospitalization for the most severe symptoms of depressant withdrawal have a 2% to 5% risk of death, similar to severe alcohol withdrawal. However, most people get help before reaching that stage. In general, formal treatment is likely to reduce the risk of relapse (returning to the addictive behavior).