Sedative, hypnotic, or anxiolytic use disorder is a substance-related disorder involving abuse or dependence on a sedative, hypnotic, or anxiolytic medication. Treatment requires medical detoxification and psychotherapy.

What are sedatives, hypnotics, and anxiolytics?

Sedatives, hypnotics, and anxiolytics are prescription medications used for treating anxiety disorders, sleep disorders, seizures, or as anesthesia during surgery [3]. They are commonly known as "depressants" due to their slowing effects on physiological functioning.

Sedative, hypnotic, and anxiolytic drugs include:

  • Benzodiazepines: Ativan, Halcion, Librium, Valium, Xanax, Rohypnol
  • Barbiturates: Amytal, Nembutal, Seconal, Phenobarbital
  • Ambien, Lunesta, Sonata [3].

These medications reduce arousal and stimulation in the brain, resulting in respiratory depression (slowed breathing)_and an initial feeling of calmness.

The abuse of sedatives, hypnotics, or anxiolytics can lead to coma or death, particularly when used in conjunction with alcohol. 

Symptoms of sedative, hypnotic, or anxiolytic use disorder

Sedative, hypnotic, or anxiolytic use disorder symptoms include behavioral and psychological changes that impede daily functioning and cause significant distress.

Acute intoxication symptoms may include:

  • Mood changes
  • Slowed breathing
  • Tiredness 
  • Slurred speech
  • Unsteady walk, trouble with coordination
  • Irregular, uncontrolled eye movements
  • Inability to focus, lack of attention
  • Stupor
  • Coma [5]

Sedative, hypnotic, or anxiolytic dependence symptoms may include:

  • Tolerance to the drug (i.e., needing larger dosages than previously)
  • Using more than intended
  • Unsuccessful attempts to stop taking the drug
  • Drug-seeking behaviors such as spending a great deal of time trying to obtain the drug (doctor shopping or illegal means), feigning illnesses, or procuring the medication illegally
  • Experiencing intense cravings to use the drugs 
  • Repeatedly failing to fulfill obligations at home, school, and work 
  • Continued use and prioritization of use despite the consequences 
  • Use of the drug in dangerous situations, such as driving a car [1]
  • Dishonesty on the extent of use or hiding use of the medications from loved ones and medical professionals

People taking medications as prescribed by their health care provider are not considered to have sedative, hypnotic, or anxiolytic use disorder. However, anyone concerned about their tolerance to these medications or experiencing cravings to use more than prescribed should speak with their medical provider. 

Withdrawal symptoms of sedative, hypnotic, or anxiolytic use disorder

Repeated use of sedatives, hypnotics, or anxiolytics causes physical dependece, or tolerance, within the body. Tolerance means the body adapts to the medication, requiring larger amounts of the drug to achieve effects. 

When someone stops taking sedative, hypnotic, or anxiolytic medications, the body will go into withdrawal. Symptoms may include:

  • Anxiety
  • Tremors, shaky hands
  • Sleep disturbances: nightmares or insomnia
  • Changes in appetite, nausea, or vomiting
  • Rapid pulse and respiratory rates
  • Changes in blood pressure
  • Fever, sweating
  • Delirium
  • Seizures [3]

The timeframe for withdrawal symptoms depends on the medication and the level of use before stopping. It is recommended that people wanting to detoxify from sedatives, hypnotics, or anxiolytics work closely with a medical professional, as these withdrawal symptoms can be life-threatening.

Causes of sedative, hypnotic, or anxiolytic use disorder

Sedative, hypnotic, or anxiolytic use disorder is caused by the prolonged and repeated use of these medications. The main factor in its development is the sheer availability of sedatives, hypnotics, or anxiolytics.

There are also some risk factors associated with the condition. People with a family history of drug use disorders, behavioral disinhibition, or impulse-control disorders may be at higher risk of developing sedative, hypnotic, or anxiolytic use disorder [6]

Research has also shown that females may be at a higher risk for sedative, hypnotic, or anxiolytic use disorder than males [4]

Diagnosing sedative, hypnotic, or anxiolytic use disorder

Sedative, hypnotic, or anxiolytic use disorder is diagnosed by a medical doctor using psychosocial evaluation and laboratory testing. 

A psychosocial evaluation will include questions about medical and mental health history, patterns of drug abuse, and the adverse effects of substance use on life obligations. A standardized screening tool or self-report questionnaire, such as the Severity of Dependence Scale (SDS), may be used [2].

Laboratory testing for the presence of sedatives, hypnotics, or anxiolytics may be completed through a urine or blood screening. The medical professional will likely test for other substances as well, as many with sedative, hypnotic, or anxiolytic use disorder abuse these prescription drugs in combination with other drugs such as cocaine or alcohol.

Prevention of sedative, hypnotic, or anxiolytic use disorder

Environmental factors are the primary factor in the development of sedative, hypnotic, or anxiolytic use disorder, which makes the disorder preventable. 

People prescribed sedatives, hypnotics, or anxiolytics should only take their medication as prescribed and under the direct care of a physician. 

Prescribed medication should never be shared with someone else. 

Teenagers and young adults may abuse these medications in party settings. Parents can help prevent sedative, hypnotic, or anxiolytic use disorder by storing medications away from where children or teenagers can gain access, and by careful disposal of any unused medication. 

Treatment for sedative, hypnotic, or anxiolytic use disorder

Sedative hypnotic or anxiolytic use disorder treatment should be individualized according to the patient's needs. Substance use disorders are complex with multiple factors to consider, including detoxification needs and relapse prevention.

Detoxification

Detoxification should be closely monitored by a physician due to the possibility of seizures and other potentially life-threatening withdrawal symptoms [4]. Medical conditions that place the patient at higher risk of experiencing complications during detoxification should be assessed. 

Sedatives, hypnotics, or anxiolytics should be gradually tapered off to prevent more severe withdrawal symptoms. The physician may decide to use an alternative medication for some time to manage withdrawal symptoms [3]

Psychotherapy

Sedative, hypnotic, or anxiolytic use disorder is complex and continued support after detoxification is needed. Psychotherapy has been shown effective at managing these symptoms and sustaining abstinence. 

Psychotherapy for sedative, hypnotic, or anxiolytic use disorder treatment is often based on cognitive behavioral therapy. This approach will focus on identifying triggers, and patterns of thoughts and behaviors, creating action plans for triggers, and building coping skills. 

Individual, family, and group sessions are often a part of the treatment plan for sedative, hypnotic, or anxiolytic use disorder. 

Self-Help Groups

Self-help methods, such as 12-step programs or other peer recovery groups, can help build a stronger support system and create new habits. 

Helping someone with sedative, hypnotic, or anxiolytic use disorder

Loved ones trying to help someone with sedative, hypnotic, or anxiolytic use disorder may worry about how to approach the topic of addiction. They may be afraid of saying the wrong thing or that their loved one may not be willing to engage in treatment.

Support and encouragement from loved ones are integral parts of people seeking treatment for sedative, hypnotic, or anxiolytic use disorder. 

A professional with experience in drug addiction treatment may offer advice, guidance, and support in navigating the complexities of coping with a loved one’s sedative, hypnotic, or anxiolytic use disorder.

Peer groups for families, many based on 12-step programs, are also available. Social support is helpful for both the person with sedative, hypnotic, or anxiolytic use disorder and their loved ones. 

Loved ones concerned about someone’s sedative, hypnotic, or anxiolytic use should also make sure to prioritize their self-care. 

Self-care activities should include:

  • Getting adequate rest. 
  • Healthy eating 
  • Talking to others 
  • Engaging in relaxing and enjoyable activities

FAQs about sedative, hypnotic, or anxiolytic use disorder

How does sedative, hypnotic, or anxiolytic use disorder impact daily life?

The consequences of sedative, hypnotic or anxiolytic use disorder to daily life are similar to those of any substance use disorder. More and more of the drug is needed as tolerance builds, resulting in significant time being spent searching for and obtaining the drug. 

People with sedative, hypnotic or anxiolytic use disorder are not able to meet the daily demands of life obligations. They may have frequent absences from work, miss scheduled meetings, or forget about plans with loved ones. Sedatives, hypnotics, and anxiolytic use may lead to excessive tiredness and frequent sleeping during the day. 

What are the complications of sedative, hypnotic, or anxiolytic use disorder?

The complications of sedative, hypnotic, or anxiolytic use disorder can include coma and death at the severe end of the spectrum. Other complications may include memory loss, injuries from falling, and confusion [4]

The development of comorbid psychiatric disorders, including substance-induced depressive disorder, is also a possible complication of sedative, hypnotic, or anxiolytic use disorder. People with sedative, hypnotic, or anxiolytic use disorder are also at risk of having a co-occurring substance use disorder, such as alcohol use disorder. Comorbid mood disorders, including depression and anxiety disorders, are also common. 

Resources:

  1. American Psychiatric Association. (2013b, May 27). Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5 (5th ed.). American Psychiatric Publishing.
  2. de las Cuevas, C., Sanz, E. J., de la Fuente, J. A., Padilla, J., & Berenguer, J. C. (2000). The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction (Abingdon, England), 95(2), 245–250. https://doi.org/10.1046/j.1360-0443.2000.95224511.x
  3. Sedative, hypnotic or anxiolytic drug use disorder. (2022, February 28). Harvard Health. Retrieved October 3, 2022, from https://www.health.harvard.edu/a_to_z/sedative-hypnotic-or-anxiolytic-drug-use-disorder-a-to-z
  4. Sedative, hypnotic, or anxiolytic (benzodiazepine) use disorder. (2021, March 30). PsychDB. Retrieved October 3, 2022, from https://www.psychdb.com/addictions/sedative-hypnotics/1-use-disorder
  5. Sedative, hypnotic, and anxiolytic-related disorders. (n.d.). Psychology Today. Retrieved October 3, 2022, from https://www.psychologytoday.com/gb/conditions/sedative-hypnotic-and-anxiolytic-related-disorders
  6. Sedative, hypnotic, or anxiolytic use disorder. (2021, July 30). Clarity Clinic. Retrieved October 3, 2022, from https://www.claritychi.com/addiction/sedative-hypnotic-or-anxiolytic-use-disorder/