What is depressants abuse? |

Causes

Humans have always sought to alleviate the effects of stress and to reduce anxiety, depression, restlessness, and tension. Alcohol and kava kava are two of the oldest depressant agents. The nineteenth century brought synthetic substances such as bromide salts and chloral hydrate. These were followed by barbiturates and benzodiazepines, which were introduced in the twentieth century.

Depressant abuse is on the rise because of the wide availability of drugs by prescription or through the illicit marketplace. Examples of illegal depressants of abuse include the date rape drugs flunitrazepam (Rohypnol) and gamma-hydroxybutyric acid (GHB, a natural depressant).

Overall, short-acting agents are more likely to be used nonmedically than those with long-lasting effects. Because of their wider margin of safety, benzodiazepines have largely replaced barbiturates. They now constitute the most prescribed central nervous system (CNS) depressants—and the most frequently abused, usually to achieve a general feeling of relaxation. However, barbiturates and barbiturate-like drugs still pose clinical problems, as many young people underestimate the risks these drugs carry. Non-benzodiazepine sedatives, such as zolpidem (Ambien), also can generate misuse and dependence.

Most sedative-hypnotic drugs work by enhancing the inhibitory activity of the neurotransmitter gamma-aminobutyric acid, thus reducing CNS activity and promoting relaxation and sleep. They are usually prescribed to treat sleep disorders, anxiety, acute stress reactions, panic attacks, and seizures. In higher doses, some agents become general anesthetics. Chronic use results in tolerance and dependence (both psychological and physical).

Risk Factors

Barbiturate abuse occurs most commonly in mature adults with a long history of use, while benzodiazepines are favored by younger persons (those younger than forty years of age). Two main categories of people misuse depressant drugs. The first category comprises people who receive depressant prescriptions for psychiatric disorders or who obtain them illicitly to cope with stressful life situations. These persons have a high risk of becoming dependent, especially if they receive high doses, take the drug for longer than one month, and have a history of substance abuse or a family history of alcoholism. However, if dose escalation is not evident and drugs are not used to achieve a state of intoxication, chronic benzodiazepine users should not be considered abusers.

A second important category comprises people who use sedative drugs in the context of alcohol or multiple-drug abuse. These people may take benzodiazepines to alleviate insomnia and anxiety (sometimes induced by stimulants), to increase the euphoric effects of opioids, and to diminish cocaine (or alcohol) withdrawal symptoms.

Symptoms

People who abuse depressants often engage in drug-seeking behaviors that include frequently requesting, borrowing, stealing, or forging prescriptions; ordering and purchasing medication online; and visiting several doctors to obtain prescriptions. These behaviors often accompany changes in sleep patterns and irritable mood and increased alcohol consumption. Recreational use and self-medication with depressants may lead to accidental overdoses and suicide attempts. Many persons use a “cocktail” of alcohol and depressant medications for enhanced relaxation and euphoria. This practice is dangerous, as it carries a high risk of overdose.

Sedative-hypnotic drug intoxication resembles alcohol, painkillers, and antihistamine intoxication. It presents with impaired judgment, confusion, drowsiness, dizziness, unsteady movements, slurred speech, and visual disturbances. Young adults attempting to get high may show excitement, loss of inhibition, and even aggressive behavior. Acute GHB intoxication leads to sleep and memory loss. These manifestations occur without alcohol odor on the breath, unless the abuser combined the drug with alcohol. In the case of barbiturates, the behavioral effects of intoxication can vary depending on the time of day, the surroundings, and even the user’s expectations.

Tolerance to barbiturates is not accompanied by an increase in lethal dose, as it is with opiates. For this reason, an overdose can be fatal. Signs and symptoms of barbiturate overdose vary, and they include lethargy, decreased heart rate, diminished reflexes, respiratory depression, and cardiovascular collapse.

All sedative-hypnotics can induce physical dependence if taken in sufficient dosage over a long time. Withdrawal from depressant medication results in a “rebound” of nervous system activity. In a mild form, this leads to anxiety and insomnia. In cases of more severe dependence, withdrawal manifests with nausea, vomiting, tremors, seizures, delirium, and ultimately, death. Therefore, discontinuation of prescription drugs necessitates close medical supervision.

Screening and Diagnosis

To evaluate a person who might abuse depressant medication, a doctor will obtain a thorough medical history, ask questions about current and previous drug and alcohol use, and perform a physical examination. A psychiatric evaluation may also be required. The diagnosis of depressant drug abuse relies on evidence of dose escalation, on obtaining multiple prescriptions, and on taking the drug for purposes other than those stated in the prescription.

Multiple tests detect the presence of drugs and also potential medical complications. These include drug screening (urine and blood), electrolyte and liver profiles, an electrocardiogram, and X-ray and magnetic resonance imaging.

Treatment and Therapy

Therapeutic strategies for depressants abuse vary according to the drug used, the severity of the manifestations, and the duration of drug action. Common therapies include detoxification, which involves the use of agents that reverse the effects of the drug (for example, using Flumazenil for benzodiazepine abuse and using Naloxone for narcotics abuse). Other common therapies include the use of medications that mitigate withdrawal symptoms, counseling in inpatient or outpatient settings, support groups, and relaxation training. When a person receiving treatment has combined a CNS depressant with alcohol or other drugs, all aspects of this addiction have to be addressed and treated.

Prevention

Sedative-hypnotic medication should be used only as prescribed. Combinations of CNS depressants (such as alcohol/drug or over-the-counter drug/prescription medication) pose high risks and should be avoided.

People who are unsure of a drug’s effects, or who suspect dependence, should consult a pharmacist or a doctor. Those people who are contemplating the discontinuation of a CNS depressant or who are experiencing withdrawal symptoms should seek medical care immediately.

A careful assessment is necessary before prescribing depressant medication in persons with a history of drug abuse. These individuals require close monitoring. Also, caregivers and health care providers should verify that there are no alternative sources for obtaining the drug of abuse.

Bibliography

Hanson, Glen R., Peter J. Venturelli, and Annette E. Fleckenstein. Drugs and Society. 9th ed. Sudbury: Jones, 2006. Print.

Parker, James N., and Philip M. Parker. The Official Patient’s Sourcebook on Prescription CNS Depressants Dependence. San Diego: Icon, 2002. Print.

Sadock, Benjamin J., and Virginia A. Sadock. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 10th ed. Philadelphia: Lippincott, 2007. Print.

Sue, David, Derald Wing Sue, and Stanley Sue. Understanding Abnormal Behavior. Boston: Wadsworth, 2010. Print.