Running Head: SEDATIVE-HYPNOTICS AND ADDICTION 1 Sedative-Hypnotics and Addiction Michelle Reynolds John Carroll University SEDATIVE-HYPNOTICS AND ADDICTION 2 Abstract This study examined the history and effects sedative-hypnotics have, both physically and psychologically, as well as the effect on society. Sedative-hypnotics are one of the oldest classifications of drugs, and as such, one of the most commonly abused drugs. They depress the central nervous system, many times inducing a feeling of relaxation and pleasure. There are many reasons a person might become addicted to sedative-hypnotics, but the most common issue is medication (sometimes self-medication) for insomnia, anxiety, and/ or pain relief. Many sedative-hypnotic addicts are also addicted to other substances, usually opioids. Polydrug use is common with sedative-hypnotics, which is usually where the danger lies for users. Treatment for sedative-hypnotic addicts is a process of weaning the addict off the substance, in combination with intensive psychological counseling to reinforce healthy thoughts and behaviors. Due to the legality of many sedative-hypnotics, this large social issue will most likely continue to be a problem for many years to come. SEDATIVE-HYPNOTICS AND ADDICTION 3 History of sedative-hypnotics Sedative-hypnotics are one of the most commonly used and abused drugs in the United States today (Kane, 2013). In the broadest sense of the definition of sedative-hypnotics, this classification of drugs includes anything that depresses the central nervous system, including ethanol alcohol and marijuana. These drugs might be used to calm an anxious person, promote sleep, relieve pain, and even anesthetize for a medical procedure. However, when many of these drugs are used, fine and gross motor activities are affected and consciousness can become a struggle to maintain; in more severe cases with higher dosages, unconsciousness, paralysis, and even death can occur. Sedative-hypnotics can also severely affect an unborn fetus, causing birth defects and behavioral problems for the babies. The focus of this paper will be mainly on the sedative-hypnotic pills that are commonly illicitly used, including the two major categories of barbiturates and benzodiazepines; however, methaqualone, ethchlorvynol, chloral hydrate, and mebrobamate are also members of the sedative-hypnotic study. The brand names for the most common names of sedative-hypnotics include Seconal, Valium, Ativan, Nembutal, Quaaludes, and Xanax (Division of Alcohol and Drug Abuse, 1993). Methaqualone (brand names: Quaaludes, Sopors), originally prescribed to treat anxiety and to promote sleep, was “one of the most commonly abused drugs and [could] cause both physical and psychological dependence” (Division of Alcohol and Drug Abuse, 1993). There are also legal, over-the-counter types of sedative-hypnotics that are readily available to the general public (Kane, 2013). Antihistamines, decongestants, and sleep aids are SEDATIVE-HYPNOTICS AND ADDICTION 4 considered sedative-hypnotics because of the general drowsiness caused by many of the products. The use of sedative-hypnotics throughout history is long and for drugs like alcohol and marijuana, celebrated. Early societies used synthetic sedative-hypnotics, such as ethanol analogues, piperidinedione derivitives, and potassium bromide, which commonly caused bromism, a disease characterized by excessive sedation and delirium (National Institute on Drug Abuse, 2012). Barbiturates were also a popular method of pain and anxiety relief. Ciraulo & Knapp (2011) noted that “barbiturates have been clinically available since the 1900s and were widely the most prescribed agents for anxiety until the introduction of meprobamate in 1955 and, subsequently, the advent of benzodiazepines with chlordiazepoxide in 1957” (Ciraulo & Knapp, 2011). Benzodiazepines became the preferred sedative-hypnotic of choice for many people because the risk of overdose and toxic effects of barbiturates was so high. Today, sedative-hypnotics are used in many capacities, both legally and illegally. Some are used to treat anxiety and relieve pain. Others are used medically to prepare for surgery (Kane, 2013). Barbiturates seem to produce greater mood enhancement and self-administration than benzodiazepines, in recent studies. The toxic threshold, however, is so high for barbiturates that unacceptable side effects are commonly seen among barbiturates (Longo & Johnson, 2000). As with many substances that are intended to be medications, many sedative-hypnotics that are prescribed are used illicitly, which can cause addiction and adverse effects on the user (Longo & Johnson, 2000). SEDATIVE-HYPNOTICS AND ADDICTION 5 Effects on society Because of the legality of many sedative-hypnotics, they are very commonly abused and misused. A 1990 study for the American Psychiatric Association found that “11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year” (Salzman, 1990). The Substance Abuse and Mental Health Services Administration also found that an estimated 2.6% of the U.S. population 12 years of age or older used tranquilizers or sedatives illicitly, compared with a total of 15.3% of the population who used any substance illegally” (SAMHSA, 2010). However, good news has been found, despite increased media reports of deaths due to sedative-hypnotics. SAMHSA also found that in 2010, of the 2.8% of the total U.S. population diagnosed with substance abuse or dependence, less than half a percent were diagnosed for drug use/abuse related to sedatives or tranquilizers (SAMHSA, 2010). Polydrug use is also common among users of benzodiazepines. Longo and Johnson (2000) found that “an estimated 80 percent of benzodiazepine abuse is part of polydrug use, most commonly with opioids… Studies indicate that 3 to 41 percent of alcoholic persons report that they abused benzodiazepines at some time, often to modulate intoxication or withdrawal effects” (Longo & Johnson, 2000). Sedative-hypnotics and benzodiazepine overdoses tend not to be fatal; however, when another drug is coingested with a sedative-hypnotic, the risk of death is increased exponentially. Combinations of sedative-hypnotics and opioids or alcohol commonly depress the respiratory system, leading to fatal effects (Ciraulo & Oldham, 2013). A major effect that sedative-hypnotics have had on society in general is facilitation of date rape. A study by the Canadian Sexual Assault Centre found that of the 1,400 women who reported that they were raped, almost 25% of them were facilitated through surreptitious drug SEDATIVE-HYPNOTICS AND ADDICTION 6 administration, usually benzodiazepines, such as flunitrazepam (Rohypnol) or gamma hydroxybutyrate acid (GHB) (Weir, 2001). However, alcohol and marijuana are also sedative- hypnotics and are commonly used to “lower sexual inhibition and enhance the possibility of unwanted sexual intercourse” (Weir, 2001). Rape treatment centers in the U.S. found that 69% of urine samples submitted by victims of suspected drug-facilitated rapes showed the presence of alcohol and marijuana was found in another 18% of samples, as compared to only 4% for GHB and flunitrazepam (Weir, 2001). Nevertheless, in today’s society, women are being strongly cautioned to watch their drinks and never leave their drinks unattended, to prevent unwanted drug administration. Physiological effects of sedative-hypnotics Sedative-hypnotics can cause both physical and psychological dependence. The Missouri Department of Mental Health notes “When regular users stop using large doses of these drugs suddenly, they may develop physical withdrawal symptoms ranging from restlessness, insomnia and anxiety, to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function. Finding and using the drug becomes the main focus in life” (Missouri Department of Mental Health, 1993). Geoff Kane notes that sedative-hypnotics work “by augmenting the effects of gamma- aminobutyric acid (GABA)… Boosting GABA both calms the brain and increases dopamine in the nucleus accumbens” (Kane, 2013). This reward of increased dopamine means that the user is more likely to have pleasurable effects from the drug and thus, repeat the experience. Studies show that sedative-hypnotics are addictive and long-term use of the medication can cause SEDATIVE-HYPNOTICS AND ADDICTION 7 tolerance levels to rise and withdrawal symptoms to occur if the user suddenly stops the medication (Kane, 2013; Scher, 2014). Babies born to mothers who abuse sedatives during pregnancy may be physically dependent on drugs and show symptoms of withdrawal after birth. Their symptoms “may include breathing problems, feeding difficulties, disturbed sleep, sweating, irritability, and fever” (UnityPoint Health). Benzodiazepines can also be found in a using mother’s breast milk, and so are usually inappropriate for breast-feeding mothers to use. It is also noted that newborns who have been exposed to sedative-hypnotics may demonstrate floppy baby syndrome and withdrawal symptoms. Using sedative-hypnotics during pregnancy also carry an increased risk of cleft lip and other malformations to the fetus (Ciraulo & Oldham, 2013). Sedative-hypnotics have a profound effect on the psychomotor skills of the user. Both quantitative and qualitative studies have found delayed reaction times among sedative-hypnotic users, especially the elderly, who generally have lower metabolisms and greater susceptibility to central nervous