Commonly used and abused sedatives that can lead to addiction include alcohol, barbiturates, and benzodiazepines, and benzodiazepine-like drugs. Although there can be a paradoxical effect, all the sedative and hypnotic drugs have the effect of decreasing metabolism, inducing a state of calmness and/or sleep, and decreasing anxiety and activity. Besides alcohol barbiturates and benzos, there are other classes of sedatives that are only used in hospital setting and in anesthesia which are not addressed on this site.
Barbiturates and benzos are addictive substances, so they are controlled by the U.S. Drug Enforcement Agency (DEA). Both classes of drugs rate lower than heroin, cocaine, and tobacco on addiction risk scales and are probably lower than alcohol as well. But, addiction to barbiturates and benzodiazepines is common. Oftentimes, the sedative dependence coincides with another addiction, especially an addiction to opiates or meth, with benzos. Also becoming more common is an addiction to benzos and “club drugs” like Tina (crystal meth) and MDMA (XTC, Ecstasy). When entering a drug rehab, expect that treatment will be given for all addictions simultaneously, including barbiturate and benzo addiction. This first step will be to undergo an inpatient barbiturate detox or an inpatient benzo detox.
According to the Centers for Disease Control (CDC), Alcohol is estimated to cause over 30,000 deaths per year, and this statistic doesn’t even include those deaths indirectly related to alcohol, such as unintentional injuries, homicide and other causes, nor does it include deaths due to fetal alcohol syndrome. If one incudes indirect deaths, morbidity (disease states), and loss of production, alcohol has an enormous, almost immeasurable impact upon worldwide society. Undergoing inpatient alcohol detox followed by alcohol rehab is common and is necessary to prevent death from withdrawal. Since alcohol is also a food source, and the most commonly abused sedative, it is addressed in-depth in its own section of this site.
Chloral hydrate – trichloroacetaldehyde monohydrate – was synthesized in the early to mid-1800s and became a prevalent sleep aid in the later 1800s. Chloral hydrate and barbiturates were the first, widely-used and commercially available sedatives and hypnotics. Addiction to chloral hydrate was recognized shortly after it was introduced to the medical market. But, the treatment for chloral hydrate addiction was not advanced, as this addiction was mostly attributed to a “moral” deficit of the addict. Much of the treatment centered around the patient focusing on traditional values; and, since there were no formal inpatient or residential detox centers, the detox was typically carried-out at home or in a sanitorium.
The first barbiturate was synthesized from barbituric acid and was known simply as, barbiturate. It was found to induce sleep (a hypnotic). But, because the metabolism of barbiturate is slow, the induced state of sleep is longer than desired. Later, phenobarbital was developed. It, too, has a long duration of action, but is less sleep-inducing than barbiturate and was found to control seizures.
Following the increase in the understanding of the chemistry and pharmacology of barbiturate, thousands of barbiturate analogs were developed, with close to 50 of them eventually being used to treat medical conditions. Because the list is long, only the most commonly prescribed and abused barbiturates will be mentioned.
MOST COMMONLY PRESCRIBED & ABUSED BARBITURATES
- Seconal – secobarbital
- Amytal – amobarbital
- Butisol – butabnarbital
- Nembutal – pentobarbital
- Luminal – phenobarbital
- Fiorinal and Fioricet – butalbital
Barbiturates are classified according to the onset of action and duration of action. Rapid onset and short duration of action barbiturates are commonly used in anesthesia. Whereas, long-acting barbiturates are typically used to control seizures. Intermediate acting barbiturates are more commonly used as sleep aids and for headache relief.
The most common indications for the prescription of barbiturates are for anesthesia, as sleep aids, anti-seizure medications, rarely for muscle relaxation, and for headache relief. In the past, they were also commonly used to reduce anxiety. Because barbiturates have a relatively narrow therapeutic window (the difference between the effective dose and a lethal dose), they are less commonly prescribed than benzodiazepines. Sedatives not only induce sleep, decrease anxiety and prevent seizures, but they also decrease the respiratory rate and blood pressure, which can lead to death. Therefore, the prescription of barbiturates use must be carefully monitored and the prescriber should use diligence when selecting this class of medications.
The first drug, Librium (chlordiazepoxide), from the addictive drug group benzodiazepines (benzos), was first identified in the mid-1950s and became commercially available for medical use in 1960. Librium was found to have actions like those of barbiturates, but did not create the same concerning level of respiration suppression and sedation. Librium is a sedative, muscle relaxant, anticonvulsant (decreases seizure activity), and decreases anxiety, but is not as hypnotic as most of the barbiturates. Because of Librium’s relative safety, the race was on to develop more effective benzodiazepines with less side effects. At first, Librium was reported to be non-addictive, but was later found to be addictive. The next benzodiazepine that was developed was Valium (diazepam) and it became available in 1963. There are about 15 benzodiazepines on the market in the U.S. today.
Benzos are commonly prescribed for anxiety, seizure treatment, sedation, insomnia, detox from alcohol and other sedatives, muscle relaxation and anesthesia. Today, commonly prescribed benzodiazepines that are used primarily for seizure treatments, sedative withdrawal and anxiety include:
COMMON BENZODIAZEPINES FOR SEIZURE TREATMENTS SEDATIVE WITHDRAWAL & ANXIETY
- Librium – chlordiazepoxide
- Valium – diazepam
- Serax – oxazepam
- Ativan – lorazepam
- Xanax – alprazolam
- Klonopin – clonazepam
- Tranxene – clorazepate
BENZODIAZEPINES FOR SLEEP INDUCTION
- Pro-Som – estazolam
- Rohypnol – flunitrazepam
- Restoril – temazepam
- Halcion – triazolam
- Dalmane – flurazepam
To be considered a benzo, the molecule must be synthesized using a benzene ring and a diazepine ring. There are other drugs that have been made and are currently in medical use that act like a benzo because they cause action at the same receptor, but are not truly benzodiazepines. They are primarily used to induce sleep and include:
- Lunesta – eszopiclone
- Sonata – zaleplon
- Ambien – zolpidem
- Imovane – zopliclone
Benzos and barbiturates are extremely useful when closely monitored and appropriately prescribed. Benzos are much safer than barbiturates and tend to be prescribed more widely. Benzos and barbiturates can be used to intentionally sedate someone to commit a theft or rape and some are known as a “date rape” drug. Neither benzos or barbiturates should be mixed with alcohol or used in combination (unless upon the advice of a physician in very strict circumstances) because their effects are not just additive or cumulative. The results of using a combination of sedatives is that they are exponential and this inappropriate pattern of use can lead to overdose and death. In fact, typically a sedative, such as alcohol, benzos or barbiturates shouldn’t be combined with an opiate, except upon the advice of a physician.
As with most other addictive drugs, the neurotransmitter dopamine is involved. Dopamine is strongly related to reward and pleasure. In most areas of the brain, barbiturates increase the release, mimic, or increase the effects of another neurotransmitter, called GABA, which inhibits neurons. Because the neurons that inhibit action of dopamine are inhibited, dopaminergic neurons are less inhibited. When the neurons that naturally release dopamine are less inhibited, they fire more often and release more dopamine, which creates euphoria and pleasurable feelings.
The GABA system is stimulated in other parts of the brain, which are what lead to increased sedation because many neuronal are inhibited by the GABA system, the opposite of what happens in the dopamine system. This is what leads to respiratory depression, hypotension (low blood pressure), decreased heart rate, decreased metabolic rate, seizure prophylaxis, and is what makes barbiturates so dangerous. Barbiturates and benzos are highly reinforcing (addictive) because of the initial euphoria created by dopamine and their anxiety reducing actions created by the GABA system.
SEDATIVE ADDICTION TREATMENT
If you or a loved one is suffering from a barbiturate addiction or benzo addiction, it is important to seek help immediately. Both classes of drugs can cause overdose when abused. Additionally, formal drug detox followed by residential drug detox is likely to be recommended because the withdrawal from barbiturates and benzos can be life-threatening. Of note, benzo withdrawal treatment is prolonged, lasting much longer than alcohol withdrawal.
To learn more about barbiturate abuse or benzo abuse, feel free to contact an Addiction Specialist at NAI by calling 844-889-8140 or by completing our confidential contact form.