Anxiety medication abuse
Anxiety medication abuse refers to the misuse of anxiolytic medications, primarily benzodiazepines, which are prescribed to alleviate symptoms of anxiety and panic attacks. This abuse occurs when individuals take medications in ways not directed by healthcare providers, such as using them more frequently, in higher doses, or for extended periods. Alprazolam (Xanax) is the most commonly abused benzodiazepine, often sought for its euphoric and sedative effects. Although benzodiazepines are generally safe when used as prescribed, their abuse can lead to severe side effects, including confusion, impaired memory, and even life-threatening outcomes like coma or death.
Risk factors for anxiety medication abuse include being non-Hispanic White, young adult males, and adolescents, with women being particularly susceptible due to higher prescription rates. Individuals with a history of substance abuse or co-occurring mental health disorders are also at increased risk. Treatment options often include gradual medication tapering to minimize withdrawal effects, alongside behavioral therapies to address underlying issues. Preventive measures involve careful prescribing practices and monitoring to reduce the likelihood of abuse or “doctor shopping.” Overall, understanding the complexities of anxiety medication abuse is essential for effective intervention and support.
Anxiety medication abuse
ALSO KNOWN AS: Anxiolytic medication abuse
DEFINITION: Anxiolytic medications are typically prescribed to reduce the symptoms of anxiety and panic attacks. Anxiety medication abuse occurs when these drugs are used for reasons other than what is instructed by a healthcare provider. The drugs may have been prescribed for a medical reason or may have been obtained illegally. They are taken more frequently, at a greater dose, or for a longer period of time than directed to produce changes in one’s mental or physical state.
Causes
The most commonly abused class of anxiety medications is the benzodiazepines, and the most frequently abused benzodiazepine is alprazolam (Xanax) because of the increasing frequency with which physicians prescribed this medication in the late 1990s and early 2000s. Other common types of benzodiazepines are clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Additional classes of anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs), are not as popular with abusers because they fail to deliver the same euphoric and sedating effects. Still, there are case reports in the medical literature of the recreational use of SSRIs and other anxiety drugs. Tolerance and physical dependence may occur after a short time of abuse, causing people to use larger quantities of medication to produce the same effects and to avoid withdrawal symptoms, respectively.
Risk Factors
Persons who abuse anxiety medications are more often non-Hispanic, White, adolescents, or young adult males, although all ethnicities, ages, and genders have been reported to misuse anxiolytic drugs. Women are at risk of anxiety medication abuse because they are more likely to be prescribed medications and have a higher incidence of anxiety disorders. Adolescents are at particularly high risk because of the ability to safely obtain the substance from a friend or from a family member who is prescribed the medication. The increasing knowledge many teenagers have regarding the dark web, where prescription medications can be obtained in online anonymous forums, is also a source.
Alcohol users and persons with a psychiatric diagnosis are also at high risk for anxiety medication abuse. Those who are contemplating suicide are more likely to add benzodiazepine medications to alcohol. Abusers of illegal drugs, such as opiates (heroin and methadone), marijuana, and cocaine, often also abuse anxiolytic drugs. However, it is more likely for an illicit substance abuser to secondarily abuse a benzodiazepine than it is for a benzodiazepine abuser to secondarily begin abusing other illegal substances.
Symptoms
While these drugs are typically considered safe and effective when taken in prescribed doses, they may lead to significant and life-threatening symptoms when abused. Benzodiazepines are intended to produce a calming and drowsy sensation to reduce anxiety or panic attacks by depressing the central nervous system. Persons who abuse the drug seek the euphoria or extreme sleepiness that occurs when taken in excess quantity. When combined with other illegal substances, especially opiates, the benzodiazepines often enhance or extend the other drug’s high. Additionally, anxiety medication may counteract the unwanted effects of abusing illegal substances.
Adverse effects of abuse include confusion, lack of coordination, impaired memory, tachycardia, hallucinations, and coma. Although rare, case reports of death have been documented. Some but not all publications in the medical literature found that when compared with other benzodiazepines, the greatest risk for death is with Xanax abuse. Withdrawal symptoms, such as nausea, tremors, abdominal cramps, sweating, and seizures, may result from sudden discontinuation of the drugs.
Screening and Diagnosis
A urine drug screen will detect the presence of benzodiazepines. However, a healthcare provider would need to determine if the test was positive because of a legal prescription or if the substance was being abused. Because anxiety medication abuse often occurs in conjunction with other illegal substance or alcohol abuse, physicians should screen patients for concurrent disorders before prescribing anxiety medications. Inquiring about other psychological diagnoses may also help identify persons at risk for abusing the prescription.
Treatment and Therapy
As with many substances of abuse, a gradual tapering off of the anxiety medication may help with the process of detoxification and minimize withdrawal symptoms. Persons who abuse anxiety medications seek treatment less frequently than those who abuse illegal substances or alcohol; those who have an addiction may be referred to Narcotics Anonymous or Pills Anonymous to complete a twelve-step program. Individual or group inpatient or outpatient therapy has proven effective for treating underlying anxiety, coexisting mental health disorders, or substance abuse problems.
Prevention
Physicians should take care when prescribing medications to ensure that other physicians have not recently evaluated their patients. Many people who abuse anxiety medications are known to “doctor shop,” that is, they simultaneously seek the care of multiple physicians for the same prescription. Pharmacists should verify that a patient is not filling excessive prescriptions for the medication and that the prescription is not fraudulent. The proliferation of electronic medical records has helped stop doctor shopping. Also, parents and child caretakers who are prescribed benzodiazepines should be sure that children do not have access to the prescribed medications.
Bibliography
Fenton, Miriam C., et al. "The Role of a Prescription in Anxiety Medication Use, Abuse, and Dependence." The American Journal of Psychiatry, vol. 167, no. 10, 2010, p. 1247, doi.org/10.1176/appi.ajp.2010.09081132. Accessed 22 Aug. 2024.
Forrester, Mathias. "Alprazolam Abuse in Texas, 1998–2004." Journal of Toxicology and Environmental Health, Part A, vol. 69, 2006, pp. 237–43.
Hernandez, S., and L. Nelson. "Prescription Drug Abuse: Insight into the Epidemic." Clinical Pharmacology and Therapeutics, vol. 88, no. 3, 2010, pp. 307–17.
Safai, Yalda. "Popular Anti-anxiety Medications may be Highly Addictive, FDA Says. But Is the Warning too Late?" ABC News, 14 Mar. 2020, abcnews.go.com/Health/popular-anti-anxiety-medications-highly-addictive-fda-warning/story?id=73295488. Accessed 22 Aug. 2024.
Terlizzi, Emily P., and Tina Norris. "Mental Health Treatment Among Adults: United States, 2020." CDC, Oct. 2021, www.cdc.gov/nchs/products/databriefs/db419.htm. Accessed 22 Aug. 2024.
Vandergriendt, Carly. "How to Recognize and Treat Xanax Addiction." Healthline, 18 Aug. 2021, www.healthline.com/health/addiction/xanax-addiction#how-to-recognize-addiction-in-others. Accessed 21 Nov. 2022.