Antianxiety Drugs and Sedatives
Prescription drugs used to treat anxiety (antianxiety drugs) and induce sleep (sedatives or sleep aids) can cause dependence. Such drugs include benzodiazepines, barbiturates, glutethimide, chloral hydrate, and meprobamate. Each works in a different way, and each has a different dependency and tolerance potential. Most people dependent on antianxiety drugs and sedatives started out taking them for a medical reason. Dependency can develop within as little as 2 weeks of continual use.
 See the sidebar Classifying the Abuse Potential of Prescription Drugs.
Symptoms and Complications
Antianxiety drugs and sedatives decrease alertness and can result in slurred speech, poor coordination, confusion, and slowed breathing. These drugs may make a person alternately depressed and anxious. Some people experience memory loss, faulty judgment, a shortened attention span, and frightening shifts in their emotions. Older people may appear demented, speaking slowly and have difficulty in thinking and in understanding others. Falls may occur that result in broken bones, especially hip fractures.
People who have used sedatives for more than a few days often feel that they cannot sleep without them. They may become anxious and nervous at bedtime without the drugs and may awaken irritable.
Abrupt withdrawal from antianxiety drugs and sedatives can produce a severe, frightening, and potentially life-threatening reaction, much like alcohol withdrawal (delirium tremens (see Section 7, Chapter 108)). The time course of withdrawal reactions varies from drug to drug. Within the first 12 to 24 hours, the person may become nervous, restless, tremulous, and weak. Seizures may occur in those taking high doses. Occasionally, a seizure may occur even 1 to 3 weeks after withdrawal.
Other effects that can occur during withdrawal include dehydration, delirium, insomnia, confusion, and visual and auditory hallucinations (seeing and hearing things that are not there). Serious withdrawal reactions are more common with barbiturates or glutethimide than with benzodiazepines. The person is usually hospitalized during the withdrawal process because of the possibility of a severe reaction.
Treatment
Emergency Treatment: A person who has overdosed on antianxiety drugs or sedatives requires hospitalization, usually in the intensive care unit. Benzodiazepines do have an antidote--flumazenil. Supportive care is given; which may include intravenous administration of fluids, drugs if blood pressure drops, and a ventilator.
Detoxification and Rehabilitation: People with mild withdrawal symptoms require social and psychologic support to help them overcome a strong urge to begin using the drug again to stop the feelings of anxiety. People with severe withdrawal symptoms usually need to begin taking the drug again at a lower dose and under close medical supervision, sometimes in the hospital. The dose is decreased gradually over days or weeks and then discontinued. Even with the best treatment, a person may not feel normal for a month or more.
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