What is anxiety medication abuse?

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 are prescribing this medication. 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, although there are case reports in the medical literature of 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, Caucasian, adolescent or young adult males, although all ethnicities, ages, and genders have been reported to misuse anxiolytic drugs. 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.

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 other 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, although a health care 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 also may 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 with minimizing 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 their patients have not recently been evaluated by other physicians. 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. Also, parents and child caretakers who are prescribed benzodiazepines should be sure that children do not have access to the prescribed medications.

Bibliography

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Forrester, Mathias. “Alprazolam Abuse in Texas, 1998–2004.” Journal of Toxicology and Environmental Health, part A, 69 (2006): 237–43. Print.

Hernandez, S., and L. Nelson. “Prescription Drug Abuse: Insight into the Epidemic.” Clinical Pharmacology and Therapeutics 88.3 (2010): 307–17. Print.

"Prescriptions for Anti-Anxiety Medications Put Teens At Risk." National Institute on Drug Abuse. Natl. Insts. of Health, 29 Dec. 2014. Web. 27 Oct. 2015.

"Signs and Symptoms of Prescription Drug Use." Narconon. Narconon International, n.d. Web. 27 Oct. 2015.