Anxiolytic Dependence: Signs, Symptoms, & Treatment

Understanding Sedative-Hypnotic or Anxiolytic Use Disorder

Barbiturates used to be the most prescribed drugs for anxiety in the United States until alternative medications called benzodiazepines were created, which produced milder side effects. Both substances fall into the drug class or sedative-hypnotic or anxiolytic medications, which are prescription drugs used to treat anxiety.

Sedative-hypnotic or anxiolytic medications of all types can lead to dependence and addiction, especially when used for long periods. A sedative, hypnotic, or anxiolytic use disorder, is a substance use disorder characterized by the repeated use of drugs like benzodiazepines, carbamates, barbiturates, and hypnotics, despite the significant physical and psychological problems associated with their abuse.

People with substance use disorders are usually unable to control their urges to use the substances in question, leading to long-term health, mental, and social problems. An anxiolytic use disorder usually occurs in those who begin to abuse sedatives, hypnotics, or anxiolytics by taking higher doses or mixing them with other substances.

Many patients who have taken benzos or barbiturates for long periods may develop a tolerance to a particular dose, which could slightly decrease the overall efficacy of the drug. To compensate, the person may take higher doses without consulting their doctor, so they experience the same relief or effects as before. This pattern of behavior is usually what gives way to addiction.

Anxiolytic Dependence & Withdrawal Symptoms

Anxiolytic dependence is marked by withdrawal symptoms, which occur when the person reduces or stops drug use. Anxiolytic withdrawal or detox can be extremely uncomfortable and challenging without the aid of a medical team or guidance of a detox schedule.

Common sedative, hypnotic, or anxiolytic withdrawal symptoms include:

• Tremors
• Insomnia
• Agitation
• Anxiety
• Paranoia
• Hallucinations
• Convulsions
• Lack of coordination
• Restlessness
• Nausea and/or vomiting

Withdrawing from anti-anxiety medication can also lead to rebound symptoms of insomnia or anxiety symptoms that the medication is being taken to treat in the first place. These withdrawals can occur days to weeks after cessation. The reappearance of a mood or anxiety disorder may also occur during anxiolytic withdrawal and may not subside over time.

The severity of withdrawals depends on the dose the person was used to taking and the duration of use. While anxiolytic withdrawal may not occur in someone who took low doses of benzodiazepines for less than four months, higher doses taken for longer periods could produce more severe and longer-lasting side effects.

Usually, physical dependence is most common among patients who use their medications for long periods and among those who use them in non-medical settings, such as, to self-medicate psychotic symptoms, enhance the euphoria, or manage the withdrawals of other drugs.

Patients who are prescribed high doses of anxiolytic medications for more than a month are at higher risk of dependence, especially if they have a personal history of alcohol or prescription drug abuse, or a family history of alcoholism or benzodiazepine use disorder.