Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

with 10 percent of teens using inhalants at least once. It is often seen with other substance use

disorders, conduct disorder, antisocial personality disorder (in adults), depression, and

suicidality. There is an increased risk of nicotine, alcohol, cocaine, amphetamine, and

hallucinogen use in adults, as well as personality, anxiety, and mood disorders.

There are no medications that are helpful in treating inhalant abuse. The patient can be

treated with typical substance abuse treatment strategies as well as psychotherapy. Many will have comorbidities that may be treated with medications and/or therapy. Inpatient or

outpatient treatment strategies can be used. Patients with severe comorbidities often are more

motivated to quit inhalant use. Because of their comorbidities, many will require lifetime

psychiatric or psychological support.

SEDATIVE, HYPNOTIC, OR ANXIOLYTIC-RELATED DISORDERS

Since ancient times, self-medication for insomnia and anxiety has taken place. A combination of alcohol and opium was initially used, with other drugs used in the 19th century. Barbiturates and benzodiazepines became popularized in the 20th century. The use of sedative-hypnotics

and benzodiazepines continues to this day. Both substance abuse and substance dependence

on these drugs exist. Abuse implies use that is harmful to the individual and dependence

implies the need to use the drug to function normally. These can happen together or

separately.

The new DSM-V has combined the abuse and dependence on these types of drugs into one

substance use disorder, in which there needs to be distress or functional impairment when

using the drug. Drug craving is one of the symptoms but it is not a requirement. Legal problems

have been removed as a symptom. Some will use these drugs to self-medicate, while others

are using it for euphoria and other positive symptoms. Use for a minimum one month is

necessary for drug dependence to occur.

Use of the drug can cause drowsiness, impaired judgment, and motor impairment. Anterograde

amnesia is a typical complication of using benzodiazepines or sedative-hypnotics.

Complications tend to occur when the patient is using some other type of drug along with

benzodiazepines or sedative-hypnotics. Barbiturates on their own will cause stupor, coma, and

respiratory depression—even in small doses. Withdrawal can cause hallucinations, seizures,

anxiety, insomnia, tremor, autonomic symptoms, and psychomotor agitation. Reemergence of

an anxiety or mood disorder can happen and does not usually subside. Withdrawal is seen after

four months or more of use. Even with therapeutic doses, there can be prolonged insomnia,

irritability, and anxiety after stopping the drug.

The diagnosis requires two of these criteria to be met:

• Continued use of the drug despite negative personal consequences.

• Impaired functioning in one or more life areas.

• Use in hazardous situations.

• Continued use despite social or interpersonal issues when taking it.

• Tolerance to the drug.

• Withdrawal symptoms when stopping the drug.

• Unsuccessful attempts to stop drug use.

• Spend time procuring, using, or recovering from the drug.

• Avoiding activities in order to use.

• Persistent cravings for the drug.

Flumazenil can be used for overdose or intoxication but it can cause seizures and severe

withdrawal symptoms. Benzodiazepine use alone probably does not need reversal as it can be

treated supportively and does not result in death. Barbiturate overdoses can be treated with urine alkalization or dialysis. Phenobarbital tapering will also help an overdose/dependence

situation. Withdrawal can be prevented by tapering doses of phenobarbital as well. Melatonin

and zolpidem will reduce the insomnia seen after stopping these drugs. Cognitive behavioral

therapy and twelve-step programs can help with treating the addiction.