Abuse of benzodiazepines
Abuse, which occurs with regular intake of benzodiazepine group drugs, leads to narcotic( toxicomaniac) dependence.These psychoactive substances share a common structural chemical structure.Contents: Table of contents: General information on benzodiazepines When benzodiazepines are used, the peculiarities of effects Paradoxical reactions and side effects Development of dependence on benzodiazepine abuse How is benzodiazepine abuse manifested Disappearance syndrome, benzodiazepine abstinence Overdose with benzodiazepine abuse Treatment of benzodiazepine abuse
Each drug of this class of medicinesThe following effects are inherent in different degrees:
- sedative( calming, tranquilizing);
- sleeping pills;
- anxiolytic( eliminating anxiety);
- is myorelaxing( removing excessive muscle tension, both striated and smooth musculature);
When they are used, there is a kind of mental state, akin to alcoholic, or barbituric intoxication . This is the reason why a person taking benzodiazepine without special need tries to achieve these sensations again and again.
Note: the emerging addiction( the absence of the expected effect from the usual doses) leads to the reception of an increased amount of benzodiazepines.
General data on benzodiazepines
The classification of this series is quite extensive, but our task is somewhat different - to consider the development of painful abuse of these drugs.We only note that benzodiazepines are of three types: short, medium and long-lasting.
The history of the appearance of the first benzodiazepine - Chlordiazepoxide( Librium) begins in 1955 on the basis of the experimental work of L. Sternbakh.After 4 years, the following drug was synthesized - Diazepam.Thanks to its positive influence, a new group of substances became actively used in many fields of medicine.But by the 80th years of the XX century, physicians were seriously confronted with the massive development of abuses of benzodiazepines.It became clear that the drugs required special control when administered.Despite the ongoing work on finding new types of drugs in this group that will not cause addiction, the problem remains at the same level.
The benzodiazepine list and the standard dosage are given in the table:
The benzodiazepine drug is based on a change in the quality of gamma-aminobutyric acid( GABA), increasing its effect on neurons, leading to an anti-anxiety and soothing effect.
When benzodiazepines are used, the special effects of
Drugs are prescribed for the treatment of mental disorders against the abstinence syndrome in chronic alcoholism, for the prevention and amelioration of epileptic seizures, in the practice of treating neuroses.Especially these drugs are effective for eliminating panic attacks, anxiety conditions, sleep disorders.
It should be remembered that in pregnancy, breastfeeding and in old age, benzodiazepines give undesirable effects much more often than in other categories of people.
Paradoxical reactions and side effects
In some cases, on the background of reception, instead of the expected result may occur:
- more frequent and increased convulsive manifestations;
- attacks of aggression, maliciousness, impulsiveness;
- suicidal behavior, pronounced depression;
- sexual disorders;
- memory problems, thinking;
- speech defects;
- pathological changes in the intestines, loss of appetite, toxic liver damage.
Dependence on the abuse of benzodiazepines
The constant, uncontrolled abuse of medicines leads to a gradual development of addiction.The effect of therapy decreases.This causes patients to increase the dose and the frequency of medication. The continuous reception of benzodiazepines forms the psychic craving and physical dependence of .
Please note: to avoid mental complications, you should stop taking medication periodically, replacing them with others, or without taking anything at all.
Patients should be aware that this group of substances can only eliminate the symptoms of the ailments, but not cure them. To escape from the disease, it is necessary to eradicate its cause.Therefore, it is very important to carry out the main "etiotropic" treatment while benzodiazepines are acting.
Therapeutic periods for admission should not exceed 2-3 months.If during this time you can not eliminate the causes that caused the main manifestations of the disease, then after the withdrawal of drugs in patients will develop a withdrawal syndrome( return of fears, insomnia, anxiety, etc.), and possibly in a stronger form - bounce syndrome.
In case of untreated cases, patients quickly return to the main drug.Manifestations of dependence gradually increase.
In some cases, using benzodiazepines, people who take drugs are trying to escape their influence, soften the narcotic withdrawal.Most often this ends with the formation of a new type of polydrug use, and after a time - the development of severe benzodiazepine dependence.
How the abuse of benzodiazepines is manifested
For the effects of the drugs in this series, the
- is characterized by a feeling of complete soothing, drowsiness, impaired coordination and slow motion;
- offensive in the body of a feeling of relaxation;
- mood improvement( but its possible changes);
- periodic development of motor and non-target activity;
- Difficult perception of external stimuli, slowness of the switchability of attention;
- decrease in the overall rate of mental reactions.
Note: the manifestation of benzodiazepine intoxication by most features resembles that of barbiturates and alcohol.
When examining a patient, the physician draws attention to:
- unsteady standing( especially in the Romberg position);
- the patient with difficulty performs delicate operations( take a pen, book);
- Dysarthritic disorders - vague, plaiting speech, difficult pronunciation of sounds;
- obsessive repetition of words, phrases, movements;
- emotional impoverishment, or vice versa, inadequate reactions( inappropriate laughter, inadequate sadness, sadness);
- significant dilatation of the pupil of the patient, pallor of the skin;
- white plaque on the tongue, dry skin and mucous membranes;
- excessive muscle relaxation, loss of their tone, lethargy;
- decreased reflexes.
Phenomena gradually increase, the patient falls asleep after several hours. After awakening, there remains a pronounced weakness and emotional "stupor".Gradually the manifestations go away.
The constant reception of medicines forms addiction to the medicine, tolerance increases( low sensitivity to usual doses).The absence of habitual sensations forces patients to constantly increase the dose.On the first place in intoxication come mental changes, and discoordination problems decrease. Doses of benzodiazepine-dependent people can repeatedly exceed one-time and diurnal doses.
Abstinence syndrome, benzodiazepine abstinence
During abstinence, painful sensations arise that require the use of the next dose.That is, the withdrawal syndrome becomes more and more obvious.The patient is increasingly beginning to look for an excuse and possibilities for taking medications.
The dependent appears:
- marked pallor, lethargy, depression;
- irritability with capriciousness and tearfulness, even in men;
- heart rate increases dramatically, pressure decreases, the patient sweats profusely;
- fingers are shaking;
- pupils widen sharply;
- severe depression;
- sleep disorders with nightmarish, often intermittent dreams;
In more severe cases, convulsive seizures, psychoses with hallucinatory experiences, suicidal thoughts and actions may occur.In some patients, depersonalization develops.
Note: The abstinence can last about 2-3 weeks and more, depending on the individual characteristics.
Over time, the course of abuse of benzodiazepines is complicated by psychopathy and personality disorders. Patients have severe memory problems, intellectual disabilities, impoverishment of emotional coloring, face acquires a mask.A person is progressing with egocentrism, moral distortions( the whole world needs something to him).In character traits, rudeness and rudeness, indifference to others, cruelty are manifested.Mental loads are given with difficulty.Ability to physical work is reduced.
Overdosing for benzodiazepine abuse
Overdoses of benzodiazepines occur in rare cases.The poisoning effect of these drugs is more common when combined with alcohol, opiate group drugs, antidepressants of the tricyclic series.
Overdose manifests itself:
- expressed by drowsiness, turning into a stupor and to whom;
- drop in blood pressure;
- by dysfunction of eyeballs with nystagmus( pendular movement);
- problems with speech;
- with sphincter disorders;
- by stopping breathing and cardiac activity.
Treatment of benzodiazepine abuse
The treatment of benzodiazepine dependence has a number of characteristics.If the patient's condition allows, then it can be carried out on an outpatient basis. Severe cases, especially combined dependence, require hospital conditions.
The question of the termination of admission is examined on an individual basis. For the correct approach, it is necessary to take into account many factors. The optimal solution is a one-stage, complete cessation of use of the drug.Although some narcologists use and step-down dose reduction .Practice shows that a sharp "break" in the reception gives more effective results, even at high doses of benzodiazepines.
Most patients have very severe depression, fear of death, weight loss, and asthenia.
In this case, an experienced narcologist selects the necessary antidepressant.In recent years, the drug Trittico proved very well.With his help, the withdrawal syndrome softens and passes almost painlessly.It usually takes a few months to eliminate all negative manifestations of withdrawal symptoms.Trittico acts very gently and does not contain strict contraindications.
After leaving antidepressants, you will have to remove the effects of asthenia for a long time.For this purpose, the nootropics of are most suitable.They should be selected depending on the dominant residual phenomena.Sometimes nootropics are required with a stimulating effect, sometimes - on the contrary, with a calming effect.Reception of this group of medicines can be necessary for a long time, since after benzodiazepine dependence there remains a pronounced damage to the mnestic functions in the patient.
It is important to maintain the heart( the most optimal is Mildronate), and the liver. Prolonged reception of benzodiazepines exerts a marked load on the liver cells.Therefore, the use of hepatoprotectors in a short time eliminates toxic effects.From modern protecting and purifying toxins of hepatic drugs, special attention can be paid to Gepadif, both in injecting and capsule form.
An important role is given to psychotherapy.The methods of suggestion and persuasion, which are the main form of the effect of this method of treatment, are applied both individually and in group effects.
Hypnotherapy allows you to consolidate motivational goals based on the abandonment of benzodiazepines.
After the treatment is over, psychiatrists and narcologists have a psychotherapy course.From their ability to stabilize mental processes in a recovering patient depends on the duration of remission.
Alexander Lotin, medical reviewer