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What is Anxiolytic Use Disorder?

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Because of the wide range of drugs in Sedative, Hypnotic, and Anxiolytic Use Disorder, it is difficult to describe a singular, typical user. While they can be used alone, they are more frequently abused in concert with other substances. Combining them with alcohol and opiates intensifies the desired high, while stimulant users often add benzodiazepines to their regimen to reduce the agitation that comes with stimulants. Elderly patients frequently get benzodiazepines to help with sleep, and patients often leave intensive care settings on high doses as well. This category also includes the so-called ‘date-rape drugs’, which sexual predators use to incapacitate unsuspecting victims.

But what do they all have in common? The drugs in anxiolytic use disorder are central nervous system depressants. They slow brain function, promote muscular relaxation and sleep, decrease anxiety, and treat seizures by boosting the effects of GABA, the main inhibitory brain messenger. Because these drugs share their mechanism of action with alcohol, intoxication results in similar symptoms, such as slurred speech, difficulty walking, slowed reaction time, decreased reflexes, impaired thinking, reduced inhibitions, and stupor. However, the drugs’ effects are often distorted because they are mixed with other substances.

Types of sedatives

While benzodiazepines are quite safe alone, combination with alcohol or opiates can easily lead to respiratory depression, coma, and death, and the causative doses are variable and unpredictable. In the elderly, even moderate benzodiazepine doses can mimic dementia by impairing thinking and memory, as well as increasing risk of falls (and subsequent high-risk trauma like hip fractures). Most episodes of severe toxicity from sedatives are actually instances of attempted suicide, and most of those involve benzodiazepines because those are the most readily available sedatives.

Older sedatives, like barbiturates, Quaalude (methaqualone), Miltown (meprobamate), and GHB (gamma-hydroxybutyrate), are much more toxic alone than benzodiazepines. They have a lower threshold for interfering with breathing and motor control, and causing dangerously low blood pressure. GHB and the now-illegal benzodiazepine, Rohypnol (flunitrazepam), are the most well known date-rape drugs. Sexual predators slip these into the drinks of unknowing victims to rapidly induce deep sedation and amnesia. GHB is especially dangerous as it can induce muscle spasms, heart rhythm abnormalities, and coma, sometimes necessitating intensive care monitoring.

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