Condition Header Background

What is Anxiolytic Use Disorder?

LISTEN TO THIS ARTICLE:

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.

FIND A PROVIDER

 

Causes and Risk Factors

Who uses these drugs?

Sedatives are some of the most common drugs in the U.S., with over 12% of the population receiving a prescription in a given year. There are two distinct patient groups in this use disorder. One is those who started taking them under a physician’s supervision.  The more common case, though, is people who used them recreationally from the start. There are plenty of people who take these drugs for valid medical reasons (anxiety, insomnia) and do not develop anxiolytic use disorder. The risk increases with short-acting medications and in patients coming out of intensive care settings where they received frequent high doses.

Starting early

Patients who have always taken them illegally mostly start in late adolescence. They use them occasionally at first, in addition to other substances, and then slowly progress to heavier use. Compared to people who begin illegally using prescription drugs after age 21, those starting prior to age 13 are two and a half times as likely to develop a use disorder.

Perils in old age

One subset of those at high risk is the elderly, who frequently receive these medications to treat insomnia. They metabolize the medications slower and develop physical dependence easier. This is a risk factor for developing a use disorder. Rather than attempting to get ‘high’ (as is the case with younger people using sedatives recreationally), the elderly suffer a combination of the biological realities of advanced age and interactions from their multiple other medications.

Many addictions

Patients who abuse multiple drugs are at high risk for abusing sedatives. One third of opiate abusers (usually methadone) combine them with benzodiazepines because the resulting ‘high’ far exceeds that of either drug alone. Heavy drinkers are also at high risk for abusing these drugs. They are frequently prescribed these medications for anxiety and insomnia related to drinking (by unknowing physicians). They report more powerful effects than the general population, likely due to the similar mechanisms of action.

Diagnosing Sedative, Hypnotic, and Anxiolytic Use Disorder

What are all these drugs?

Drugs in anxiolytic use disorder are usually taken orally, as tablets or liquids, or crushed and snorted. Benzodiazepines are a large class including drugs like Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Klonipin (clonazepam), and Librium (chlordiazepoxide). They are used to treat anxiety, insomnia, and seizures. Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon), which work similarly to benzodiazepines, aid in sleep disorders as well.

Barbiturates, like Amytal (amobarbital) and Seconal (secobarbital), also treat anxiety, insomnia, and seizures. However, they are much less common since being replaced by safer benzodiazepines in the 1970s.

Rounding out the drugs in this disorder are Quaalude (methaqualone), Miltown (meprobamate), and GHB (gamma-hydroxybutyrate). All have similar effects to benzodiazepines, but abuse of these is far less common now. They have fallen out of favor in medical practice because of their much more dangerous side effect profiles and consequently are very hard to find.

Signs and symptoms

Diagnosis requires at least two symptoms over the course of one year. Patients exhibit the following behaviors:

  1. Take large doses of sedatives, hypnotics, and anxiolytics, or take them beyond the time prescribed
  2. Want or try to cut down, but can’t
  3. Make a full-time job out of finding, using and recovering from sedatives, hypnotics, and anxiolytics
  4. Crave sedatives, hypnotics, and anxiolytics or fight strong impulses to use them
  5. Shirk responsibilities at home, work or school
  6. Suffer socially and in relationships because of their sedative, hypnotic, and anxiolytic use
  7. Abandon once-important social, career, or leisure activities
  8. Risk life and limb under the influence of sedatives, hypnotics, and anxiolytics, such as driving a car or operating machinery
  9. Don’t care that their drug use is harming their physical or mental health
  10. Need increasingly large doses to achieve the desired effect (and can’t get it on a lesser dose)
  11. Undergo withdrawal (nausea, vomiting, tremor, increased heart rate, hallucinations, difficulty sleeping, anxiety, psychomotor agitation, seizures) when they stop using sedatives, hypnotics, and anxiolytics, or use just to avoid the symptoms of it

Increasing numbers of symptoms determines the severity of the disorder. Four or five symptoms qualify as a moderate case; it’s a severe case if there’s six symptoms or more. Patients are in early remission if they have had none of those criteria for at least three months and not more than one year. Late remission extends beyond one year.

Treating Sedative, Hypnotic, and Anxiolytic Use Disorder

Withdrawal like alcohol

The effects of drugs in anxiolytic use disorder on the brain are similar to those of alcohol. As a result, the first step in treatment is seizure prevention during withdrawal. In heavy users, doses need to slowly wean down over several days with phenobarbital (a sedative chosen for its long period of action) in a hospital setting.

In mild cases, patients can detox in the outpatient setting using the long-acting benzodiazepine, clonazepam, over several weeks. The addition of non-habit forming anticonvulsants like Tegretol (carbamazepine), Neurontin (gabapentin), and Topamax (topiramate) also shows promise in aiding detoxification. A study showed that adding Tegretol to a benzodiazepine taper significantly increased the chance of attaining and maintaining abstinence. There is also some evidence that adding Topamax can reduce the symptoms of benzodiazepine withdrawal.

Overdose management

Romazicon (flumazenil) rapidly reverses the effects of benzodiazepines and can be life-saving in acute overdoses. However, if the patient is a long-standing user of benzodiazepines, Romazicon can induce seizures and should not be used. Overdoses of barbiturates require a special medication called sodium bicarbonate. This accelerates the drug’s excretion through urine, and severe cases may need temporary dialysis.

Helpful medications

When patients on benzodiazepines for anxiety slowly transitioned to Lyrica (pregabalin), as part of detoxification, patients experienced fewer problems with sleep. Furthermore, Lyrica during detox cuts both anxiety and depression rating scores in half. If patients had received benzodiazepines as a sleep aid, melatonin can significantly improve sleep during and after detoxification.

Cognitive Behavioral Therapy

Patients with anxiolytic use disorder often receive CBT as part of detoxification because of its success in treating anxiety. It is also helpful in patients who were taking these drugs for insomnia. In patients with Panic Disorder, the addition of CBT to benzodiazepine taper tripled the rate of successful detoxification compared to taper alone. However, in patients without an anxiety disorder, the few studies examining CBT’s efficacy show little added benefit from CBT.

Managing Sedative, Hypnotic, and Anxiolytic Use Disorder

Get help getting started

Patients who are avoiding treatment for financial reasons should feel assured that detoxification can be relatively inexpensive because most people will not need to stay in the hospital. Any general practitioner or psychiatrist can prescribe weaning doses of benzodiazepines. Patients with anxiolytic use disorder should not attempt to stop alone or all at once. Because of the seizure potential when withdrawing from these drugs, it is critical that detoxification be conducted under a physician’s direction.

Peer support

Options for free group-oriented support include Narcotics Anonymous and the more recently founded Pills Anonymous, which focuses specifically on those who abuse prescription medications.

Don’t neglect the original problem

In cases where patients started benzodiazepines for legitimate medical reasons like anxiety or insomnia, those conditions should be addressed as part of treatment. Failing to treat the original condition will hamper progress in recovery. Even if this is not the case, anxiety commonly presents a significant barrier during detoxification, and appropriate anxiety treatment increases chances of successful recovery.

Sedatives and the elderly

Look out for elderly loved ones who are having memory and cognitive issues or have had a recent fall. Doctors can rule out sedatives as a possible culprit before going forward with a workup for dementia or misattributing the nature of a fall.

Types of Substance Use Disorders

Wondering about a possible disorder but not sure? Let’s explore your symptoms.

IDENTIFY YOUR SYMPTOMS
References
  1. Drug Enforcement Administration. (2015). Drug Fact Sheet: Rohypnol. [Citation is in section Methods of abuse, paragraph 1]
  2. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Associated Features Supporting Diagnosis, paragraph 1]
  3. Licata, S. C., & Rowlett, J. K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABA A receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1), 74-89. [Citation is on p.4, paragraph 3]
  4. Drug Enforcement Administration. (2015). Drug Fact Sheet: Depressants. [Citation is in section Overview, paragraph 1]
  5. Cooper, JS. 2015. Sedative-Hypnotic Toxicity. Available at http://emedicine.medscape.com/article/818430-overview#showall. Accessed 10/28/16. [Citation is in section Pathophysiology, paragraph 1]
  6. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Intoxication, subsection Diagnostic Criteria, Criteria C.1-6]
  7. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Functional Consequences of Sedative, Hypnotic, or Anxiolytic Use Disorder, paragraph 1]
  8. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Development and Course, paragraph 4]
  9. Bogunovic, O. J., & Greenfield, S. F. (2004). Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatric Services, 55(3), 233-235. [Citation is on p.2, paragraph 2,3]
  10. Cooper, JS. 2015. Sedative-Hypnotic Toxicity. Available at http://emedicine.medscape.com/article/818430-overview#showall. Accessed 11/2/16. [Citation is in section Epidemiology, subsection Morbidity/Mortality, paragraph 1,2]
  11. Cooper, JS. 2015. Sedative-Hypnotic Toxicity. Available at http://emedicine.medscape.com/article/818430-overview#showall. Accessed 11/2/16. [Citation is in section History, subsections Barbiturates, Methaqualone, Meprobamate]
  12. Drug Enforcement Administration. (2015). Drug Fact Sheet: Rohypnol. [Citation is in section Overview, paragraph 1; section Methods of abuse, paragraph 1]
  13. Benzer, TI. 2015. Gamma-Hydroxybutyrate Toxicity. Available at http://emedicine.medscape.com/article/820531-overview#showall. Accessed 11/2/16. [Citation is in section Epidemiology, subsection Morbidity/Mortality]
  14. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders. Available at http://emedicine.medscape.com/article/290585-overview#showall. Accessed 10/28/16. [Citation is in section Epidemiology, paragraph 1]
  15. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Development and Course, paragraph 1 and 2]
  16. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Diagnostic Features, paragraph 2]
  17. Licata, S. C., & Rowlett, J. K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABA A receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1), 74-89. [Citation is on p.4, paragraph 4]
  18. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Development and Course, paragraph 1]
  19. McCabe, S. E., West, B. T., Morales, M., Cranford, J. A., & Boyd, C. J. (2007). Does early onset of non‐medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction, 102(12), 1920-1930. [Citation is on p.5-6, paragraph 6]
  20. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Development and Course, paragraph 3,4]
  21. Licata, S. C., & Rowlett, J. K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABA A receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1), 74-89. [Citation is on p.4, paragraph 4; p.5, paragraph 2]
  22. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Development and Course, paragraph 4]
  23. Licata, S. C., & Rowlett, J. K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABA A receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1), 74-89. [Citation is on p.4, paragraph 3]
  24. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Risk and Prognostic Factors, subsubsection Environmental, paragraph 1]
  25. Licata, S. C., & Rowlett, J. K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABA A receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1), 74-89. [Citation is on p.4, paragraph 3]
  26. Drug Enforcement Administration. (2015). Drug Fact Sheet: Benzodiazepines. [Citation is in section Methods of abuse, paragraph 1]
  27. Drug Enforcement Administration. (2015). Drug Fact Sheet: Benzodiazepines. [Citation is in section Looks Like, paragraph 1]
  28. MedlinePlus. 2015. Zolpidem. Available at https://medlineplus.gov/druginfo/meds/a693025.html. Accessed 10/27/16. [Citation is on section Why is this medication prescribed?]
  29. MedlinePlus. 2015. Zaleplon. Available at https://medlineplus.gov/druginfo/meds/a601251.html. Accessed 10/27/16. [Citation is on section Why is this medication prescribed?]
  30. Lafferty, KA. 2014. Barbiturate Toxicity. Available at http://emedicine.medscape.com/article/813155-overview#showall. Accessed 10/28/16. [Citation is on paragraph 7]
  31. Drug Enforcement Administration. (2015). Drug Fact Sheet: Barbiturates. [Citation is in section Overview, paragraph 1; Looks Like, paragraph 1]
  32. Cooper, JS. 2015. Sedative-Hypnotic Toxicity. Available at http://emedicine.medscape.com/article/818430-overview#showall. Accessed 10/28/16. [Citation is in section Background, subsection Non-Barbiturates]
  33. Benzer, TI. 2015. Gamma-Hydroxybutyrate Toxicity. Available at http://emedicine.medscape.com/article/820531-overview#showall. Accessed 10/28/16. [Citation is in section Background, paragraph 4]
  34. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Diagnostic Criteria, Criterion A]
  35. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, and Anxiolytic Use Disorder, subsection Diagnostic Criteria]
  36. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Diagnostic Criteria, Severity Criteria]
  37. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Diagnostic Criteria, Remission Criteria]
  38. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). [Citation is in section Sedative, Hypnotic, or Anxiolytic Use Disorder, subsection Diagnostic Criteria, Remission Criteria]
  39. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 10]
  40. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 11,12,13]
  41. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 16, 18]
  42. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 19]
  43. Schweizer E, Rickels K, Case WG, Greenblatt DJ. (1991). Carbamazepine treatment in patients discontinuing long-term benzodiazepine therapy. Effects on withdrawal severity and outcome. Arch Gen Psychiatry, 5:448-452. [Citation is on p.4, section Comment, paragraph 2]
  44. Cheseaux, M., Monnat, M., & Zullino, D. F. (2003). Topiramate in benzodiazepine withdrawal. Human Psychopharmacology: Clinical and Experimental,18(5),375-377. [Citation is on p.2, section Discussion, paragraph 1]
  45. Michopoulos, I., Douzenis, A., Christodoulou, C., & Lykouras, L. (2006). Topiramate use in alprazolam addiction. The World Journal of Biological Psychiatry, 7(4), 265-267. [Citation is on p.76, section Discussion, paragraph 2]
  46. Gresham, C. 2016. Benzodiazepine Toxicity Treatment and Management. Available at http://emedicine.medscape.com/article/813255-treatment#showall. Accessed 10/28/16. [Citation is in section Flumazenil, paragraph 1, 3]
  47. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 8]
  48. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 26]
  49. Oulis, P., & Konstantakopoulos, G. (2010). Pregabalin in the treatment of alcohol and benzodiazepines dependence. CNS neuroscience & therapeutics, 16(1), 45-50. [Citation is on p.4, section PGB in BDZ-dependence, paragraph 3]
  50. Peles, E., Hetzroni, T., Bar‐Hamburger, R., Adelson, M., & Schreiber, S. (2007). Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: a double‐blind randomized clinical trial. Addiction, 102(12), 1947-1953. [Citation is on p.5, section Discussion, paragraph 2]
  51. National Institute on Drug Abuse. 2014. Prescription Drug Abuse. Available at https://www.drugabuse.gov/publications/research-reports/prescription-drugs/treating-prescription-drug-addiction/treating-addiction-to-cns-depressants. Accessed 10/29/16. [Citation is on section Treating Addiction to CNS Depressants, paragraph 1]
  52. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Outpatient Care, paragraph 2]
  53. Michael, W. (1993). Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry, 150(10), 1485-1490. [Citation is on p.3, section Results, paragraph 1]
  54. Voshaar, R.C.O., Gorgels, W.J., Mol, A.J., Van Balkom, A.J., Van de Lisdonk, E.H., Breteler, M.H., Van den Hoogen, H.J. and Zitman, F.G. (2003). Tapering off long-term benzodiazepine use with or without group cognitive–behavioural therapy: three-condition, randomised controlled trial. The British Journal of Psychiatry, 182(6), 498-504. [Citation is on p.6, section Efficacy of group CBT, paragraph 1]
  55. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 15]
  56. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Follow-up. Available at http://emedicine.medscape.com/article/290585-followup#showall. Accessed 11/2/16. [Citation is in section Further Outpatient Care, paragraph 1]
  57. Pills Anonymous. 2016. Home. Available at http://www.pillsanonymous.org/. Accessed 11/2/16. [Citation is on main page, paragraph 1]
  58. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 25]
  59. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 26]
  60. Scher, LM. 2014. Sedative, Hypnotic, and Anxiolytic Use Disorders Treatment and Management. Available at http://emedicine.medscape.com/article/290585-treatment#showall. Accessed 10/28/16. [Citation is in section Medical Care, paragraph 26]
  61. Oulis, P., & Konstantakopoulos, G. (2010). Pregabalin in the treatment of alcohol and benzodiazepines dependence. CNS neuroscience & therapeutics, 16(1), 45-50. [Citation is on p.4, section PGB in BDZ-dependence, paragraph 3]
  62. Bogunovic, O. J., & Greenfield, S. F. (2004). Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatric Services, 55(3), 233-235. [Citation is on p.2, paragraph 2]