Addictions: Tranquillisers

Tranquilliser or minor tranquilliser are commonly used terms for three main drug types, that have sedative, hypnotic or anxiolytic action.
• Sedatives slow down the brain and the body. They are often prescribed for when people are upset or anxious.
• Hypnotics are used to induce sleep (unusually called sleeping pills). Hypnotics work by slowing the brain down.
• Anxiolytics aim to take anxiety away.
Tranquillisers can also be divided into three main ‘classes’ of drugs, (i)barbiturates, (ii) benzodiazepines and (iii)others. Drugs in each of these classes has sedative, hypnotic and/or anxiolytic action.
Barbiturates were commonly used 20 to 30 years ago. Their use has generally been discontinued because of the problems that were associated with them. Commonly used barbiturates were drugs such as Seconal and Tuinal. You should no longer be given barbiturates for sedative/hypnotic/anxiolytic reasons
Benzodiazepines (also referred to as benzos) are commonly used drugs that have sedative, hypnotic and anxiolytic properties. The benzodiazepines available in New Zealand are (the drug name is first, with different brand names in the brackets):
• alprazolam (Xanax)
• chlordiazepoxide (Nova-Pam)
• clobazam (Frisium)
• diazepam (Diazemuls Inj, D-Pam Tab, Pro-PamTab, Stesolid Rectal Tube)
• lorazepam (Ativan, Lorapam, Lorzem)
• lormetazepam (Noctamid)
• midazolam (Hypnovel)
• nitrazepam (Insoma, Nitrados)
• oxazepam (Benzotran, Ox-Pam, Serepax)
• temazepam (Euhypnos, Somapan)
• triazolam (Halcion).
Other tranquillising drugs include Imovane (Zo-Tab) which is used as a sleeping pill, and chlormethiazole (Hemineurin) is sometimes used in assisting alcohol withdrawal.
Because benzodiazepines are the most commonly used tranquilliser compared with the other drugs mentioned, the material below will discuss problems related to their use. The principles involved apply to all the other drug types listed.
Tranquillisers act as brain depressants. The word depressant means that the brain is slowed down, not that the person taking the drug becomes depressed in their mood. The amount of brain depression or slowing that occurs is dose-related – that is, the higher the drug dose you take, the more it will slow down your brain.
Tranquillisers can be prescribed for a number of reasons:
• to help with sleeping problems
• to help people cope with emotional distress or to help cope with anxiety disorders, by slowing down or calming the brain
• benzodiazepines are good muscle relaxants and are sometimes used to reduce muscle spasm after, for example, a back strain or injury
• benzodiazepines are useful in treating epilepsy and diazepam is probably the drug of choice to use in emergency situations when someone has an epileptic seizure (or fit).
Causes of problems with tranquillisers
Benzodiazepines should only be used for brief periods of time. The main reason for this is that they don’t actually fix problems, rather they help people to cope better with their problems.
Benzodiazepines should also only be used for brief periods because they can become addictive. The technical term for addiction is dependence and two kinds of dependence can occur.
Psychological dependence
When a person feels as if they need the drug to function normally, they become psychologically dependent. People start to depend on their medication to get through the day or to feel as though they are coping. Psychological dependence is more likely to happen with drugs that make people feel good – if you take a drug for the first time and you think that its effects are beneficial you are more likely to become reliant on that drug than if it gave you a bad reaction. When people are feeling anxious or stressed, benzodiazepines can give them a feeling of calmness and they can begin to depend on the benzodiazepines to help them feel calm. Psychological dependence can occur from an early stage
Physical dependence
When the body gets used to a drug and starts to need it to maintain its balance, the body is physically dependent. There are two signs of physical dependence – tolerance and withdrawal. Tolerance means that the effect of a particular dose of drug starts to wear off and bigger doses of the drug are needed to achieve the same effect. People who become physically dependent on benzodiazepines will usually need to gradually increase their dosage. Withdrawal means that if you go without your drug, your body starts to object, generating unpleasant physical symptoms which are relieved if you take the drug again. In this way, people can continue to use their drugs for longer periods to avoid withdrawal symptoms.
Side effects
Whether or not you experience side effects will depend on how much medication you take and how long you take it for. With short-term use, people can sometimes experience general effects of brain slowing such as tiredness, blurring of vision, mild dizziness, slurred speech and mild short-term memory loss. Some people find that benzodiazepines affect their emotional state and they can feel a bit confused, irritable at times and possibly depressed. These general slowing effects make it dangerous for people to drive or operate machinery. With longer-term use people can describe feeling generally unmotivated or apathetic, increasingly irritable and, again, depressed. They may have headaches.
Dependency or addiction
As described above, either physical or psychological dependence can occur. This means that people end up taking the drug for longer than they meant to and in higher doses than was originally intended. When they try to control their drug use, people find that they are unable to do so. Use of the drug becomes a central part of the person’s life and a good deal of time is spent thinking about the drug, making sure that an adequate supply is available, and planning activities around the taking of the drug.
If a withdrawal state occurs, a number of symptoms of brain over-activity can be experienced (remember that benzodiazepines work by slowing brain function – if the slowing is taken away, the brain rebounds and switches to an overactive state). Symptoms of withdrawal include:
• insomnia (sleeplessness)
• anxiety, sometimes occurring as panic attacks
• tremor, sweatiness, muscle cramps and feeling as though you have the flu
• an increased sensitivity to light, touch and sound (noises, for example, seeming to be louder and more startling than usual)
• feelings of unreality and disorientation
• possible feelings of fear and paranoia
• possible convulsions (fits) and hallucinations (seeing or hearing things when there is nothing to be seen or heard).
Dependence on benzodiazepines will almost always occur if you take regular doses for several months or more. However, withdrawal symptoms have been reported after use for as little as one to two weeks. The degree to which a person experiences these symptoms varies. Not all people will experience all of them.
Using tranquillisers to get high or stoned
Benzodiazepines can make you feel happy and in a good mood. As they slow your brain function, they can ease your anxiety and decrease your inhibitions or self-limitations, perhaps making it a lot easier for you to face a number of different situations. Some people use benzodiazepines for these reasons – to induce a form of pleasant intoxication or being slightly stoned. Benzodiazepines can be bought and sold illegally and are often used by people addicted to other drugs such as alcohol, cannabis or opioids to supplement their drug intake.
Medication interactions
A special mention should be made of the negative effects that can occur if benzodiazepines are combined with alcohol. Alcohol, too, slows down the brain and if the two are taken in combination the effects can be additive. Most seriously, people can become increasingly drowsy to the point where they become unconscious.

How to identify problems with tranquilliser use
Any of the above problems – having side effects like feeling sedated, being controlled by your drug or being stoned by your drug – can lead to other life problems. Reactions can be slowed and this can cause accidents. Relationships of all kinds can be strained because the person is now essentially different. Work performance may decline especially if the person feels sedated and slowed. If people become disinhibited, they can do impulsive things and end up in all kinds of trouble.
The first step is to recognise that you might have a problem. This can sometimes be difficult – it is often easier to carry on taking a drug than it is to try and stop it. Apart from those people who abuse benzodiazepines for particular effects, people start taking benzodiazepines because they have another underlying problem. They often blame the problems caused by benzodiazepines on the underlying problem instead. It is sometimes hard for people to accept that benzodiazepines are causing problems, for example, not functioning properly at work or being more irritable and moody than they used to be.
You need to honestly look at any problems that might be caused by your benzodiazepine use and decide for yourself whether or not a problem exists. In particular, you need to think about signs of being hooked or addicted. You need to allow others to be able to tell you if there is a difference in you or if your behaviour has changed.
The problems that your benzodiazepines can cause you can be distressing for your family or whanau and friends and those people should have the right to be able to tell you that they think there is a problem. If they do this, it is not that they do not love you, understand you or care for you. Pointing out problems is more helpful than keeping quiet about them and hoping that they will go away.
People often do something about their drug problem when it becomes important enough for them to do so.
If you are considering giving up or cutting down on tranquilliser use, draw up a list of the good things and the less good things that you experience with taking benzodiazepines. Write down all the good things that you can think of, for example, that taking the drugs make you feel better, that it means you have a good time with your friends, or whatever. In terms of the less good things, consider any of the negative effects that might be influencing your life. Consider what your family or whanau is saying about your taking benzodiazepines. Consider the effect that this may have on them. Consider any effects that benzodiazepines might be having on your health. Look at the balance of the good things and the less good things. Is your drug taking a problem for you or for other people? Do you need to change something about it? If taking benzodiazepines is causing problems in your life are you ready to do something about it?
Treatment of Problems with Tranquilliser Use
Getting help
The best place to start seeking help is to see a doctor (for some people who may have been prescribed tranquillisers before their addictive qualities were commonly known, issues of anger that a trusted professional allowed a situation to develop to the point where you became addicted to your medication will need to be dealt with).
Almost always you will need a plan to wean you off your pills and a doctor needs to set this in place with you. The doctor should also know about local drug and alcohol services and be able to refer you there.
These services can give you information about your drug problem and are able to help you find counselling, group support or other programmes which can help you make the change away from taking pills. You can discuss with either your family doctor, or your drug and alcohol counsellor, whether or not you may need to see other people such as a therapist, a psychologist or a psychiatrist to help you with any other problems you might have to deal with in making positive changes in your life.
Warning against suddenly stopping tranquilliser use
If you have a problem because you take benzodiazepines, the obvious answer would be to stop taking them. However it can be unpleasant and dangerous to suddenly stop taking them. In addition to this, if the benzodiazepines were initially taken to help an underlying problem – and the underlying problem has not been attended to – suddenly stopping the benzodiazepines might make you feel worse again.
Despite this, some people take the cold turkey option and abruptly stop benzodiazepines with the decision to tough out any withdrawal symptoms that come along. Because of the different lengths of actions of the different benzodiazepines, withdrawal symptoms can last for variable lengths of time (up to months and years) and they can come on up to weeks and months after you stop taking the drug. The incidence of serious side effects (for example fits and hallucinations) is not high, but when they occur these are serious and dangerous problems. There is no clear way to predict whether or not any one person will have these serious complications of withdrawal or not.
Summary of treatment options
The safest option is to wean yourself off benzodiazepines gradually in what is referred to as detoxification. While you are coming off your benzodiazepines, any other problems that exist need to be attended to. If problems such as depression or anxiety emerge you may need to seek support and help from a counsellor, psychologist or psychiatrist. If you have other problems in your life which benzodiazepines have been helping you to cope with, you will need to increase your efforts to deal with these problems and, again, you might need to seek the help of a therapist. If you do not attend to any co-existing problems, and if these co-existing problems cause you distress, it is more likely that you might again seek the comfort of benzodiazepines.
Whether or not you decide to give up or cut down your tranquilliser use it is important that you have support to help you stick to your decision. It is also important to try and manage stress, maintain good physical health, and, if desired, take advantage of a range of complementary services or treatments to help you either give up or reduce your dependency on benzodiazepines.

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