The Centers for Disease Control and Prevention, or CDC, reports that between 50 and 70 million people in the United States suffer from a sleep or wakefulness disorder that may disrupt their quality of life. Benzodiazepines have traditionally been the main class of medication prescribed, at least for short-term relief, of sleep disorder symptoms. Benzos, as they are often called for short, work to suppress the central nervous system functions like heart rate, respiration, temperature, and blood pressure, which in turn help a person to relax and be able to fall and stay asleep. These medications are habit-forming, however, and commonly abused.
In 2011, the Drug Abuse Warning Network (DAWN) showed that more than 350,000 people had visited an emergency department (ED) for a negative reaction involving the nonmedical use of benzodiazepines like Xanax (alprazolam). Another class of drugs, called z-drugs, were created that have more of a hypnotic effect, are short-acting, and thought to potentially work better than benzodiazepines for insomnia; however the Journal of Medical Toxicology publishes that these drugs actually act very similarly to traditional benzos and may actually have more possible side effects. Ambien, or zolpidem in its generic form, is a popular z-drug, which ABC News reports 27 million Americans have been prescribed.
Ambien Use vs. Abuse
When used as directed under the supervision of a medical professional, Ambien may be an effective sleep aid. By slowing down nerve firings, and calming down the stress reaction that may prevent a person from falling asleep, Ambien can help a person to relax enough to fall asleep and therefore be beneficial for symptoms of insomnia. The chemistry in the brain is changed when taking a hypnotic drug like Ambien, as the sedative effects work on the gamma-aminobutyric acid, or GABA, receptors in the brain. GABA works like a kind of natural tranquilizer, and benzodiazepines and z-drugs both interact with the brain’s production and absorption of the neurotransmitter, creating a larger amount of it in the brain at one time.
In addition to GABA, if Ambien is taken in a manner other than the method or dosage it was prescribed, pleasure-inducing neurotransmitters may also flood the system resulting in a “high.” Any time a prescription medication is taken in a way or amount other than as prescribed, it is considered drug abuse.
Ambien abuse may begin innocently enough as people may develop a tolerance to the drug and feel they need more in order for it to continue working effectively. Taking more than the prescribed dose at one time or taking Ambien after a prescription has run out is still abuse. People may also exaggerate their symptoms, or go to more than one doctor to try and obtain multiple prescriptions. Family members may “borrow” pills from the home medicine cabinet that were not prescribed for them.
Other forms of abuse may include crushing Ambien tablets to then snort, smoke, or inject the resulting powder. The National Institute on Drug Abuse (NIDA) publishes that almost 21 percent of Americans over the age of 11 have abused a prescription medication at some point in their lives (as of 2014), with those between the ages of 18 and 25 abusing them most frequently. Prescription drugs and over-the-counter medications are the most commonly abused substances in the United States behind only marijuana and alcohol for individuals aged 14 and older, NIDA further reports.
Side Effects of Ambien
Ambien may have a range of unintended side effects even when taken as intended, and these potential hazards are amplified if the drug is abused. Users of Ambien may sleepwalk and complete a variety of tasks, such as making and eating food, having sex, talking on the phone, or even driving while still asleep and under the influence of Ambien. They may then wake the next day with no memory of these actions. This possibility is even published with the prescribing information and in the warnings for Ambien by the U.S. Food and Drug Administration (FDA).
The National Highway Traffic Safety Association (NHTSA) reports that zolpidem can impair a person for between one and eight hours, depending on the dose, resulting in reduced coordination, slowed reaction time, less muscle control, dizziness, disorientation, difficulties concentrating, trouble paying attention, other cognitive issues, memory impairment, double vision, nausea, and distortions of time. In many states, Ambien is one of the top 10 substances impairing motorists, ABC News publishes.
Next-day impairment may also be an issue. In 2013, the FDA recommended reducing the recommended dosage for women, since they tend to metabolize the drug slower. In studies reported by The New York Times, 10-15 percent of women still had enough zolpidem in their systems to impair their driving eight hours after taking the drug. These studies led to the recommended reduction in dosage levels for women.
Zolpidem may also affect a person’s behavior, causing agitation, erratic or bizarre behaviors, and even hallucinations while under its influence. Aggression, decreased inhibitions, and other side effects similar to alcohol intoxication may be observed when someone is under the influence of Ambien. Some crimes have even been committed where the defendant cites zolpidem intoxication as the culprit.
Zolpidem negatively affects a person’s balance. This may be particularly concerning for the elderly population who may be more prone to use sleep aids for long-term relief despite recommendations against it. Falls, and increased injuries, potentially with no knowledge of how they occurred, may be side effects of zolpidem use and potential signs of its abuse in the elderly population. Using zolpidem may also cause a person to feel depressed or even become suicidal, particularly if they have a history of depression or mental illness, the FDA warns.
Abuse of Ambien, of course, increases all the potential risks and hazards of the drug. In 2011, DAWN reported over 30,000 ED visits involving the abuse, or nonmedical use, of zolpidem. Zolpidem is also regularly combined with other drugs or substances. In 2008, DAWN found that less than half of the zolpidem-related ED visits were for zolpidem alone, meaning the majority of the time the drug was used in tandem with another mind-altering substance, heightening the odds for an adverse reaction.
It’s Never Too Late to Get Help
When Misuse Becomes Addiction
Initially it was believed that z-drugs like Ambien may be less habit-forming than traditional benzodiazepines, making them more attractive to individuals with a medical need for the sleep aids as well as potentially increasing its attraction for recreational users. Several studies and reports, as published by the British Journal of General Practice (BJGP), have shown otherwise, however, stating that z-drugs may have just as high of a dependence potential as benzodiazepines do.
Ambien is considered a Schedule IV controlled substance by the Drug Enforcement Administration (DEA), which means that it is recognized to have a potential for abuse, diversion, and possible dependence and addiction. Dependence occurs when the body and brain rely on the drug to continue to perform normally. Since regular use of Ambien changes the way the brain produces, sends, and reabsorbs some of its chemical messengers, the “normal” function may be altered. The new normal may require Ambien, and the brain may not work the same way it did before the drug’s interference.
One of the largest indicators of drug dependence is the presence of withdrawal symptoms when the drug isn’t present in the bloodstream. Some of the symptoms of Ambien withdrawal may include:
- Rebound insomnia
- Panic attacks
- Muscle aches
- Stomach cramps
- Nausea and vomiting
- Suicidal thoughts
- Mental “fogginess”
Dependence and addiction are not the same thing, as a person can be dependent on Ambien without being addicted to it; however, someone who battles addiction is likely dependent on the drug as well. Drug dependence can lead to addiction, as withdrawal symptoms may be uncomfortable and taking more Ambien can offer short-term relief. Drug cravings may also be strong during Ambien withdrawal, and an individual may lose control over the ability to stop taking Ambien.
Addiction is considered a disease that is both compulsive and chronic, recognizable by changes in behavior, mental status, and physical attributes. Those battling addiction will continue to use Ambien with no regard for the possible consequences and may do so in potentially hazardous situations. They may be unable to stop using the drug despite many attempts or promises to quit, and may seem to be spending most of their time finding a way to get Ambien, being under its influence, and recovering from the drug. Other activities not involving Ambien, such as, obligations, relationships, and social interactions, may fall by the wayside. Withdrawal from friends and family, relationship problems, mood swings, unpredictable behaviors, and even a shift in personality may be evidence of Ambien addiction, as may changes in physical appearance, like weight fluctuations, skin rashes, or a lack of concern for personal hygiene. Sleep patterns may be highly unpredictable as well. There may be more and more incidents of sleep activities and amnesia, or doing things that they don’t remember the next day.
Help Is Available
Like with other benzodiazepines, Ambien may have powerful emotional and even physical withdrawal symptoms that may be potentially dangerous. These symptoms can be safely managed through medical detox, which is performed in a specialized facility that provides 24-hour medical care and supervision. Medical detox is a safe environment can ensure individuals in withdrawal do not harm themselves or others.
Medications are often beneficial during medical detox to help keep individuals comfortable and withdrawal symptoms to a minimum. Since Ambien is a short-acting z-drug, it may be replaced with a longer-acting sedative-hypnotic in order to smooth out the withdrawal process. This can then be tapered down slowly to avoid adverse side effects and drug cravings.
Insomnia is often benefited by nonmedical treatments as well, and improving sleep helps to improve overall quality of life. When people are rested, they are more clearheaded and more apt to handle stress and other life events successfully. Holistic treatment methods, such as mindfulness meditation, yoga, massage therapy, and chiropractic care, may all help treat both insomnia and Ambien withdrawal symptoms.
Therapeutic methods can get to the potential psychological causes of insomnia and also possibly the trigger for drug abuse and subsequent addiction as well. Behavioral therapy can help to manage all potential factors and triggers simultaneously by helping to positively modify behaviors and thought patterns.
Ambien may be abused as a form of self-medication for underlying psychological issues, or for recreational purposes. Regardless of the reason for abuse, therapy can identify the root cause and work to improve coping mechanisms and regulate emotions. A comprehensive approach that involves pharmaceutical, therapeutic, and holistic methods is often ideal for treating Ambien abuse or addiction.