Sedative, Hypnotic, Anxiolytic Use Disorders Follow-up

  • Author: Lorin M Scher, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK)  more...
 
Updated: Feb 18, 2014
 

Further Outpatient Care

Patients with sedative-hypnotic use disorders are frequently treated in the outpatient setting, as most are stable and require minimal monitoring. Inpatient hospitalization is reserved for the most severely impaired patients requiring complicated withdrawals, patients who have been unsuccessful as outpatients, or patients with medical and/or psychiatric comorbidity.

A recent study confirms the efficacy of cognitive behavior therapy (CBT) in both hypnotic-abusing and nonabusing patients with chronic insomnia. The results of this study suggest that tapered withdrawal of third-generation hypnotics during CBT therapy for chronic insomnia could be associated with improvement rather than worsening of sleep continuity.[29, 30]

Some may benefit from enrollment in support groups, such as Pills Anonymous, and attending drug-free outpatient counseling.

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Further Inpatient Care

Definitive treatment is a lengthy process, taking months or years. A return to drug use should not be considered a treatment failure, but rather a time to intensify treatment.

After successful medical treatment of sedative/hypnotic withdrawal/intoxication, the patient may be transferred to the psychiatric unit, if he or she meets criteria for inpatient psychiatric treatment.

Effective treatment requires a thorough evaluation of the patient's psychiatric problems and development of long-term treatment plans.

Urine drug screens should be performed periodically to monitor illicit drug use.

Family counseling should be completed to focus on the family's role in helping the patient develop a successful long-term treatment plan.

Referrals for long-term outpatient or residential treatment for sedative-hypnotic addiction should be made early in the treatment process to prevent relapse.

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Prognosis

Some individuals respond to treatment and stay in remission, while others experience periods of relapse, in which they begin sedative-hypnotic-anxiolytic use/abuse after a period of remission, and again meet the criteria for substance dependence. Some individuals are never able to abstain from use and do not experience any periods of remission.

Only a handful of studies have looked into long-term success of benzodiazepine discontinuation programs. Most studies indicate a high relapse state; however, outcome is more favorable in those individuals who manage to complete a discontinuation program.[31] A 4- to 6-year post discharge follow-up study of patients primarily admitted for primary sedative-hypnotic dependence showed that 84% of the patients had resumed using sedative-hypnotics, 52% were abusing drugs at follow-up, and 42% had been readmitted for drug abuse.[32]

A 10-year follow-up study analyzed the importance of the physician-patient relationship and examined whether a discontinuation letter from the provider was enough motivation to stop using the medication. After 10 years, researchers found that 58% of patients had discontinued their benzodiazepines and those who had not used lower doses of benzodiazepines and those who had discontinued by 21 months of the intervention had a higher rate of being abstinent at a 10-year follow-up.[33]

Outcome is better in individuals with good social support, absence of psychiatric co-morbidity or remission of preexisting psychiatric symptoms, and absence of dependence on other drugs.[34]

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Patient Education

Excellent patient education resources are available at eMedicineHealth's Mental Health Center. Also, see eMedicineHealth's patient education articles Benzodiazepine Abuse, Barbiturate Abuse, and Substance Abuse.

Sedative-hypnotic abuse/dependence can affect the entire family, it is necessary to inform them of the pertinent issues. In certain cases, family members can be enablers.

It is important for the prescribing physician to know about the harmful effects and complications related to sedative-hypnotic use. Often, the patient will seek supply of these drugs from many practitioners. Physicians may also benefit from feedback on their prescribing practices.

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Contributor Information and Disclosures
Author

Lorin M Scher, MD Director, Emergency Psychiatric ServicesHealth Sciences Assistant Clinical ProfessorDepartment of Psychiatry and Behavioral SciencesUniversity of California, Davis, School of Medicine

Lorin M Scher, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Alpha Omega Alpha, American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Siddarth Puri, MA University of California, Davis, School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Society of Clinical Psychopharmacology, Royal College of Psychiatrists, American Association for Geriatric Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Additional Contributors

Jennifer S Morse, MD Associate Medical Director, Optum Health

Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgements

Olakunle PA Akinsoto, MD, MBBCh Consulting Staff, Family Health Center, Jacksonville Medical Center

Disclosure: Nothing to disclose.

Amit Chopra, MD Resident Physician, Department of Psychiatry, Mayo Clinic, Rochester

Disclosure: Nothing to disclose.

Abhinav Rastogi, MBBS, MRCPsych Resident Psychiatrist, Stratford Road Day Centre, Birmingham, UK

Disclosure: Nothing to disclose.

Christopher L Sola, DO Assistant Professor in Psychiatry, Mayo Clinic School of Medicine; Medical Director of Inpatient Medical Psychiatry Program, Department of Psychiatry and Psychology, Mayo Clinic

Christopher L Sola, DO is a member of the following medical societies: Academy of Psychosomatic Medicine, American Medical Association, American Osteopathic Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Joji Suzuki, MD Fellow in Addiction Psychiatry, Department of Psychiatry, Boston University School of Medicine

Disclosure: Nothing to disclose.

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