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Medicine
Date
Dec 6, 2023
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Uploaded by DeaconWildcat3311
Sydney Tolleson
Grand Canyon University
PCN-150 Psychopharmacology in Treatment of Addiction and Substance Use Disorders
Dr. Salvucci
July 13, 2023
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Introduction
Benzodiazepines are a relatively new class of drugs that were developed as a safer
alternative to barbiturates to treat anxiety, sleep, and other mood disorders. These types of drugs
are also known as anxiolytics, hypnotics, muscle relaxants, anticonvulsants, and even amnestic
medicines (Kuebler, 2023). The first benzodiazepines, chlordiazepoxide and diazepam, were
introduced in the late 1950’s and then more were introduced to the United States in 1975,
branded as anxiolytics (2023).
The discovery of these drugs seemed to be a game changer in the
medical field to help treat a variety of mental health disorders, however the long-term effects and
risk of abuse were not researched and made known until more recent years. Benzodiazepines
have been used for many years to treat anxiety and sleep disorders due to their ability to
stimulate the GABA receptors in the brain, however, their use has now been associated with
many issues including addiction, dependence, and withdrawal, increasing the need for counseling
and medical help due to addiction and to discontinue use after only a short amount of time. This
has proven to be challenging for not only prescribers, but also for professionals in the counseling
field as well.
History and Neurobiology
Benzodiazepines are also known as anxiolytics, hypnotics, muscle relaxants, anticonvulsants,
and amnestic medications and have been used for decades to treat conditions such as anxiety,
insomnia, muscle spasms, seizures, agitation, and even alcohol withdrawal (Kuebler, 2023). The
first in this group of drugs, chlordiazepoxide and diazepam, emerged in the 1950’s. After a short
time, research concluded that extreme dependence, tolerance, social dislocation and hard to
manage withdrawals were effects of long-term use of diazepam (2023). Clonazepam and
lorazepam were introduced to the United States in 1975, branded as anxiolytics because people
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could take a lower dose of these medications and achieve the same results, masking their initial
potency (2023). Today, the three most prescribed benzodiazepines, alprazolam, clonazepam, and
lorazepam, are anywhere from 10 to 20 times more potent than the original drug, diazepam
(2023). As the number of prescriptions and the use of these types of drugs has increased, so has
the number of overdoses resulting in death.
Within the human brain, specifically the central nervous system, gamma-aminobutyric
acid, also referred to as GABA, is considerably one of the most important inhibitory
neurotransmitters (Ellen, et. al., 2008). GABA controls the state of excitability in all areas of the
brain by binding to the GABA receptor complexes found in the brain, spinal cord, and retina
(2008). When the GABA receptors are stimulated, there is an increase in chloride ion
permeability, resulting in the hyperpolarization of the neuromembrane (2008). The balance
between excitatory inputs and GABA is what essentially regulations the neuronal activity in the
central nervous system, which is crucial to the entire brain and body to function. When the
balance is skewed toward GABA, the effects of benzodiazepines such as sedation and relaxation
prevail, and when the balance is skewed against GABA conditions such as insomnia and
restlessness appear. Benzodiazepines work by mimicking GABA and binding to the receptors to
produce the effects of sedation, helping relieve the symptoms of conditions like anxiety and
insomnia.
Current Trends and Issues
Anxiety is the body’s natural reaction to stressful or dangerous situations and is felt by
apprehension and nervousness when in those types of situations (Hancock & McKim, 2018). In
recent years, there has been a significant increase in the number of patients being diagnosed with
anxiety disorder, PTSD, insomnia, and other mental health disorders that can be treated with
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benzodiazepines. Between the years of 1996 and 2013, the use and prescriptions of
benzodiazepines increased by 320%, and the number of deaths from overdosing on these
medications increased over 500% (Kuebler, 2023).
During the first multistate report that
examined trends in nonfatal and fatal overdoses due to the use of benzodiazepines in 2019-2020,
it was discovered that there were increases of both fatal and nonfatal overdoses involving both
benzodiazepines and opioids, significant increases in overdose death caused by illicit use of
benzodiazepines, yet the number of deaths caused by prescription benzodiazepines was still
significantly higher, and there was also an increase in nonfatal overdoses caused by the use of
benzodiazepines without the use of opioids (Liu, et. al., 2021). This information shows that the
use of benzodiazepines has increased, even though the co-prescribing of benzodiazepines and
opioids has been greatly restricted, and risk of potential addiction and overdose is more known.
With the opioid epidemic that has spiked in recent years, the mixing of benzodiazepines and
opioids has become more common, creating an increased risk for overdose. Furthermore, the
FDA has recently changed the box label on all benzodiazepine drugs to show the serious risk of
abuse, addiction, physical dependence, and withdrawal, even when taken as prescribed by a
healthcare provider (Pergolizzi et. al., 2021). The rising number of overdoses due to the use of
these drugs provides a challenging set of circumstances in the healthcare and counseling
professions when trying to treat people who have become addicted to benzodiazepines, as these
are not drugs that can just be stopped due to serious, and even deadly withdrawal symptoms.
Influence on Counseling Profession
Benzodiazepines have influenced counseling and other helping professions in both
positive and negative ways. The use of both prescription and illicit benzodiazepines continues to
rise, even though there have been numerous restrictions placed on healthcare professionals for
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prescribing them. Counselors and other helping professions have shifted from prescribing these
medications regularly, to regularly treating patients who have become addicted, or who want to
discontinue use after being on these drugs long-term. When benzodiazepines were first
discovered, many prescribers including counselors and other health professionals began using
them to treat a variety of mental health disorders including anxiety, insomnia, and PTSD. These
drugs are extremely helpful in treating many conditions and, in some cases, are very beneficial to
clients.
As time progressed, this class of drugs has turned into something that these same
professionals are seeing being abused and are having to treat clients that are now addicted. Due
to the chemical makeup and neurobiology of these drugs, they require a taper regime to
discontinue use, safely. Professionals in counseling and other helping professions are now
conducting studies to develop interventions to support the discontinuation of long-term use of
benzodiazepines (Lynch et. al., 2022).
The influence benzodiazepines have had on counseling
and other helping professions has been both positively and negatively profound.
Conclusion
The use and prescription of benzodiazepines is an ongoing, controversial topic
throughout the medical, counseling, and other helping professions. Since their discovery in the
1950’s, the use of benzodiazepines has increased greatly, due to their ability to bind to the GABA
receptors in the brain, reducing excitability throughout the entire central nervous system, making
them very efficient in treating many mental health disorders such as anxiety and PTSD. In more
recent years, studies have shown that these specific drugs have an extremely high potential for
abuse, addiction, and overdoses, both fatal and nonfatal, especially when combined with opiates
and other drugs. The controversy between the benefits and negative consequences of this class of
drugs is something that proves to be challenging in the counseling and helping professions, as
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well as other medical fields. The positive effects and benefits of benzodiazepines to treat mental
health disorders are now being reevaluated due to the high risk of dependence and withdrawal
from these medications. In conclusion, benzodiazepines are a relatively new class of drugs found
to be less potent than barbiturates and have proven to be both effective as well as dangerous.
References
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