Treating Sedative Hypnotic or Anxiolytic Use Disorder

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Cognitive Behavioural Therapy Techniques

For Treating Sedative, Hypnotic or Anxiolytic use disorder

Sedative-Hypnotic are a Class of Medications that Includes Barbiturates.

Sedative hypnotic refers to the medication such as benzodiazepines, barbiturates and nonbenzodiazepine. All these are medications used to treat insomnia. They are referred to as Z drugs because the members consist of zaleplon, the eszopiclone and zolpiden all of which contain letter Z. Benzodiazepines are the most prescribed drugs across the globe. They are used to treat anxiety, disorder, insomnia and panic disorders. The drugs are used to treat disorders even though they are hazardous, and expose the user to other conditions such as physical dependence misuse, overdose as well as abuse (Levounis, Herron & American Psychiatric Association, 2014). When the individuals become dependent, they suffer from anxiolytic, hypnotic or sedative; a condition where one becomes dependent on the substances that cause a calming effect. They may also suffer from (hypnotics) sleep inducing effect and anxiolytics anti-anxiety effect. The three: sedative, anxiolytic or hypnotic essentially use disorder DSM-S category, which refers to addiction to any of the medication found in this category.

The medication includes barbiturate, benzodiazepine receptor agonists that include Zaplon. The DSM- 5 Manual identifies eleven symptoms, which suggest hypnotic, sedative or anxiolytic use disorders. It specifies that the individuals should have two symptoms in a period of 12 months. Tolerance and withdrawal symptoms are the key signs of hypnotic, sedative or anxiolytic disorders. However, this may not be the case in situations where one is taking the medicine as prescribed or when he is under the supervision of a physician. One can also use them as modifiers in both early and sustained remission or in controlled environment as suggested by the physician. However, experts advise that there should be some level of comorbidity between the use of tobacco products, alcohol and illicit drugs. Reference can be found to it in the 5th edition of the diagnostic and mental disorder manual (American Psychiatric Association, 2013). This, sometimes, makes the differential diagnosis of the condition difficult. Substance withdrawal including rebound anxiety may be diagnosed according to the DSM-5 (Doweiko, 2014).

Analysing Symptoms

A person who is intoxicated to hypnotic sedative and anxiolytic may appear drunk like a person who has taken alcohol even though such individual may not have ingested alcohol. The symptoms present may not be attributed to any other medical condition such as hypoglycaemia. Unfortunately, the DMA-5 manual did not differentiate between the discontinuance syndromes which are always present when one is discontinued from using the medications. The drug abusers may not experience the withdrawal syndrome when they stop using the medications and the intensity of the withdrawal symptoms may make it necessary to monitor or supervise the withdrawal. In some cases, the intensity of the withdrawal symptoms may be life- threatening making the medical supervision of this process necessary. Anyone who is diagnosed of the hypnotic, sedative, and disorders brought about by the anxiolytic may demonstrate symptoms of psychiatric syndromes. This expression is caused or exacerbated by abusing medications. The condition includes psychotic conditions, bipolar behaviour, state of depression, and anxiety.

The anxiolytic, hypnotic and sedative- related disorders may be reserved for people who have demonstrated signs of anxiolytic, hypnotic, sedative related disorders but who may not meet the diagnosis criteria (Doweiko 2014)

Levounis and colleagues have demonstrated that sedative hypnotic and anxiolytic disorders involve behavioural and pharmacological strategies especially in patients who experience physiological dependence or those where the detoxification strategy has been used.

Physicians may be used to monitor the patient's withdrawal symptoms and give the patient basic education concerning withdrawal symptoms that may require that he visit the hospital. Already, there is evidence -- based medication which can be used to treat withdrawal. Also, there is effective evidence based on the medication, which can be used to treat sedative withdrawal. However, there is no medication approved by the U.S. food and Drug Administration which can be used to treat anxiolytic, hypnotic and sedative disorders. Success has been registered in the replacement or agonist therapy used to treat opioid and tobacco disorder. However, it has not in any way been replicated in treating hypnotic, anxiolytic and sedative disorders. The reason why the agonist therapy does not work in these cases is not known. (Levounis, Herron & American Psychiatric Association, 2014).

Medication approaches

A number of drugs may be used to manage acute sedative, anxiolytic and hypnotic disorders. The selection of drugs depends on whether withdrawal symptoms may be targeted (Scher, 2014).

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Benzodiazepine antagonist

These agents are used to reverse depressant effects of an overdose of benzodiazepine. It has the ability to reverse any benzodiazepine induced respiratory difficulties. Benzodiazepine antagonist has a high affinity for the benzodiazepine receptor. This makes it a competitive antagonist. Flumazenil has a half --life of 0.7-1.3 h. On the other hand, Benzodiazepine antagonist's affinity is high and has a longer half-life. Thus, multiple doses of flumazenil may be required to help return one back to sedative state (Scher, 2014)

Barbiturates

These agents facilitate a smooth withdrawal in patients with barbiturate and benzodiazepines dependence. Barbita, luminal, solfoton (Phonobarbital) may be chosen and used in withdrawal because they have along half-life and have a wide therapeutic index. Generally, all sedatives with a longer half-lives have withdrawal symptoms that are less severe. Arbitrary doses may be given and customised to suit individual needs (Scher, 2014)

Benzodiazepines

They are used in similar manner as phenobarbital to help wean patients suffering from short- acting benzodiazepines. The principle is that sedatives with longer half-lives have less severe withdrawal symptoms that are. Different patient specific dosing strategies may be used depending on the symptoms. In some cases, various patient specific dosing strategies may be employed in cases where they are severe enough and requires inpatient attention. In such cases, IV Diazepam and Lorazepam may be used. Once the patient has stabilized, the tapering doze could be calculated by dividing the total dose by 5, thence the amount may be reduced weekly (Scher,2014)

Cognitive Behavioural Therapy Analysis

According to Levounis and colleagues (2014), the patient should be put on the outpatient substance abuse treatment just the same way it is done with patients abusing other drugs. This helps in developing recovery skills. However, it is necessary to note that the psychotherapy is so far the mainstream treatment for sedative disorders. There is evidence supporting the use of cognitive -- behaviour therapy, the 12-step facilitating techniques as well as the relapse prevention therapy. For people suffering from co-occurring sleep disorders or anxiety brought about by substance abuse, they must be put on ongoing treatment to successfully treat the substance abuse. When one uses pharmacological treatment, agents that have low abuse liability including buspirone and gabapentin should be used to manage anxiety. For people suffering from insomnia, use of antihistamines, sedative antidepressant as well as melatonin is recommended because of the decreased risk of abuse. A psychosocial intervention for managing co-occurring disorders is important in helping the recovery process. Patients should engage in psychotherapy to manage these disorders and learn about psychiatric symptoms in relations to the substance use.

Education about sleep & hygiene should be given to patients who have sedative sleep history. The treatment depends on the overall medical conditions, functional impairment and stability. Detoxification is necessary and the patient must be rehabilitated using both intensive and extensive outpatient therapy. Cognitive-behaviour therapy, motivational interviewing as well as psychotherapy have been demonstrated to have positive outcome in all patients who have been put to the therapy (Levounis et el., 2014).

Gorenstein Kleber, Mohlman, Dejesus and al (2005), have hypothesized that patients suffering from late-life anxiety should undergo some cognitive behavioural therapy and some medication taper (CBT-MM) so as to realize a better reduction in use of medication and improvement in the psychological symptoms than what the control team put on the medical management (MM) achieves. According to the results, CBT-MM completers will significantly reduce the use of medication even though not at a greater rate than the MM completers. CBT-MM completers on the other hand, experienced some meaningful alleviation of the psychological symptoms even though it was not better than the MM completers.

In a study carried out by Gorenstein et al. (2005), only a few of the treatment gains were maintained at a 6-month follow up intended to treat analysis by employing the mixed effect model that showed weaker treatment effects as compared to the completer analysis. Gorenstein et al. (2005) arrived at a conclusion that the cognitive- behavioural therapy may be used to alleviate the psychological symptoms in all the elderly patients suffering from anxiety even when such patients reduced anxiolytic medication.

It has been observed that the benefit-risk ratio of antianxiety medication is normally unfavourable in the elderly patients who may seek limited symptom relief. Cognitive --behavioural therapy has in the past proven to be of great benefit in treating young adults and has been used to treat the elderly patients suffering from generalized anxiety.....

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