Addicted to Anti-Anxiety or “Nerve” Pills — Benzodiazepine use disorder and what to do about it

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Image by Pete Linforth from Pixabay

Many people, especially women, develop feelings of anxiety and worry. Some call it “bad nerves.” This predisposition to feeling anxious can cause problems with everyday living, coping, and sleeping. I have assessed and interviewed many older people with a range of problems with anxiety. Feeling anxious is a completely normal reaction to stress or a situation where you may feel fearful. However, being in a continuous state of feeling afraid can cause problems both mentally and physically. Some say they feel like they are “trembling inside.”

Anti-anxiety medications (also known as “nerve pills”) are used by many people. These pills come from the family of “benzodiazepines.” Some of the commonly prescribed anxiolytics in Canada or the United States include (but not limited to):

  • Clonazepam (Rivotril)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Diazepam (Valium)

A commonly prescribed non-benzodiazepine that acts like one is Zopiclone (eszopiclone in the USA). It is commonly used as a “sleeping pill.”

Generally, benzodiazepines end in “pam” or “lam.” Use of these medications can initially improve symptoms by offering a sedating effect, however, they can also be addictive. Side effects of these drugs include increasing the risk of cognitive impairment, confusion, delirium, falls, fractures, drowsiness, and motor vehical accidents. They are not recommended for use by older adults. In fact, older people are recommended to gradually reduce their dosage (a slow and steady decrease is recommended over a sudden discontinuance due to withdrawal symptoms). Always talk to a doctor about any changes to your medication. As the dose is gradually reduced and preferably stopped, it is important to identify and optimize alternatives to managing any underlying issues. These alternatives are preferably not other medicines.

Sometimes these medications are used on an “as needed” basis. For example, if you are afraid of flying, and you need to go on an airplane, you can take one of these medications (prescribed by your doctor) to use in specific situations. Or, if you have claustrophobia and you need to go for a scan such as an MRI, taking this medication may make it more bearable.

I have also seen where these medications are prescribed for help with sleep. People who have an anxiety disorder may be prescribed this classification of medications to see if it helps reduce anxiety or panic attacks. In older people, antidepressants are the preferred class of medications to help with anxiety.

Some other key tips to remember:

  • Avoid taking benzodiazepines with opioids or alcohol.
  • These medications are more often prescribed to women (Almost 1 in 5 Canadian women report to have used in the past year).
  • Almost 1 in 10 Canadians in Quebec have been reported to have an addiction to benzodiazepines.
  • If a benzodiazepine addiction is present, consider there may also be other substance use disorders or behaviours present (e.g, alcohol, opioids, marijuana, gambling).
  • If you are older, it’s best not to start taking benzodiazepines.
  • If the addiction is getting worse, an admission to a treatment facility may be necessary.

If you are finding yourself feeling “addicted” or “dependent” on these medications (or other substances or behaviours), you are “craving” these drugs, or you are needing to increase your dosage, you may want to see your doctor to discuss alternatives. Reducing the risk of harm is key.

For more details, The Canadian Coalition for Seniors Mental Health has published the Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults (2019) and is found online: https://ccsmh.ca/wp-content/uploads/2019/11/Benzodiazepine_Receptor_Agonist_Use_Disorder_ENG.pdf

Angela G. Gentile, MSW, RSW

Low-Risk Alcohol Usage Guidelines for Older Adults – Know your limits

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Most adults enjoy drinking alcohol on occasion. Sometimes, though, this occasional drink turns into a daily habit. One drink turns into two or more. If a person is not mindful, this habit could turn into an addiction. Addiction is also known as dependency or substance use disorder.

People can become addicted to not only alcohol but drugs, including prescription drugs (such as benzodiazepines and opiates). For example, nicotine, the drug found in cigarettes, is very addictive. Addictive behaviour can also be problematic, as in gambling, sex, or online gaming.

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives. – American Psychiatric Association, retrieved 03 Dec 2019.

For a number of reasons, it is essential to keep in mind that as we age, it is recommended we reduce our consumption of alcohol. For adults aged 65 and older, it is important to be aware of the low-risk guidelines.

Canada’s Low-Risk Guidelines (DrinkSense for Seniors) which is provided by the “Canadian Centre on Substance Use and Addiction”, states that limits for adults (not older adults) who drink alcohol should be 10 drinks a week for women with no more than two per day, and 15 drinks a week for men with no more than three drinks a day on most days. There is no specific limit for older adults, but one of their “Safer Drinking Tips” includes the advice of “Always consider your age, body weight, and health problems that might suggest lower limits.”

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Standard Drink Portions:

      • Beer – 341 ml (12 oz.) of 5% alcohol content
      • Wine – 142 ml (5 oz.) of 12% alcohol content
      • Cider/Cooler – 341 m. (12 oz.) 5% alcohol content
      • Distilled alcohol/80 proof liquor (rye, gin, rum, vodka, etc.) – 43 ml (1.5 oz.) 40% alcohol content

Note: Not all wines are created equal. Some wines start at 5% alcohol content, some go as high as 18%!

I attended an “Aging and Addictions” course in November 2019 which was held by the Addictions Foundation of Manitoba, and they supported the drafted recommendations entitled “Prevention: Low-Risk Drinking Guidelines” for those 65 and older (noted below).

Low-Risk Drinking Limits (65+)

    • Women: No more than 1 standard drink per day, with no more than 5 drinks in total per week.
    • Men: No more than 1-2 standard drinks per day, with no more than 7 per week in total.
    • Non-drinking days are recommended every week.

Source: Canadian Coalition for Seniors’ Health. Canadian Guidelines for Older Adults. Prevention, Assessment, and Treatment of Alcohol Use Disorder, 2019.

These drafted guidelines are more in line with what I would recommend. I have seen what alcohol dependence can do to people and it is heartbreaking. And as noted in a previous post here on my website, to help preserve cognitive health, experts recommend no more than 2-4 drinks per week (see my Memory Rescue book review.)

For those who have a drinking problem, there is often stigma and shame attached. Many people can’t abstain or reduce their drinking behaviour on their own (harm reduction) and need help. If you or someone you know has a drinking problem, addiction or dependence, please contact the Addictions Helpline in your area.

> Addictions Helpline Canada 

> Addictions Helpline USA

AA 12-Step (https://www.aa.org/) or Smart Recovery (https://www.smartrecovery.org/) are peer support options to consider as well.

If you are considering getting on top of your drinking problem and need someone to talk to, please contact me and I can assist you in finding the help you need.

Angela G. Gentile, MSW, RSW

References:

https://www.psychiatry.org/patients-families/addiction/what-is-addiction

https://amho.ca/wp-content/uploads/Mon-300pm-IP1-3a-Older-Adults-with-Alcohol-Related-Problems-Best-Practice-Guidelines.pdf

https://www.canada.ca/en/health-canada/services/substance-use/get-help/get-help-problematic-substance-use.html

https://www.samhsa.gov/find-help/national-helpline

https://www.aa.org/

https://www.smartrecovery.org/

https://www.drinksenseab.ca/drinksense-tips/seniors/

https://ccsmh.ca/alcohol-guidelines/

“A Standard Drink” image source: https://studentaffairs.lehigh.edu/content/what-standard-drink