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Integrative Approach to Sedative-Hypnotic Use Disorder 

Integrative Approach to Sedative-Hypnotic Use Disorder
Chapter:
Integrative Approach to Sedative-Hypnotic Use Disorder
Author(s):

Gayla Rees

, Benjamin Shapiro

, and Matthew Torrington

DOI:
10.1093/med/9780190275334.003.0005
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date: 20 January 2021

Sedatives, hypnotics, and anxiolytics are CNS depressants with GABAergic activity that are potentially habit-forming due to their activity in brain reward pathways. They are central in the drug overdose epidemic with benzodiazepines (BZD) being involved in approximately 31% of all fatal overdoses. There are 4 withdrawal syndromes: High dose minor and major withdrawal, low dose withdrawal, and protracted withdrawal. Benzodiazepines are chemically related positive allosteric modulators of the GABA at the GABA-A receptor. In differential expression 5 different receptor subunits play a role in acute and prolonged withdrawal syndromes. Benzodiazepines have supplanted barbiturates for treatment of anxiety and insomnia due to their wider therapeutic index. Barbiturates can be helpful managing opiate and benazodiazapeine withdrawal. Traditional Chinese Medicine can improve hypnotics-dependent insomnia. Mindfulness-based relapse prevention and yoga may offer benefits but are poorly studied.

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