Mara Zuschlag

December 12, 2010

Argosy University

Addictive and abuse risk for individuals with polysubstance addictions, anxiety and history of family mental health disorders.

BZDs abuse is a risk for individuals with polysubstance addictions, anxiety and history of family mental health disorders

BZDs are commonly prescribed for anxiety, insomnia and clinical depression.

BZDs are popular with drug users. Coordination of care between mental health

providers, medical professionals and substance abuse modalities is crucial for effective recovery.

BZDs were first introduced the physical dependence potential was unknown

Common mental health illnesses and treatment with BZDs are panic disorders, anxiety, post-traumatic stress disorders, schizophrenia and personality disorders (Ashworth, Gerada and Dallmeyer, 2002).

BZDs prescribed were common practice as part of the management of primary care mental health problems.

Ambiguity is not an adequate argument to prescribe BZDs, of which includes fatal results

This study is contradictory for support of BZDs treatment for those patients with reported substance abuse as found with Ciraulo and Nace, hence the abuse comes from the obtaining from non-medical sources, use in higher than prescribed amounts and use for poorly defined conditions (2000).

Studies of Posternak and Mueller, BZDs have been effective of efficacy in treatment of those with anxiety, panic disorders, agoraphobia, social phobia and alcohol-induced anxiety disorders.

BZDs prescribed for these patients, are well tolerated, however their studies have found their potential for abuse and harm (Posternak and Mueller ,2001).

BZDs prescriptions need to be replaced with alternatives to treat anxiety and depression during treatment of opiate

addiction.

Studies have found anxiety in the family history increases the risk of BZDs abuse (Van Valkenburg and Akiskal, 1999).

Antisocial behavior reported by the patient or by a family member increases risk of BZDs abuse.

Without a patient’s history review,

• prescription is ordered• risks are increased if

other substances are abuse• potential in fatal car

accidents, • falls in the elderly • compromising medical

conditions that could lead to death.

Harm and safety risk of benzodiazepine abuse increases for individuals with severe dependence, polysubstance dependence, and antisocial personality disorder, of which is in general consensus with other studies (Ciraulo and Nace, 2000).

If current studies have validated harm reduction in negating use of BZDs when substance abuse is prevalent, then medical professionals need to increase their responsibility to restrict their use.

Increased risk of safety with BZDs use and polydrug abuse

BZDs use attributed to memory loss, and injection use constitutes a major clinical and public health problem (Darke and Ross, 1994).

BZDs included in polydrug abuse is a contributing factor in overdose among opiate users

Cardiovascular, respiratory failures

Overdoses

Standard prescribed use to prevent dependency is 2 – 4 weeks

Coordination of care is necessary to limit BZD use (Salzman, 1998). Prior to prescribing

BZDs, close review of family history is imperative to reduce risk of addiction.

Reduction in potential abuse of BZDs results: Close patient

monitoring Adherence to

recommended 2-4 week dosing guidelines

Single source dispensing, periodic drug tapering

Practice of consistent urine toxicology screenings

Prevention begins with accurate review and assessment of patient medical, family and drug use history prior to

prescribing Diazepam has been

found to be the BZD to replace other prescribed BZDs for an effective detox process for illicit drug users (Elliott, Glenday, Freeman, Ajeda, Johnston, Christie, et al., 2005).

Only 2- 4 week prescriptions

Cross prescription checks Discontinue

benzodiazepine use in pharmacotherapy

Cognitive behavioral therapy

Initial low dose of BZD, together with cognitive-behavioral therapy (CBT). Posternak and

Mueller’s studies found evidence that BZDs may inhibit gains made from CBT, thus lower the dose to gain effective treatment, to include a tapering to abstinence (2001).

Herbal solutions to treat anxiety symptoms are available, such St. John’s Wort.

Relaxation techniques meditation Yoga spiritual

environments

Safety concerns exist with the physical aspects such as cardiovascular and respiratory failures with the abuse of BZDs, to include severe physical and mental impairments with polydrug use (Ciraulo and Nace, 2000; Ashworth, Gerada and Dallmeyer, 2002; Elliott, Glenday, Freeman, Ajeda, Johnston, Christie, et al., 2005).

Medical professionals must review all history of a patient, prior to prescribing BZDs to minimize risk of abuse. Ciraulo and Nace’s studies found increase risk of BZDs abuse for

individuals with severe dependence, polysubstance dependence, and antisocial personality disorder (2000).

Supportive studies found by Posternak and Mueller that BZDs should be avoided in anxiety disorder patients with a history of substance abuse or dependence (2001).

Prevention begins with accurate review and assessment of patient medical, family and drug use history prior to

prescribing

Several valid and reliable studies have found that BZDs use is not safe in patients with substance abuse, increased thorough assessments must be done, to include cross pharmacy checks for duplication of BZDs prescriptions.

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Ciraulo, D., & Nace, E. (2000). Benzodiazepine Treatment of Anxiety or Insomnia in Substance Abuse Patients. American Journal on Addictions, 9(4), 276-284. doi:10.1080/105504900750047346.

Darke, S., & Ross, J. (1994). The use of benzodiazepines among regular amphetamine users. Addiction, 89(12), 1683-1690. Retrieved from Psychology and Behavioral Sciences Collection database.

Elliott, L., Glenday, J., Freeman, L., Ajeda, D., Johnston, B., Christie, M., et al. (2005). Reducing diazepam prescribing for illicit drug users: A randomised control study. Drug & Alcohol Review, 24(1), 25-31. doi:10.1080/09595230500125138.

Fenton, M., Keyes, K., Martins, S., & Hasin, D. (2010). The Role of a Prescription in Anxiety Medication Use, Abuse, and Dependence. The American Journal of Psychiatry, 167(10), 1247-53.  Retrieved from Research Library. (Document ID: 2162719931).

Fløvig, J., Vaaler, A., & Morken, G. (2009). Substance use at admission to an acute psychiatric department. Nordic Journal of Psychiatry, 63(2), 113-119. doi:10.1080/08039480802294787. 

Posternak, M., & Mueller, T. (2001). Assessing the Risks and Benefits of Benzodiazepines for Anxiety Disorders in Patients with a History of Substance Abuse or Dependence. American Journal on Addictions, 10(1), 48-68. doi:10.1080/105504901750160484.

Salzman, C. (1998). Addiction to Benzodiazepines. Psychiatric Quarterly, 69(4), 251. Retrieved from Psychology and Behavioral Sciences Collection database.

The Substance Abuse and Mental Health Services Administration (2010). Office of Applied Studies. Non-Medical Use and Abuse: Prescription-type and Over-the-Counter Drugs. SAMSHA. Retrieved from http://www.samhsa.gov/

Van Valkenburg, C., & Akiskal, H. (1999). Which patients presenting with clinical anxiety will abuse benzodiazepines?. Human Psychopharmacology: Clinical & Experimental, 14S45-S51. Retrieved from Psychology and Behavioral Sciences Collection database.

Weizman, T., Gelkopf, M., Melamed, Y., Adelson, M., & Bleich, A. (2003). Treatment of benzodiazepine dependence in methadone maintenance treatment patients: a comparison of two therapeutic modalities and the role of psychiatric comorbidity. Australian & New Zealand Journal of Psychiatry, 37(4), 458-463. doi:10.1046/j.1440-1614.2003.01211.x.