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Long-term Effects of Ambien Abuse

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What Are the Consequences of Ambien Abuse?

Prescribed to help people sleep, the negative long-term effects of Ambien aren’t well understood. While Ambien can compromise health in several ways, dependency and addiction are among the more serious consequences. In many cases, Ambien addiction can be managed with effective treatment.

What is Zolpidem?

Long-term effects of ambien.Ambien (zolpidem) is a non-benzodiazepine medication used to treat insomnia. It works by slowing brain activity enough to facilitate sleep. The drug is available in both immediate- and extended-release tablet form. Other branded versions of zolpidem (Edluar, Intermezzo, Zolpimist) are available as sublingual tablets (under the tongue) and metered sprays.1

Zolpidem is one of the 3 “Z drugs” developed in the 1980s as safer alternatives to using benzodiazepines for insomnia.2  Classified as a Schedule IV drug by the Controlled Substances Act, Ambien is a member of the sedative-hypnotic pharmaceutical family.3,4 Schedule IV drugs are prescription medications that are considered to have a low risk for dependency and abuse. In spite of this classification, Ambien is not free of dangers. Short-term use presents a variety of risks while long-term Ambien use can lead to tolerance, dependence, and addiction.2

Why Do People Abuse it?

Self-medicating with drugs or alcohol.In a process often referred to as “self-medication,” people sometimes abuse drugs, such as Ambien, to address otherwise untreated psychological issues. While Z drugs like Ambien do not possess the same anxiety-relieving properties of benzodiazepines, zolpidem provides an avenue to sleep as a means of some relief from the stresses of daily life. Others abuse sedatives for their potentially euphoric effects, and describe the high as similar to alcohol intoxication.5

People with a prescription for zolpidem may be tempted to take more pills than indicated should sleep onset be delayed or interrupted, which can be dangerous.5 Another serious problem with Ambien abuse is combining it with other drugs, in some cases to enhance the effects of the respective substances. No matter the reason for combining drugs, the practice can be harmful. According to research, more than half (57%) of emergency room visits involving Ambien included combinations with other drugs.6

Along with drugs of abuse, such as marijuana, stimulants, and hallucinogens, these drugs may include:5,6

  • Alcohol.
  • Opioid painkillers.
  • Benzodiazepines.
  • Antidepressants.
  • Antipsychotics.
  • Muscle relaxants.
  • Anticonvulsants.
  • Cardiovascular medicines.

Abusing Ambien on its own can have adverse consequences, and combining Ambien with other drugs can greatly increase the risk of dangerous effects.

Consequences of Chronic Use

Consequences of chronic abuse.Ambien is recommended for short-term treatment to avoid habitual abuse. Long term use causes some to develop tolerance, or a a need for increasing doses of the drug. In many cases, as use increases to overcome tolerance, physical dependence and addiction soon follow.1,5

There is an association between the long-term use of sedative medications such as benzodiazepines and Z drugs like Ambien and certain populations such as women, people in poor physical health, and the elderly. In fact, up to a third of older adults are prescribed a sedative.5  Zolpidem is designed for short-term relief of insomnia, and should not be taken more than 2 weeks.1 Longer-term use can result in a number of adverse health outcomes. Alcohol particularly enhances some of these risks.

Potential consequences of Ambien abuse include:2,5-8

  • An increased risk of falls, especially among the elderly.
  • Increased risk of parasomnia, a sleep disorder that includes complex sleep-related disorders, such as sleep-eating, sleep-sex, and deadly sleep-driving.
  • Impaired ability to multi-task, maintain proper balance, and function due to impaired cognition and memory.
  • Preliminary studies suggest an association with long-term use of zolpidem and dementia.
  • An unpredictable onset of amnesia or anxiety symptoms may occur.
  • Agitation.
  • An exacerbation of depression.
  • Hallucinations and psychosis.
  • Distressing and potentially dangerous withdrawal symptoms following the cessation of use.
  • Tolerance, characterized by needing more Ambien to feel the desired effects.
  • Addiction, characterized by chronic use regardless of negative consequences.

As with many mind-altering drugs, users may develop a tolerance to ever-increasing doses of Ambien. The sensation caused by Ambien results from a neurochemical process in the brain. Like benzodiazepines, chemical elements of the drug bind with gamma-aminobutyric acid (GABA) receptors in the brain. Over time, these receptors no longer respond to the same dose and require more of the drug to elicit the desired effect, a phenomenon known as tolerance. Tolerance can contribute to the eventual development of physiological dependence, as people take higher and higher doses in an effort to overcome the tolerance.5,9

Ambien Dependence

What withdrawal feels like.While the likelihood of developing a dependence on Ambien may be somewhat less of an issue than that seen with benzodiazepines, the risk remains very real. Once neuroadaptations occur in response to the consistent presence of Ambien, the brain essentially requires Ambien in order to function at an optimal level. Without continued Ambien use, unpleasant and even potentially fatal withdrawal symptoms emerge.

In many ways, the symptoms of sedative withdrawal resemble those of alcohol withdrawal.5 These symptoms can range in intensity depending on a variety of factors. Risk factors for experiencing a severe withdrawal syndrome include long-term Ambien dependence, using high doses, older age, and medical and psychiatric comorbidities. The presence of any polysubstance use may also play a role in the severity of symptoms to develop.

Some of the symptoms of zolpidem withdrawal include: 2,5,8

  • Insomnia – people taking high doses of zolpidem may experience “rebound insomnia,” a severe recurrence of symptoms that led to Ambien use in the first place.
  • Fatigue.
  • Strong cravings for Ambien.
  • Anxiety and panic attacks.
  • Seizures and psychosis (rarely).
  • Delirium.
  • Heightened body temperature, sweating, and flushing.
  • Increased blood pressure.
  • Elevated heart rate.
  • Irregular heart rhythm or heart palpitations.
  • Muscle cramps and tremors.
  • Vomiting, stomach cramps, and other abdominal discomfort.
  • Uncontrollable crying.

Ambien withdrawal symptoms usually begin 48 hours following cessation of use but can begin as soon as 4 hours after the last dose. Symptoms peak after about 5 days.5  Withdrawal symptoms may begin with elevated vital signs, then progress to tremors, disorientation, and even hallucinations. Seizures sometimes occur early during withdrawal.

Depending on an individual’s health condition, these symptoms can escalate into a medical crisis. Almost half of people visiting an emergency room for zolpidem-related issues were admitted to a hospital or transferred to another facility. A quarter of these transferred to an intensive care unit.6

Professional Ambien detox services help reduce these risks and ease the symptoms of withdrawal. Detox treatment does not replace addiction treatment. Instead, it serves as a gateway to effective substance abuse treatment and a return to a drug-free life.

Progressing to Addiction

Like so many other drugs, once dependence develops, quitting the drug becomes an almost impossible burden for some. Dependence is a normal physiological response to the use of many kinds of substances. Ambien addiction, on the other hand, is a set of compulsive drug-seeking behaviors. It is entirely possible to be dependent on Ambien yet not addicted. You are much less likely to be addicted but not dependent.9  

Additionally, in people with significant levels of physiological dependence, withdrawal is distressing enough to drive continued use of the drug that led to dependence to begin with, which may further the development of addiction.

Signs of a developing addiction.There are certain neurochemical changes thought to underlie or accompany addiction development. Drugs of abuse, including Ambien, are thought to result in a surge of dopamine activity throughout our brain reward center when used. Artificially overstimulating this reward system with drugs may lead to short-lived euphoric sensation that further reinforces drug-seeking behavior in the future. All told, the brain changes associated with the development of dependence and addiction help to explain why quitting on your own is so difficult.9,10,11

According to the American Psychiatric Association (APA), tolerance, dependence, and withdrawal are just a few of several diagnostic criteria that, when present, could indicate what’s known as a sedative, hypnotic, or anxiolytic use disorder.12

Some of the other signs and symptoms of such a sedative use disorder include:12

  • Spending a great deal of time obtaining, using, or recovering from Ambien use.
  • Failing to engage in recreational, social, or occupational activities because of Ambien use.
  • Experiencing impaired ability to perform at work, school, or home.
  • Using the drug in hazardous situations – like driving.
  • Continuing to use the drug in spite of known negative consequences.
  • Using more Ambien than prescribed or for longer periods than intended.

Preventing & Treating Long-term Effects

The first important step that many take to begin recovery from Ambien addiction is detoxification. The goal of Ambien detoxification is to manage withdrawal symptoms while the body clears itself of the drug. Because addiction is a progressive condition that tends to worsen over time, the sooner it is treated the better. Longer-term use can result in more severe withdrawal symptoms, which can make quitting even harder. However, it is never too late to seek help.

Difference between inpatient and outpatient rehab.Detoxification entails three components. First, an evaluation determines what drugs are in the body and at what levels. It carefully assesses an individual’s physical, social, and psychological status. This information is used to create the initial treatment plan and guides what level of detoxification and treatment are needed.

Following an evaluation, stabilization begins. This usually involves any needed medical interventions and psychological support to help return an individual to a stable and substance-free state. At this stage, medications may be administered and any health complications to arise are managed. Outpatient detox services cater to those who want to continue working, attending school, or fulfilling home responsibilities. Outpatient services are generally less intensive, and more responsibility is placed on the user. For sedative detox, 24-hour inpatient care is recommended to manage withdrawal symptoms.13 Inpatient detox services have the advantage of constant supervision and support services.11,13

Fostering entry into an appropriate treatment setting is the final component of professional detoxification.13 Following detoxification, transition to an appropriate Ambien addiction treatment setting is recommended. Employing a combination of medication (if applicable), individual and group therapies, addiction treatment centers focus on approaches to prevent relapse and improve coping skills. Much like inpatient detox, inpatient addiction treatment programs have the added benefit of 24-hour supervision, structured schedules, and separation from your using environment.

Addiction treatment is also available at the outpatient level with services ranging from intensive treatment throughout the entire day to individual and group counseling for a few hours weekly. These programs allow you the freedom to continue fulfilling your obligations while recovering from an addiction.

For those seeking to break the cycle of Ambien abuse and addiction, help is available. Users should seek immediate help. A phone call to an appropriate detox center is the first step to a new, drug-free life.

Sources

  1. National Library of Medicine (2018). Zolpidem.
  2. Gunja, Naren (2013). The Clinical and Forensic Toxicology of Z Drugs. Journal of Medical Toxicology June; 9 (2): 155-162.
  3. Drug Enforcement Administration. Drug Schedules.
  4. Drug Enforcement Administration. Depressants.
  5. Weaver, Michael F., MD (2015). Prescription Sedative Misuse and Abuse. Yale Journal of Biology and Medicine Sep; 88(3): 247-256.
  6. Substance Abuse and Mental Health Services Administration (2014). The DAWN Report: Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem.
  7. National Institute for Health and Care Excellence (2018). Hypnotics.
  8. Food and Drug Administration (2008). NDA 19908 SO27 FDA Approved Labelling: Ambien.
  9. National Institute on Drug Abuse (2007). The Neurobiology of Drug Addiction.
  10. National Institute on Drug Abuse (2014). Drugs, Brains, and Behavior: The Science of Addiction.
  11. National Institute on Drug Abuse (2018). Principles of Drug Abuse Treatment: A Research Guide.
  12. American Psychiatric Association. (2015). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association.
  13. Substance Abuse and Mental Health Services Administration (2013). Detoxification and Substance Abuse Treatment.
  14. National Institute on Drug Abuse (2016). Misuse of Prescription Drugs: How can prescription drug addiction be treated?

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