Pregabalin Addiction Explained
Many people suffering from epilepsy, anxiety, neuropathic pain and other conditions have their lives immeasurably by prescription of pregabalin. However, pregabalin use can lead to the development of addiction and dependence, and pregabalin addiction is now a growing problem across the UK.
What is Pregabalin?
Pregabalin is a gabapentinoid – a class of drugs derived from inhibitory neurotransmitter gamma-aminobutyric acid (GABA) – used to treat a number of different medical conditions. Pregabalin was first synthesised in 1990, initially designed for use as an anticonvulsant, and was cleared for use in the European Union in 2004. However, a number of adverse side-effects including a moderate dependence liability have been associated with pregabalin use, and although pregabalin’s recreational use is still comparatively uncommon in the UK, its mildly euphoric and sedative properties mean that it is taken recreationally by some users, both on its own and in combination with other substances of abuse.
The consumption of pregabalin can cause a number of adverse reactions. Typically, taking pregabalin can cause weight gain, dizziness, euphoria, impaired or disturbed vision, swelling (especially in limbs), fatigue, and loss of motor control. Some other common adverse drug reactions which are associated with pregabalin use include: drowsiness; diplopia; confusion; changes in libido; ataxia; vivid dreams or nightmares; irritability; attention deficit; impaired memory; tremors; vertigo; dysarthria; dry mouth; vomiting; paraesthesia; flatulence; peripheral oedema; asthenia; erectile dysfunction; nasopharyngitis; depression; anorgasmia; hallucinations; agitation; hypoaesthesia or hyperaesthesia; myoclonus; tachycardia; hypoglycaemia; heavy sweating; rashes; myalgia; urinary incontinence; arthralgia; muscle cramps; dysuria; kidney calculus; neutropenia; hypotension or hypertension; pancreatitis; first degree heart block; dysphagia; oliguria; rhabdomyolysis; and suicidal ideation.
Available Forms of Pregabalin
Pregabalin is available in capsule or tablet form – typically in doses of 150 mg – for oral consumption.
Medical Uses of Pregabalin
Pregabalin was initially designed as an anticonvulsant, and its primary medical use today is in the treatment of conditions provoking seizures, including epilepsy where it is mostly used as an add-on therapy for partial seizures. Pregabalin is also used to treat neuropathic pain (including diabetic neuropathy and postherpetic neuralgia) and fibromyalgia, as well as restless leg syndrome, and is less commonly used to treat generalised anxiety disorder. Pregabalin has also been used experimentally in the treatment of chronic low back pain and alcohol withdrawal, though there is little evidence of efficacy in these treatments.
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Legal Status (UK)
Since April 2019, pregabalin has been categorised as a class-C controlled substance under the Misuse of Drugs Act 1971, with a maximum sentence for unlawful possession (that is, possession without a valid prescription) of two years’ imprisonment plus an unlimited fine, and for supply of 14 years’ imprisonment and an unlimited fine.
Routes of Administration
Pregabalin is taken orally in tablet or capsule form.
Pharmacological Actions of Pregabalin
Pregabalin inhibits certain calcium channels in the brain and body, thus restricting the passage of electrical information to and from the brain, effectively limiting pain impulses; specifically, pregabalin acts upon voltage-gated calcium channels in skeletal muscle, smooth muscle, and bone, and throughout the brain and peripheral nervous system.
Pregabalin also causes an increase in the expression in the brain of L-gutamic acid decarboxylase (GAD) which is the enzyme responsible for synthesising gamma-aminobutyric acid (GABA), which in turn increases levels of GABA in the brain.
Pregabalin has the chemical formula C8H17NO2 and the chemical synonyms 3-isobutyl GABA and (S)-3-isobutyl-γ-aminobutyric acid.
Pregabalin Brand and Other Names
Historically, pregabalin has been most commonly marketed under the brand name Lyrica, by which it is still sold in the USA. However, since it became available as a generic medicine pregabalin has been sold under a huge variety of brand names around the world, including Algerika, Alivax, Alyse, Alzain, Andogablin, Aprion, Averopreg, Axual, Balifibro, Brieka, Clasica, Convugabalin, Dapapalin, Dismedox, Dolgenal, Dolica, Dragonor, Ecubalin, Epica, Epiron, Gaba-P, Gabanext, Gabarol, Gabica, Gablin, Gablovac, Gabrika, Gavin, Gialtyn, Glonervya, Helimon, Hexgabalin, Irenypathic, Kabian, Kemirica, Kineptia, Lecaent, Lingabat, Linprel, Lyric, Lyrica, Lyrineur, Lyrolin, Martesia, Maxgalin, Mystika, Neuragabalin, Neugaba, Neurega, Neurica, Neuristan, Neurolin, Neurovan, Neurum, Newrica, Nuramed, Paden, Pagadin, Pagamax, Painica, Pevesca, PG, Plenica, Pragiola, Prebalin, Prebanal, Prebel, Prebictal, Prebien, Prefaxil, Pregaba, Pregabalin, Pregabalina, Pregabaline, Prégabaline, Pregabalinum, Pregabateg, Pregaben, Pregabid, Pregabin, Pregacent, Pregadel, Pregagamma, Pregalex, Pregalin, Pregamid, Pregan, Preganerve, Pregastar, Pregatrend, Pregavalex, Pregdin Apex, Pregeb, Pregobin, Prejunate, Prelin, Preludyo, Prelyx, Premilin, Preneurolin, Prestat, Pretor, Priga, Provelyn, Regapen, Resenz, Rewisca, Serigabtin, Symra, Vronogabic, Xablin, and Xil.
As a combination drug with mecobalamin, pregabalin is also sold under brand names including Agemax-P, Alphamix-PG, Freenerve-P, Gaben, Macraberin-P, Mecoblend-P, Mecozen-PG, Meex-PG, Methylnuron-P, Nervolin, Nervopreg, Neurica-M, Neuroprime-PG, Neutron-OD, Nuroday-P, Nurodon-PG, Nuwin-P, Pecomin-PG, Prebel-M, Predic-GM, Pregacent-M, Pregamet, Preganerv-M, Pregeb-M OD, Pregmic, Prejunate Plus, Preneurolin Plus, Pretek-GM, Rejusite, Renerve-P, Safyvit-PR, and Vitcobin-P.
Although recreational pregabalin use is relatively limited, it is occasionally known on the street by names including Gabbies, Budweisers and Bud Lights.
Pregabalin Addiction and How it Develops
Fundamentally, addiction is a disorder of the brain’s reward system. The repeated engagement in rewarding behaviour over time can lead to an adjustment of reward centres in the brain, in which an increasing quantity of chemicals including dopamine (associated with feelings of well-being, pleasure and reward) is produced when the behaviour in question – for instance, consuming pregabalin and experience its effects – is repeated, driving further engagement in that behaviour. Meanwhile, abstaining from that behaviour can cause a deficiency in dopamine and other chemicals, leading to low mood and other unpleasant and undesirable sensations, which the user may seek to dispel by re-engaging in the behaviour (in other words, by taking more pregabalin).
The repeated use of pregabalin over time can also lead to physical dependence. Dependence is a phenomenon whereby an individual’s brain and body become used to the presence of a certain substance, and become reliant upon certain levels of that substance being present in order to perform their normal functions. If that substance is then suddenly withdrawn from the system of independent individual – i.e., If they suddenly stop taking it – that system may enter into a period of abnormal functioning during which a variety of potentially unpleasant and dangerous symptoms may manifest, collectively known as withdrawal syndrome.
Why is Pregabalin Addictive?
Pregabalin is both psychologically and physically addictive. The pleasant euphoric effects of pregabalin, even resulting from medical use, can drive the user to keep taking the drug – potentially for much longer than recommended by the prescribing doctor – in a manner which constitutes abuse and which can distort the brain’s reward centres in a way which leads to the development of addiction. Meanwhile, pregabalin’s physical dependence liability means that taking the drug over time can lead to the development of dependence; if a dependent individual stops taking pregabalin they are likely to begin to exhibit and experience symptoms of withdrawal, which they may seek to dispel by the further consumption of pregabalin even if they may not wish to keep taking the drug.
Causes & Risk Factors of Pregabalin Addiction
Addiction is an increasingly well understood phenomenon, but it is still not perfectly clear why one individual may develop an addiction to a substance of abuse one another in very similar circumstances may not. Clearly, somebody who never takes pregabalin will never develop a pregabalin addiction, so the single greatest and most obvious risk factor for pregabalin addiction is taking pregabalin at all in any circumstances.
However, a number of other factors have been identified as increasing the likelihood that a given individual will go on to develop a pregabalin addiction, including:
- a family history of substance abuse and addiction
- a family history of mental health issues
- a personal history of mental health issues
- early exposure to substance abuse
- previous experience of substance abuse
- socialising with a peer group within which substance abuse – especially the abuse of pregabalin – is commonplace
- easy access to pregabalin
- suffering from conditions for which pregabalin may typically be prescribed
- experiencing childhood abuse
- experiencing stress, trauma or challenging life situations
- social isolation and withdrawal
- a tendency to engage in risky behaviour
- a strong desire to fit in
Common Drug Combinations
Because pregabalin has only relatively recently reached the marketplace, and still more recently begun to be used recreationally, our understanding of how and when pregabalin is typically abused is comparatively limited. However, it is known that pregabalin is commonly abused alongside other substances of abuse, typically including opioids. Individuals using pregabalin for its euphoric effects are also more likely than the average to abuse other medications with similar properties, including benzodiazepines.
Co-Occurring Disorders with Pregabalin Addiction
Substance use disorders frequently co-occur with other mental health issues, a condition known as dual diagnosis. Substance abuse can often be caused by mental health disorders, as individuals suffering from poor mental health often self-medicate with substances of abuse or use them for the purposes of escapism; meanwhile, mental health issues can also result from substance abuse, either because of the neurological impact of the substances in question, or because of the detrimental effects addiction typically has upon life circumstances and prospects.
Dual diagnosis is particularly common in cases of pregabalin addiction because of pregabalin’s use in the treatment of generalised anxiety disorder, which itself often co-occurs with other mental health issues.
Dual diagnosis can complicate the treatment of addiction significantly, as both issues need to be addressed simultaneously, and each can impede the treatment of the other. Specialist care is typically required in cases of dual diagnosis, often in dedicated treatment centres including residential rehabilitation (rehab) facilities.
Signs, Symptoms and Effects of Pregabalin Addiction
It can be difficult to identify the presence of an addiction, even in someone very close to you whom you think you know well: addicts typically go to great lengths to conceal their condition as a result of the stigma associated with addiction and the potentially catastrophic reputational harm which can result from having an addiction become common knowledge. The abuse of a prescription medication such as pregabalin, and any addiction resulting from it, can be particularly hard to identify as such medicines do not typically cause the same degree of alarm as illegal substances, and because individuals taking pregabalin can reassure concerned parties that they are doing so strictly in accordance with doctor’s instructions even if this is not actually the case.
Nevertheless, some signs may be observed which can betray the presence of a pregabalin addiction, including:
- visiting multiple doctors to receive several prescriptions (“doctor shopping”)
- neglecting appearance and hygiene
- poor performance at work or in academia
- neglecting responsibilities including family
- loss of interest in previously enjoyed hobbies
- using money set aside for necessities to buy pregabalin
- appearing permanently relaxed
- experiencing frequent short-term memory loss
- becoming irritable or violent when unable to accesspregabalin
- exhibiting poor judgement under the influence of pregabalin
- disrupted sleep patterns
- stealing or engaging in other criminal activity in order to buy drugs
- mood swings
- nausea and vomiting
- poor muscle control
- weight gain
- double vision
- slurred speech
- damage to the heart, liver, and kidneys
Impact of Long-Term Pregabalin Abuse on the Brain
Research into pregabalin abuse over the long term is comparatively limited. However, at this stage there do not seem to be any noteworthy long-term neurological consequences of abusing pregabalin – though that is not to say that none will be revealed in future studies.
Signs and Symptoms of Pregabalin Withdrawal
Individuals who develop pregabalin dependence are likely to experience withdrawal symptoms upon cessation of use. Pregabalin withdrawal syndrome includes both psychological and physical symptoms, some of which can be extremely unpleasant and distressing.
Although each case of pregabalin withdrawal syndrome is unique – as is every individual pregabalin user – some symptoms associated with withdrawal from pregabalin include:
- flulike symptoms
- suicidal ideation
Although withdrawal from pregabalin does not typically last as long as many other withdrawal syndromes, with most symptoms subsiding after a couple of days, some users go on to develop post-acute (or protracted) withdrawal syndrome (PAWS), in which various symptoms may last much longer: months, or even years. Cases of PAWS typically require specialist care.
Because some of the symptoms of pregabalin withdrawal can be extremely unpleasant, and include suicidal ideation, withdrawal from pregabalin is considered dangerous. If you are addicted to pregabalin – or any other substance abuse – you should never embark upon a process of detoxification or withdrawal without medical assistance: always consult your GP and/or an addiction specialist about getting help for your pregabalin withdrawal.
Overcoming Pregabalin Addiction
Inpatient and Outpatient Treatment
Treatment at some rehab facilities may be provided on either an inpatient or an outpatient basis. Each has its own advantages.
Inpatient stays typically last between one and three months; addiction treatment is provided according to a holistic treatment plan drawn up at the start of a stay, and typically includes a detoxification (detox) phase followed by therapy, with elements such as bespoke fitness and diet plans running throughout the programme (and other elements potentially provided depending on the nature of the facility in question). Rehabs provide calm, secure, friendly, pleasant and confidential environments in which clients can focus fully upon their treatment and recovery; quality facilities and organisations will provide free aftercare for up to a year after the end of treatment to provide the surest possible footing for recovery.
Outpatient treatment, with some appointments attended on site but much of the treatment programme carried out independently, can be preferable for addicts who feel unable to take the time out from their daily responsibilities which an inpatient stay would entail. While outpatient treatment may seem like a better option for some addicts, however, it can be problematic in that it does not remove addicts entirely from their daily environments in which substance abuse and addiction have developed, and therefore make relapse significantly more likely than if treatment were provided in a secure residential environment free of substances of abuse.
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Pregabalin Detox Process
Every rehab has its own procedures and processes, and what is applicable for one facility or organisation may not apply to another. Typically, however, upon entering rehab a client will receive a full physical and psychological assessment, following which an addiction treatment programme will be drawn up, and if necessary a first dose of medication will be prescribed.
How long detox lasts, and the severity of any withdrawal symptoms which may manifest, depends to a large extent on a number of factors including the duration and severity of addiction and the physiology of the addict. However long the detox phase, in rehab the withdrawing client will be monitored and assisted by highly trained medical professionals who will ensure their safety and that they are as comfortable as possible.
Detox is an indispensable aspect of addiction treatment, as an addict’s system needs to be cleansed of substances of abuse in order for them to overcome any dependence which may have developed, and subsequently be able to focus fully upon therapy and other aspects of healing. While withdrawal syndrome may be intimidating, going through detox and withdrawal is vital if further treatment is to be effective – and the short-term discomfort of withdrawal (which can in any case be alleviated to a certain extent by medication) is infinitely preferable to a life of addiction and all that entails.
Pregabalin Addiction Treatment Medications
There is no pharmaceutical cure for pregabalin addiction. However, various medications may be prescribed to treat some of the symptoms of withdrawal which may manifest after you stop taking pregabalin:
- Clonidine – sold under the brand name Catapres, among others – can be used to treat high blood pressure if doctors deem it to have reached problematic levels; it is also used as a sedative to treat any withdrawal-related agitation.
- Dexmedetomidine – available under the trade name Precedex, among others – is an anxiolytic, sedative and analgesic which is used for the same purposes as clonidine (though because it is comparatively expensive it is typically only used if clonidine is unavailable or cannot be prescribed for any medical reason).
- Sleeping aids of various kinds may be prescribed for the treatment of insomnia or other sleep disorders, which are a very common symptom of withdrawal from pregabalin and many other substances of abuse.
- Antidepressants – including selective serotonin reuptake inhibitors (SSRIs) – can treat depression, including major depressive disorder, resulting from withdrawal including any depression forming part of PAWS.
- Nausea medication(such as Zofran) and loperamide (best known by the trade name Imodium) can treat nausea and gastric disturbances which are common in cases of pregabalin withdrawal.
- Anti-convulsants(including some benzodiazepines) can be prescribed for the management of seizures.
Therapy for Pregabalin Addiction
Therapy lies at the heart of all addiction treatment, and in rehab can be provided in a wide variety of models, methodologies and settings. Therapy aims to uncover and tackle the fundamental causes of substance abuse and addiction in any individual client, and to allow the client to remediate the problematic thought processes and behaviours which have resulted in the development of addiction. Moreover, therapy is a critical aid in the preparation of the addict for life after treatment, including via the development of psychological defence mechanisms against relapse and coping strategies for the various challenging situationswhich the addict is likely to face in life outside a treatment facility.
and it may be that various different therapy models and approaches may need to be tried before the addict settles upon a therapeutic structure which works best for them. Moreover, each facility may offer different therapy models, with some facilities able to offer more niche methodologies. If you are addicted to pregabalin and are considering enrolling in rehab, and have a preference for certain types of approaches to therapy, contact an addiction specialist to discuss that preference and to find out which treatment facilities and organisations may be able to provide the therapy environment of your choice.
Contingency management or motivational incentives
Contingency management (CM), sometimes known as motivational incentives, is a form of therapy founded on what is known as operant or instrumental conditioning, a learning process which conditions or remediates behaviour through the use of rewards and punishments. Desired behaviours such as passing drug tests or attending all appointments successfully can result in rewards (potentially financial, though more usually privilege-based) while deviation from desired behaviour can result in disciplinary measures. Contingency management has been proven to be considerably effective in the treatment of substance use disorders including pregabalin addiction.
Recovery is not complete the moment an addict leaves a treatment facility – indeed, in many ways the hard part is just beginning, as the recovering addict learns to adapt to life after substance abuse addiction and to navigate through various pitfalls and temptations that they will encounter whilst reshaping their life in order to achieve the happiness they seek. With this in mind, good treatment facilities will provide comprehensive aftercare plans – typically free for up to a year after treatment – including relapse prevention strategies, scheduled appointments for ensuring problems can be dealt with by familiar professionals, and other elements such as engagement in support groups or individual counselling.
Cognitive behavioural therapy (CBT)
CBT is probably the best-known therapeutic methodology provided in addiction treatment, and aims to improve mental health and well-being by uncovering and challenging unhelpful thought processes and behaviours and by improving emotional regulation and developing coping strategies. CBT is used to treat specific problems – such as substance use disorders – rather than taking a traditional psychoanalytic approach in which the therapist aims to uncover the unconscious significance of problematic behaviours and thence to formulate a diagnosis. The goal of CBT in addiction treatment is to examine the addict as a whole and work on elements of their personality and behaviour which can be changed for the better, whilst identifying those aspects which cannot be changed and coming to terms with that challenge in ways which can facilitate healing and recovery.
Motivational interviewing (MI) is a client centred counselling approach designed to elicit behavioural change by helping clients explore, consider and resolve ambivalence. Unlike many types of therapy in which the therapist does not attempt to direct the client, MI sees the therapist taking a much more active and directive role, using open-ended questions, affirmations and summary statements in a non-judgemental and non-adversarial manner.
Some individuals who complete treatment programmes in rehab may not feel fully prepared to re-enter society; for such people, recovery housing (in which secure overnight accommodation is provided, typically with easy access for medical professionals and other addiction specialists) may prove an excellent halfway step before a full reintegration into normal life.
Other Kinds of Intervention
If someone close to you is suffering from an addiction of any kind, including to prescription medication such as pregabalin, it is understandable that you may wish to leap into action and confront them about their condition and/or offer your assistance. One popular way of tackling an addiction is via an intervention; however, while interventions can be extremely successful, if carried out incorrectly they can also do much more harm than good, including alienating the addict and potentially driving them further into substance abuse.
If you would like to find out more about interventions and how best to effect one, get in touch with an addiction professional to discuss the specifics of your situation and in order to get advice on how to mount an effective intervention. Remember, above all, you must prioritise your safety and that of any others you may wish to get involved in the intervention.
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Pregabalin Addiction Statistics
- Over 30% of all patients taking pregabalin report dizziness, making it the most common side effect associated with the drug.
- Pregabalin is only available in oral form, with dosages ranging from 150mg to 600mg per day – though the abuse of up to 20 times the recommended dose has been recorded in some patients.
- Prescriptions for pregabalin in the UK increased by over 11 times in the decade to 2016, with 5,547,560 prescriptions written for pregabalin that year.
- Worldwide sales of pregabalin topped $5bn in 2017, making it the 10th most valuable drug in the worldwide pharmaceutical market.
- According to one study, over 4% of individuals taking pregabalin will suffer withdrawal symptoms on cessation of use.
Ready to get Help for Your Addiction?
If you suffer from an addiction to pregabalin, you are endangering your health and risking permanent and catastrophic damage to your health and happiness. However, no matter how distressing or debilitating your condition may seem, it is important not to give up hope: help is out there in the form of a number of high-quality treatment facilities and organisations operating across the country with significant expertise in treating pregabalin addiction.
If you are tired of living under the burden of pregabalin addiction and wish to take back control of your life, and work towards a healthier and happier future, you can do so with professional help: contact your GP and/or an addiction specialist to discuss what treatment options might be available to you.
Get help today
The sooner you can embark upon a treatment programme, the sooner you can overcome your pregabalin addiction and begin to lead an abstinent life. However, treatment will not simply come to you: you need to be proactive and take that first step path back to health and happiness by picking up the phone and talking to your GP and/or an addiction specialist. Don’t delay any further: set out on the road to recovery today, and start looking forward to a life without pregabalin.
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