Ambien Addiction Explained
What Is Ambien?
Ambien is a psychoactive drug that’s most commonly used to treat insomnia. (1) Clinical studies of the drug indicate that it’s an effective treatment for up to 35 days; (2) therefore, it’s recommended for short-term treatment only. The tablets are available in immediate-release and extended-release. Immediate-release is prescribed to those who have difficulty falling asleep. Extended-release tablets dissolve in two layers to help with falling asleep and staying asleep. (1)
Ambien is classified as a non-benzodiazepine sedative–hypnotic drug, (3) also known as a depressant or a hypnotic sedative. Depressant drugs slow down brain activity, which is what makes them successful in the treatment of sleep disorders such as insomnia. Clients who take Ambien typically experience sleepiness almost immediately after taking the drug.
Brands and Other Names for Ambien
Ambien is the brand name for the drug zolpidem. The drug may also be sold under the brand names Ambien CR, Edluar or Zolpimist. Additionally, those who abuse Ambien often refer to it by street names, which include:
- Forget-me pill
- Mexican Valium
- Sleeping pills
- Zombie pills
The difference between Ambien and zolpidem
Although Ambien and zolpidem contain the same ingredients, there are differences in the way they are sold. (2) Ambien is only available in an oral tablet and, as mentioned earlier, is available in both immediate-release and extended-release. When purchased in its generic form, zolpidem, the drug is available in oral tablets, extended-release oral tablets or sublingual tablets, which are dissolved under the tongue. Both Ambien and zolpidem are available in 5-milligram and 10-milligram tablets.
Medical Uses of Ambien
Ambien is indicated solely for the treatment of insomnia. However, doctors have been prescribing Ambien and zolpidem off-label for the treatment of neurological disorders for more than 20 years. (5) Patients treated with Ambien for consciousness, such as traumatic brain injury, non-traumatic brain injury or progressive brain damage resulting in coma or vegetative states, were found to have a vast improvement in their quality of life. Those who are treated with the drug for mood disorders such as dystonia or ataxia were found to have a moderate improvement in sleep and EEG abnormalities.
Ambien has also been found to have analgesic or painkilling properties. (6) Studies have shown that administering the drug post-surgery can provide better pain relief than opioid analgesics. The drug has also proven to be an effective pain medication for those with major injuries such as torn ligaments or rotator cuffs.
Regardless of the proven efficacy of Ambien’s analgesic properties, the US Food and Drug Administration (FDA) continues to warn the public and healthcare professionals about the dangers of using Ambien off-label. (7) In addition to the potential for addiction, the FDA warns of the inherent risks involved with using Ambien in combination with opioid pain medications or other contraindicated drugs.
Ambien Legal Status (UK)
In the UK, Ambien and zolpidem are considered controlled, Class C drugs. They’re listed in schedule IV of the UK’s Misuse of Drugs Act, (8) which regulates the use of controlled drugs and bans the possession, supply, manufacture and import without proper licensing. Under the act, Ambien is considered legal to consume only when prescribed by a doctor. Those who possess the drug illegally may face up to two years in prison, and those who supply or produce it may face up to 14 years in prison. (9)
Routes of Ambien Administration
Ambien is generally prescribed to adults or elderly individuals, and the dosage is based on their specific needs and age. (2) Healthy adults are usually prescribed a dosage of 10 milligrams once per day. Elderly persons or debilitated patients are usually prescribed a smaller dosage of 5 milligrams, as they’re often more sensitive to the drug’s effects. Although Ambien isn’t indicated for teenagers, doctors have been known to prescribe it to those with minor insomnia in varying doses.
All patients who are prescribed Ambien are advised to take it immediately before laying down in bed. Tablets are designed to release active ingredients immediately and taking it too early may result in sleeplessness and confusion. Patients are also advised to avoid eating before taking the medication as it may slow absorption and become less effective as a result.
Oral tablets are available in 5 milligram and 10 milligram tablets. Neither dosage is scored. Five-milligram tablets are pink, film coated and capsule shaped. They say AMB 5 on one side and 5401 on the other. Ten-milligram tablets are the same shape and texture; however, they’re white in colour and say AMB 10 on one side and 5421 on the other.
Generic zolpidem tablets are available for sublingual administration as well. These tablets are available in 3.5 milligram or 1.75 milligram doses. Both are white, round capsules. The 3.5 milligram tablet says NP on one side and is smooth on the other, while the 1.75 milligram tablet says N2 on one side and is smooth on the reverse side.
The Pharmacology of Ambien
Ambien is a gamma-aminobutyric acid (GABA) A receptor positive modulator. (2) Its effects are the result of it binding to the benzodiazepine site of the alpha subunit, which contains GABA A receptors. This allows the chloride channel to open at a greater frequency. Thus, neuronal activity is slowed and a hypnotic, sedative effect results.
Ambien’s chemical structure differs from that of benzodiazepines, barbiturates and other widely known hypnotic drugs. While it does share some pharmacological properties with benzodiazepines, Ambien interacts with GABA BZ receptors differently.
Benzodiazepines tend to bind to all BZ receptor subtypes, while zolpidem is selective and binds almost exclusively to alpha1 and alpha5 subunits. As a result, Ambien is effective in treating sleep onset latency but has little to no effect on stage two sleep or total sleep duration. Additionally, Ambien doesn’t typically affect the patient’s daytime alertness levels. Ambien’s active ingredient is zolpidem tartrate.
Chemical formula – C19H21N3O
The molecular formula of Ambien is C19H21N3O. (10) It has an imidazopyridine compound with a 4-tolyl group at the 2-position, with an N, N-dimethyl carbamoyl methyl group at the 3-position, as well as a methyl substituent at the 6-position.
Contraindications of Abusing Ambien
Anyone with hypersensitivity to zolpidem should avoid taking Ambien or any other zolpidem products. (2) Patients who have reacted to this medication have been known to experience angioedema (excessive swelling) in their tongue, throat or larynx. Others have experienced adverse effects including dyspnoea, nausea, vomiting and/or airway obstruction. In some cases, these reactions have been fatal.
Additionally, those who have experienced any of the following conditions or symptoms should not use Ambien:
- Attention deficit disorder
- Myasthenia gravis
- Liver disease
- Sleep apnoea
- Memory loss
Ambien is also contraindicated for individuals who use alcohol or illegal drugs. It may interact negatively with the following prescription medications:
How Addiction to Ambien Develops
If used correctly, Ambien carries a low risk of dependency. However, people who abuse the drug by taking it for a longer period of time than they’ve been prescribed it for, or by taking it at a higher dose, may face an increased risk of addiction.
Those taking Ambien can become addicted in a very short period of time if they’re taking more than the prescribed dose or using it without a prescription, which is becoming a common problem. Addiction to Ambien almost always begins with a high tolerance for the drug. Users may feel the need to take more for the drug to be effective and as such, may need to increase their dose beyond the prescribed 10 milligrams per day. This increase often leads to physical dependence on the drug in a short period of time.
Some signs of addiction to Ambien include:
- Refilling prescriptions more often than usual
- Taking more than the prescribed dose
- Experiencing cravings for the drug
- Purchasing Ambien illegally or spending large amounts of money on it
- Experiencing blackouts while using the drug
- Becoming isolated from family and friends
- Engaging in risky behaviour or dangerous situations while using Ambien
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How Ambien Abuse Affects the Brain
Ambien is known to cause memory loss. Those taking the drug before bed at night often report forgetting the brief period of time between taking their pill and falling asleep. However, those who abuse Ambien, particularly on a long-term basis, may struggle with severe memory loss issues. In fact, in a 2015 study, (11) it was determined that elderly individuals who use zolpidem for a period longer than two weeks have an increased risk of dementia or Alzheimer’s disease.
Other negative neurological and psychological effects have been reported with Ambien abuse as well. These include:
- Loss of appetite
- Suicidal thoughts
- Impaired vision
- Difficulty concentrating
In some cases, these symptoms have been known to last for a considerable period of time, even after Ambien abuse has stopped. This is particularly true when users stop taking the drug suddenly instead of tapering off under medical supervision.
Co-Occurring Disorders with Ambien Abuse
Many people who have been diagnosed with a mental health disorder are considered to have a higher risk of dependence on drugs or alcohol. When a client is diagnosed with a mental health disorder as well as an addiction to alcohol or drugs such as Ambien, it’s considered a dual diagnosis (13) or co-occurring disorders. In many cases, these two disorders may exhibit a similar set of symptoms, which can make accurate diagnoses difficult for the client’s healthcare team.
Co-occurring disorders are particularly common in those with Ambien addiction. This is because insomnia is often the result of an underlying factor, whether physiological or psychological, in the patient. These factors are typically those that Ambien is not able to alleviate and therefore, the person feels they’re not taking a high enough dose of the drug. These people often then increase their dose, which quickly leads to addiction problems.
While receiving treatment for co-occurring disorders, it’s crucial that people struggling with addiction follow an integrated treatment plan. This type of treatment addresses both concerns simultaneously, allowing the client to more effectively heal and recover.
Who Is Most at Risk of Ambien Addiction and Why?
The risk of Ambien addiction is highest in those with a previous history of drug or alcohol abuse. (14) This risk is also elevated for those with a history of mental disorder. These individuals often exhibit poor impulse control, which may lead to misuse of Ambien and other prescription medications.
In many cases, though, Ambien addiction occurs in those with short bouts of insomnia after being legally prescribed the medication. Those who increase their dose or take the drug for a period of time exceeding two weeks run the risk of physical dependence, which may lead to full addiction.
Signs and Symptoms of Ambien Abuse
Individuals who abuse Ambien often take the drug in higher doses than they’ve been prescribed or in some cases, without a prescription. It’s not uncommon for users to take Ambien for purposes other than sleep, and some may combine it with alcohol or other drugs to increase its effect. Some of the side effects of Ambien misuse include:
- Uninhibited sociability and talkativeness
- Frequent blackouts
- Strange behaviour with no memory
- Sleepwalking or sleep activities
- Hypersexual behaviour
- Impaired coordination and balance
Dangers and Effects of Ambien Addiction and Abuse
- Muscle weakness
- Nausea and vomiting
- Unsteady gait
- Mood swings
- Mental confusion
- Uncontrollable shaking
- Excessive drowsiness
- Dangerously slowed breathing
- Bradycardia, or slow heart rate
Ambien Abuse and Addiction Among Young People
Drug addiction among young adults aged 16 to 24 has steadily risen in the United Kingdom over the past several decades. As of 2018, 11.8% of men aged 16 to 24 who live in the UK (15) showed signs of drug dependence. Although this statistic includes all types of drugs, it’s important to note that addiction to prescription medications — sleeping pills, in particular (16) — is becoming more prevalent in the UK and throughout the world.
One of the biggest risks associated with teenagers and young adults misusing Ambien is their tendency to take dangerously high doses. Because Ambien is a sedative, high doses may relax the brain so much that the user forgets to breathe or fails to wake up after passing out.
Additionally, in recent years, pharm parties (17) have become a trend among young people. At these parties, teenagers typically take handfuls of unidentified prescription medications. Often these medications may include Ambien, opiates, stimulants and other sedatives. Any of these drugs can be dangerous at high doses, but in combination with each other, they’re potentially lethal.
Short-Term Effects of Ambien Abuse
Although Ambien is relatively safe when used as prescribed on a short-term basis, even those who abuse the drug for a short period of time may be subjecting themselves to uncomfortable or painful symptoms, which might include:
- Slowed breathing and heart rate
- Uncontrollable tremors or shaking
- Short-term memory loss
- Overwhelming drowsiness/inability to stay awake
- Loss of balance and coordination
Long-Term Effects of Ambien Abuse
Those who abuse Ambien for a long period of time, or even those who take the medication according to their prescription, run the risk of developing a severe substance dependence. Many long-term users may experience some of the same symptoms as listed above. Additionally, they run the risk of long-term brain damage and memory problems, as well as digestive problems, recurrent headaches, depression, anxiety, muscle pain and recurring insomnia.
Overdosing on Ambien
Ambien overdose is incredibly dangerous, and in cases of patients who build up a high tolerance to the drug, it’s unfortunately quite common. While many overdoses occur when the user ingests a high dose of Ambien, there are instances of users taking Ambien as prescribed or with alcohol or opiate painkillers. Signs of a severe Ambien overdose include:
- Fainting or loss of consciousness
- Severe drowsiness or inability to stay awake
- Slowed heartbeat and breathing
An Ambien overdose is an emergency that requires immediate medical attention.
Symptoms of Ambien Dependence and Withdrawal
- Agitation and irritability
- Convulsions and/or seizures in extreme cases
Ambien Withdrawal — Symptoms and Duration
Ambien is indicated for short-term use. Continued use often leads to severe dependence issues and withdrawal symptoms upon discontinuation. Because of this, it’s vital that any user of Ambien ceases use under the supervision of a medical professional. A person who attempts to stop taking Ambien suddenly after any period of time may experience severe physical and psychological withdrawal symptoms. These symptoms typically begin within 48 hours of stopping the drug and may include:
- Rebound insomnia
- Rapid breathing and heart rate
- Mood swings with depression and uncontrollable tears
- Anxiety and panic attacks
- Cravings for Ambien
Typically, drug withdrawal symptoms are the most severe between three and five days without the drug. In most cases, withdrawal symptoms subside within two weeks. However, this may be shorter for those who have abused the drug for a shorter time period and longer for those who have abused it excessively.
Some users may find symptoms continue beyond two weeks. These symptoms are considered post-acute withdrawal symptoms and in most cases, they last between 18 and 24 months, depending on the user’s health and the length of time they misused the drug. Post-acute withdrawal symptoms typically reduce in intensity as time passes. Most commonly, these symptoms include the inability to concentrate, insomnia, poor appetite, anxiety and mood swings.
Ambien Detoxification Process
The recovery process begins with detoxification, (18) which is the medical process in which toxins resulting from substance abuse are cleared from the user’s system. Detoxification is a difficult process that is hard on the user’s mental and physical health. Withdrawal symptoms are at their worst during the detoxification process, and therefore, it’s best that this process occurs under the supervision of a team of medical facilities in a licensed rehabilitation and addiction treatment centre.
During the detoxification process, clients may experience psychological withdrawal symptoms, physical withdrawal symptoms or a combination of the two. Some of the symptoms experienced during this time are severe enough to endanger a client’s life. In many cases, the detoxification period is the time when clients are most likely to relapse or experience suicidal thoughts due to the discomfort associated with their symptoms. While doctors may be able to prescribe some medications to treat the symptoms of withdrawal during the detoxification process, due to the nature of Ambien addiction, many drugs are off-limits during this time, especially sedatives that can treat insomnia.
It’s important to note that detoxification is only the first step on the path to Ambien addiction recovery. In most cases, addiction clients require medical detoxification followed by a long-term treatment plan that combines counselling techniques with behavioural therapy.
Ambien Addiction Treatment & Rehab
Drug rehabilitation consists of several crucial components. (19) When a client enrols in a drug rehabilitation program, they’re first put through medical detox. This is generally followed by a customized treatment plan that’s tailored to the needs of the client. This plan might include a combination of pharmacotherapy, behavioural therapy and group counselling.
Inpatient vs outpatient programmes for Ambien addiction treatment
Upon entering a drug rehabilitation program for Ambien addiction, clients are required to choose between an inpatient programme and an outpatient programme. While there are definite benefits to both programmes, there are obvious disadvantages to each, as well. When choosing a treatment plan, it’s crucial that clients consider their own needs and the type of programme they’re most comfortable and likely to succeed with.
Inpatient addiction treatment programmes are considered the most effective treatment for addiction. During inpatient programmes, clients remain at the treatment centre for the duration of their treatment. This programme typically lasts for 28 days; however, shorter programmes are usually available for those who are unable to commit to a full four weeks of treatment, as are longer programmes for those who require more intensive care. A typical inpatient treatment programme consists of medically supervised detoxification, individual and group counselling, behavioural therapy, family therapy and in some cases, medication management.
During outpatient care, clients attend the treatment centre on a regular basis — often daily or several times per week. Outpatient care programmes are considerably less intensive than inpatient programmes and therefore often last for an extended period of time to ensure patient success. In some cases, they may last beyond a year.
Most addictions treatment professionals recommend that those with the most severe Ambien addictions enrol in inpatient programmes. Those with co-occurring conditions are also most likely to succeed in an inpatient programme. This is partially due to the portion of the programme that includes medically supervised detoxification, which doesn’t often occur during outpatient programmes. Additionally, during inpatient programmes, clients can be more closely monitored for continued Ambien abuse.
Outpatient care is typically recommended for those who have been addicted to Ambien for just a short period of time. In some cases, those who have mental illnesses such as anxiety disorders or chronic depression may be more likely to succeed in an outpatient treatment programme. Often, inpatient programmes can create too much stress for those with mental illness and lead to worsening of addiction symptoms.
Therapeutic treatments for Ambien addiction
Once detoxification is completed, clients transition into a rehabilitative therapy programme. This programme includes a variety of components including behavioural, individual and group therapies. These therapies are meant to help clients understand the root of their addictions and learn to cope with triggers and avoid future relapse.
Addictions therapists and counsellors use a variety of mediums to help clients during their treatment programme. Techniques vary depending on the individual client and their needs but may include meditation, art therapy and music therapy. Additionally, clients learn to care for themselves in the long term through healthy eating and holistic therapies. Many clients complete a 12-step programme during their treatment as well.
In individual therapy, clients discuss their addictions and underlying issues with a trained addictions counsellor. Depending on the client’s treatment plan, they may meet with their counsellor daily, weekly or several times per week. Addictions counsellors may use a variety of methods during counselling sessions to help their clients determine the cause of their addiction and recognize the factors that lead them to abuse Ambien.
In addition to cognitive behavioural therapy and motivational interviewing, which are discussed below, addictions counsellors may use post induction therapy, a form of trauma therapy that is designed to help those who have experienced severe childhood trauma.
Group therapy (20) is considered an important aspect of all addiction treatment plans. In group therapy, a trained addictions counsellor leads and directs conversation between clients from all walks of life and who struggle with different types of addiction including alcoholism, opioid addiction and other substance abuse issues. There are a variety of advantages to group therapy sessions, (21) which include:
- Peer support helps clients abstain from problem substances
- People struggling with addiction tend to feel less isolated with group support
- When recovering as a group, clients are given the opportunity to witness the successes of their peers
- Clients are provided with new coping mechanisms as they learn how their peers handle difficult situations
- Groups help those who are new to recovery transition into treatment programmes
- Clients feel a sense of family in group therapy
- Other group members can effectively provide encouragement, support and comfort during difficult times when relapse is possible
- Group therapy provides clients with a sense of structure
- Group members often confront those engaging in dangerous or abusive behaviour, which is sometimes more effective than confrontation from family members, friends or addictions counsellors
Clients who are enrolled in inpatient treatment programs can expect to attend a group therapy session daily for the duration of their program. Those who are enrolled in outpatient programs may attend group therapy daily, weekly or several times per week, depending on their treatment plan.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) (22) is used for a variety of mental health conditions including eating disorders, post-traumatic stress disorder, depression and addictions. It consists of six individual phases: assessment, reconceptualization, skills acquisition, application training, generalisation and maintenance and post-treatment follow-up. During CBT, clients talk through issues with their therapist and learn to redirect their thinking to manage and cope with issues that lead to their addiction or other mental health issues. The end result is improved stress and anxiety-management skills, which usually helps clients to avoid triggers that led them to misuse Ambien and other drugs.
Another method often employed by addictions counsellors for those who suffer from Ambien addiction is dialectical behavioural treatment (DBT). (23) DBT is a form of CBT that was specifically designed to treat patients with borderline personality disorder but has proven successful in addictions counselling. It’s a technique that is support-based, cognitive-based and collaborative, which sets it apart from other forms of behavioural therapy.
DBT consists of four modules: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Throughout these modules, clients are taught acceptance, patience and appreciation for their lives.
Motivational interviewing is a technique that’s used in both individual and group therapy sessions. Its goal is to direct the client to change the behaviours that led them to abuse Ambien and/or any other substances that they are struggling with. Motivational interviewing helps to provide clients with the motivation they need to quit their addiction by providing them with tools to overcome fear or resistance to change.
During motivational interviewing, addictions counsellors are trained to engage with their clients by asking open-ended questions and invoking active listening skills to empathize with their clients. Through this method, counsellors help addicts to focus and reflect on their issues so that they’re able to effectively uncover motivation to change their destructive behaviours.
Motivational interviewing has been shown to improve engagement in treatment plans and therapies among addicts. (24)
Contingency management consists of helping clients to successfully transition home and into a healthy lifestyle once they’ve completed their treatment program. This includes a comprehensive aftercare plan tailored to help clients succeed during the first 60 days at home, the time when the risk of relapse is highest.
During contingency management, clients are taught to successfully manage medications to avoid further addiction. They also continue to receive outpatient treatment that includes life skills counselling and group therapy. During this time, clients practice and follow up on the coping skills they have learned throughout their treatment program while continuing to receive the support of their peers and addictions professionals.
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