Restoril Addiction Explained
What Is Restoril?
Restoril is the most well-known brand name for temazepam, a benzodiazepine tranquilliser that is primarily used to help people who are insomnia. The drug is also used as a premedication to relax people who are about to undergo minor surgery or dental procedures. (1) It is ingested orally in tablet or liquid form and is available only by prescription in the United Kingdom.
Restoril induces sedative effects on the user, including slowing down the functions of the body and the brain, such as breathing, thought processes and heartbeat. It can help people to break the cycle of insomnia and form a new, controlled sleeping pattern that suits their lifestyle. (2)
The drug is prescribed to those who are having such severe difficulty sleeping that it is having a debilitating impact on their day-to-day life. (3) Restoril should not be used as a long-term solution to insomnia, with the NHS recommending limiting treatment to four weeks. For people who find that their eyesight is impaired or they feel confused, dizzy or sleepy, driving or operating heavy machinery is not recommended.
Brands and Other Names for Restoril
Benzodiazepines are psychoactive drugs that have a number of colloquial and medical names, such as sleeping pills, minor tranquillisers, sedatives and hypnotics. Other medications that fall into the same group are diazepam, alprazolam, clonazepam, flurazepam and lorazepam, among others.
Temazepam is the generic name for Restoril, but it is also branded as the following in English-speaking countries:
Restoril Legal Status (UK)
Restoril is Class C, which is considered the least harmful of the controlled drugs by the government and includes GHB, steroids and some tranquillisers. Being considered the least harmful does not mean there is a reduced risk of substance abuse or substance dependence for an individual. These classifications relate to the danger a drug poses to the wider community and society as a whole. (4)
In the United Kingdom, controlled drugs are divided into three categories (A, B and C), which are meant to reflect the level of harm associated with the substance. The classes are determined by parliament according to recommendations from the Advisory Council on the Misuse of Drugs (ACMD). As well as reflecting potential harm to the user, the categories are used to determine the level of penalty available to the courts in the case of criminal misuse or distribution. (5)
In 2001, another layer of legislation was introduced by the government to designate which persons legally have the right to produce, distribute, import, export, possess and supply the substance. They also ensure that record-keeping meets stringent standards and helps to shape future legislation. Out of five categories or ‘schedules’, Restoril is schedule three.
The addictive propensity of temazepam means the government has stipulated that special prescription and safe custody requirements apply. Records in registers are not required, but all invoices denoting the sale of Restoril must be retained for two years. (6)
Restoril is ingested orally in tablet or capsule form. It is recommended that each individual is prescribed the lowest dose for their age, weight and gender. For healthy adults, 15 mg before bed is the usual dose. Debilitated or elderly individuals should commence treatment with 7.5 mg and only increase the dosage if the lower dose is ineffective. (7)
Pharmacological Actions of Restoril
Temazepam is an intermediate-acting benzodiazepine derivative that falls into the pharmacotherapeutic group of hypnotics and sedatives and also induces anxiolytic activity. It is a crystalline, white substance that is sparingly soluble in alcohol and slightly soluble in water.
Scientists believe that the effects of Restoril are due to the increased effect of the neurotransmitter gamma-aminobutyric acid (GABA). Evidence has shown a close molecular connection between the site of GABA production and the action of benzodiazepines. (8) The drug works by stimulating a neurotransmitter that ceases overactivity in the brain and promotes relaxation and sleep.
Restoril is easily absorbed by the gut and when ingested orally, peak plasma levels are usually reached within 50 minutes. It is approximately 96% bound to plasma protein, and trace amounts significant enough to impact an infant can be found in breast milk. It is predominantly metabolised by the liver and has a terminal half-life of between eight and 15 hours. The half-life varies slightly depending on the time of dosage and the age of the person.
Restoril Addiction Causes and Risk Factors
The majority of scientific studies on the genetic factors affecting addiction have been carried out on individuals who are suffering from alcoholism. One study conducted into the risk factors for addiction to benzodiazepines used such studies into alcohol-related disorders as a reference point. (11) An association has been found between the GABA neurotransmitter and affective disorders, anxiety, alcoholism and schizophrenia; scientists believe these links can be extended to Restoril addiction.
Variations of the gene that governs GABA receptors are associated with the risk of alcohol addiction. These genes have also been found to affect the propensity to become addicted simultaneously to multiple substances. It is widely accepted that these genetic variations cause increased sensitivity to the effects of alcohol, which leads to the desire in addicted persons to repeatedly obtain these magnified desired effects.
Genes affecting the production of Monoamine oxidase A (MAOA), which metabolises serotonin, dopamine and norepinephrine, are also believed to contribute to the addiction to Restoril. These neurotransmitters play an important role in the central nervous system where temazepam acts, modulating depression, anxiety and temperament. Variations of the MAOA genes have been linked to depression and alcoholism and are widely understood to contribute to benzodiazepine addiction. (11)
Those at the highest risk of use developing into substance abuse of temazepam are those who have trouble regulating their emotions. Childhood trauma or mistreatment is generally thought to be the single greatest environmental risk factor for causing the emotional dysregulation that contributes to the development of addictions. Early childhood stress has been found to cause variations in the production of MAOA, particularly serotonin; this variance is a predictor of depression and alcoholism and is thought to contribute to Restoril addiction. (11)
A number of other social and environmental factors are thought to lead to addiction to sleeping pills. Common factors found include the duration of treatment, applied dosage and circumstances at the commencement of treatment. The fact that use in excess of four weeks, as well as the strength of the dose, increases the chance of addiction significantly has led to strict protocols that doctors who are prescribing the drug must follow.
Other common factors that have been found to contribute to benzodiazepine addiction include abuse of alcohol and other psychoactive drugs, critical life events and lack of adequate intervention. Frequently cited psychological factors that give people a predisposition to Restoril addiction are cluster B personality disorders, neuroticism, anxiety and depressive disorders. (11)
A history of substance abuse is one of the most significant risk factors in developing an addiction to Restoril. Medical professionals are advised to exercise extreme caution when prescribing temazepam to people who have insomnia and ask extensive questions to ascertain if pre-existing addictions are present. It is particularly pertinent to note the potentially lethal effect on the central nervous system of combining Restoril and alcohol.
A study found that people with a pre-existing tendency for substance abuse clearly prefer benzodiazepines to a placebo drug, whereas those without a history of substance abuse showed no preference. This backs up the genetic theory that those with a greater sensitivity to psychoactive substances have a higher likelihood of developing issues with dependence.
There are several reasons why those who already suffer from pre-existing addictions show a higher propensity for sleeping pill addiction. People who habitually take stimulants may depend on their sedative effects to relieve the ‘come-down’ symptoms of agitation, anxiety and trouble sleeping. Those who have pre-existing substance dependencies may crave the escapism that is achieved by inebriation and seek it via any means available, legal sleeping pills being an easy source.
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Mental Health and Restoril Abuse — Dual Diagnosis
A dual diagnosis is when someone with a severe mental health problem is also suffering from the symptoms of problematic substance misuse to the extent that both are diagnosed. In the case of a dual diagnosis, it is the mental health system that is responsible for the care, as opposed to drug and alcohol services. (12) People who are facing these challenges often require help with suitable housing, employment and benefits and may need help to get away from a harmful or enabling relationship.
People who have been diagnosed with a mental health disorder and a substance misuse disorder are at a particularly high risk of injury, further debilitation of circumstance and relapse, especially if they do not have a support network of friends and family. There are drug rehabilitation facilities that offer therapy to treat the underlying causes of mental health problems that may have led to the person escaping into substance abuse.
Signs and Symptoms of Restoril Abusers
- Dry mouth
- Involuntary movement of the eyes
- Poor judgment
- Mood swings
Dangers and Effects of Restoril Addiction and Abuse
- Liver damage
- Kidney failure
- Respiratory depression
How Restoril Abuse Affects the Brain and Body
It can be difficult for an individual to realise that they are suffering from a potentially fatal addiction to Restoril. Due to the prescription coming from a doctor and the substance being legally available, people believe taking it on a daily basis over a long period of time must be fine. This is where the real danger of prescription drugs comes in and why it is important for individuals to be self-aware and for loved ones to look out for family members who are regularly using sleeping pills.
The main compulsive behaviour
Forcing the liver and kidneys to metabolise a chemical substance daily, often in incremental doses over time, is very harmful and can lead to a variety of long-term health problems. The most dangerous physical risk associated with Restoril abuse is the depression of the central nervous system, which, with high doses, can result in coma or death.
Overdosing on Restoril
Misusing Restoril has many detrimental effects on an individual, and due to the potential for developing a tolerance, abuse can lead to overdose and death in extreme circumstances. Abuse is characterised by an individual taking more than the doctor has prescribed, using someone else’s medication, attempting to inject or snort the drug and/or using the drug for a longer period than medically advised.
Overdosing on Restoril alone is relatively rare, although entirely possible in high quantities. Overdose on a cocktail of psychoactive substances is, however, relatively common. (13)
There are many substances that interact dangerously with benzodiazepines and are legally available, such as antidepressants, alcohol and opioids that also depress the central nervous system. These combinations have caused many accidental and intentional overdoses. People who are known to use a mixture of these substances should be monitored closely and medical treatment sought at the first sign of abuse to avoid an overdose.
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Withdrawal Symptoms for Restoril
Drug withdrawal symptoms can occur when someone stops using Restoril whether they have abused the substance or not, especially if done too quickly. This is a process that should be medically supervised in either a medical setting or with the individual meeting regularly with a medical practitioner.
Pre-existing conditions and current circumstances need to be taken into account when deciding where and how withdrawal should take place. Factors such as anxiety, depression, long-term insomnia, willingness to withdraw and co-existing addictions can complicate the process. (14) Some of the main withdrawal symptoms those stopping benzodiazepines would suffer include:
- Weight loss
- Unsteady legs
- Tingling of hands and feet
- Panic attacks
- Sore eyes
- Loss of libido
- Loss of appetite
- Increased sensitivity
- Blurred vision
- Abdominal cramps
- Difficulty sleeping
- Face and neck pain (15)
Therapeutic Treatments for Restoril Addiction
- Individual therapy
- Behavioural therapy
- Mindfulness and stress management
- Dual diagnosis treatment
- Group counselling
- Addiction education
- Relapse prevention planning
- 12-step program
Inpatient vs. Outpatient Treatment of Restoril Addiction
Addiction to sleeping pills is no less serious or harmful than any other substance and requires urgent medical attention. Intensive supervised detoxification is recommended, especially for those who are suffering from mental health or substance abuse problems.
There are a number of other factors that should be taken into consideration when deciding whether inpatient or outpatient treatment is most appropriate for the treatment of an individual or loved one. People who are addicted to other drugs or alcohol usually get the best results from being treated in a residential facility that takes them out of their daily routine. Inpatient rehab instils a new routine and provides individual and group therapy as well as medication where appropriate.
Those who receive a dual diagnosis will need to be treated for their mental health condition as well. This may begin with a stint in residential rehab to treat the drug-related problem, followed by ongoing outpatient treatment. The ongoing treatment lasts as long as it takes to get the symptoms of the individual’s diagnosis under control.
Individuals who are addicted to Restoril without any underlying issues often find that the main drive to continue taking the drug is chronic insomnia. Outpatient treatment that focuses on therapy to appease insomnia has been highly effective when combined with regular visits to a recognised rehabilitation facility. These centres also offer group therapy and workshops to clients as well as ensuring that they are treated by a group of highly qualified medical professionals. (16)
Medication-Assisted Treatment (MAT)
Benzodiazepines such as Restoril have been known to be administered as a treatment for those suffering from opioid and alcohol addictions. While they have been found to be effective in treating the problems in some cases, in others, they ended-up being too risky as they too have a high potential for abuse. The concomitant use of these substances can also be problematic to the central nervous system, which is distressed by each of these medications. (17)
Using Restoril to aid in medication-assisted treatment should be done sparingly and under strict supervision. Likewise, the use of other medications to treat abuse of temazepam should be done with caution, making sure the client does not develop an attachment to the drugs used to detoxify them.
- (1) https://www.nhs.uk/medicines/temazepam/
- (2) https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/#.XSYuIehKgdU
- (3) https://www.medicines.org.uk/emc/files/pil.3280.pdf
- (4) https://www.nidirect.gov.uk/articles/drugs-and-crime
- (5) https://www.release.org.uk/law/classes
- (6) https://bnfc.nice.org.uk/guidance/controlled-drugs-and-drug-dependence.html
- (7) https://www.drugs.com/pro/temazepam.html
- (8) https://www.medicines.org.uk/emc/product/3280/smpc
- (9) https://www.ncbi.nlm.nih.gov/pubmed/2570451
- (10) https://www.ncbi.nlm.nih.gov/pubmed/2880447
- (11) http://www.phmd.pl/api/files/view/544317.pdf
- (12) https://www.mind.org.uk/information-support/types-of-mental-health-problems/drugs-recreational-drugs-alcohol/dual-diagnosis/#.XSoqIehKgdU
- (13) https://www.therecoveryvillage.com/restoril-addiction/overdose/#gref
- (14) https://cks.nice.org.uk/benzodiazepine-and-z-drug-withdrawal#!scenario
- (15) https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/withdrawal-effects-of-benzodiazepines/#.XSsNZOhKgdU
- (16) https://cks.nice.org.uk/benzodiazepine-and-z-drug-withdrawal#!scenario
- (17) https://www.ncbi.nlm.nih.gov/pubmed/29680678
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