Psychological and Psychiatric Consequences of Sedatives, Hypnotics, and Anxiolytics

  • Wesley Sowers


The use of substances to induce sedation has a long history, even when alcohol is not considered. As early as the mid 19th century, production of agents designed for this purpose began with the introduction of bromide. Paraldehyde, chloral hydrate, urethan, and sulfonyl were also introduced prior to the beginning of the 20th century. Barbiturates dominated the early part of this century after their introduction in 1903, and up to 50 compounds in this class were eventually brought to market (Allgulander, 1986; Janicak, Davis, Preskorn, & Ayd, 1993). The benzodiazepines became available in the 1960s and their use and popularity grew steadily over the next 20 years. The benzodiazepines have now largely replaced barbiturates and other sedatives introduced around mid-century, such as methaqualone, meprobamate, ethchlorvynol, and glutethimide, for most therapeutic uses (Rosenbaum & Gelenburg, 1991; Smith & Seymour, 1991; Sternbach, 1993). This has been due largely to their relative safety (high lethal-therapeutic ratio) and an initial perception that they had a lower potential for misuse and physical dependence. It gradually became clear, however, that a dependence syndrome can be produced in some individuals within a short period of time. As these medications have been prescribed more liberally, there has been significant public concern about their level of use and misuse in society (Lader, 1991; Smith & Seymour, 1991).


Anxiety Disorder Anxiety Symptom Personality Disorder Borderline Personality Disorder Abuse Liability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allgulander, C. (1986). History and current state of sedative-hypnotic drug use and abuse. Acta Psychiatrica Scandinavica, 73, 465–478.PubMedCrossRefGoogle Scholar
  2. Ailing, F. A. (1992). Detoxification and treatment of acute sequelae, from substance abuse. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook ( 2nd ed., pp. 402–413 ). Baltimore: Williams and Wilkens.Google Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders ( 4th ed. ). Washington, DC: Author.Google Scholar
  4. Ashton, H. (1991). Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment, 8, 19–28.PubMedCrossRefGoogle Scholar
  5. Ballenger, J. C. (1995). Benzodiazepines. In A. F. Schatberg & C. B. Nemeroff (Eds.), Textbook of psychopharmacology (pp. 215–225 ). Washington, DC: American Psychiatric Press.Google Scholar
  6. Barnas, C., Rossmann, M., Roessler, H., Riemer, Y., & Fleischhacker, W. W. (1992). Benzodiazepines and other psychotropic drugs abused by patients in a methadone maintenance program: Familiarity and preference. Journal of Clinical Psychopharmacologv, 12 (6), 397–402.Google Scholar
  7. Bond, A. J., & Silveira, J. C. (1993). The combination of alprazolam and alcohol on behavioral aggression. Journal of Studies on Alcohol (Suppl. 11 ), 30–39.Google Scholar
  8. Carroll, K. M., Ball, S. A., & Rounsaville, B. J. (1993). A comparison of alternate systems for diagnosing antisocial personality disorder in cocaine abusers. Journal of Nervous Disorders and Mental Disease, 181, 436–443.CrossRefGoogle Scholar
  9. Castaneda, R., & Cushman, P. (1989). Alcohol withdrawal: A review of clinical management. Journal of Clinical Psychiatry, 50 (8), 278–284.PubMedGoogle Scholar
  10. Ciraulo, D. A., Sands, B. F., Shader, R. I., & Greenblatt, D. J. (1991). Anxiolytics. In D. A. Ciraulo & R. I. Shader (Eds.), Clinical manual of chemical dependence (pp. 135–173 ). Washington, DC: American Psychiatric Press.Google Scholar
  11. Clinthorne, J. K., Cisin, I. H., Baiter, M. B., Mellinger, G. D., & Uhlenhuth, E. H. (1986). Changes in popular attitudes and beliefs about tranquilizers. Archives of General Psychiatry, 43 (6), 527–532.PubMedCrossRefGoogle Scholar
  12. Cole, J. O., & Chiarello, R. J. (1990). The benzodiazepines as drugs of abuse. Journal of Psychiatric Research, 24, 135–44.PubMedCrossRefGoogle Scholar
  13. Cole, J. O., & Kando, J. C. (1993). Adverse behavioral events reported in patients taking alprazolam and other benzodiazepines. Journal of Clinical Psychiatry, 54(10) (Suppl.), 49–61.PubMedGoogle Scholar
  14. de Wit, H., & Griffiths, R. R. (1991). Testing the abuse liability of anxiolytic and hypnotic drugs in humans. Drug and Alcohol Dependence, 28, 83–111.PubMedCrossRefGoogle Scholar
  15. Dietch, J. T., & Jennings, R. K. (1988). Aggressive dyscontrol in patients treated with benzodiazepines. Journal of Clinical Psychiatry, 49 (5), 184–188.PubMedGoogle Scholar
  16. Dulit, R. A., Fyer, M. R., Haas, G. L., Sullivan, T., & Frances, A. J. (1990). Substance use in borderline personality disorder. American Journal of Psychiatry, 147 (8), 1002–1007.PubMedGoogle Scholar
  17. DuPont, R. L. (1995). Anxiety and addiction: A clinical perspective on comorbidity. Bulletin of the Menninger Clinic, 59(2) ( Suppl. A), A53–A73.PubMedGoogle Scholar
  18. Eadie, J. L. (1993). New York state’s triplicate prescription program (NIDA Research Monograph No. 131, pp. 176–193 ). Rockville, MD: National Institute on Drug Abuse.Google Scholar
  19. Finlayson, R. E., & Davis, L. J. (1994). Prescription drug dependence in the elderly population: Demographic and clinical features of 100 inpatients. Mayo Clinic Proceedings, 69, 1137–1145.PubMedCrossRefGoogle Scholar
  20. Francis, R., & Borg, L. (1993). The treatment of anxiety in patients with alcoholism. Journal of Clinical Psychiatry, 54, 37–43.Google Scholar
  21. Geller, A. (1991). Protracted abstinence. In N. Miller (Ed.), Comprehensive handbook of drug and alcohol addiction (pp. 905–913 ). New York: Dekker.Google Scholar
  22. Gerstley, L. J., Alterman, A. I., McLellan, A. T., & Woody, G. E. (1990). Antisocial personality disorder in patients with substance abuse disorders: A problematic diagnosis? American Journal of Psychiatry, 146 (4), 508–512.Google Scholar
  23. Goodwin, F. K., & Jamison, K. R. (1990). Manic-depres- sive illness. New York: Oxford University Press.Google Scholar
  24. Greenberg, D. A. (1993). Ethanol and sedatives. Neurologic Clinics, 11 (3), 523–534.PubMedGoogle Scholar
  25. Greenblatt, D. J., Shader, R. I., & Abernethy, D. R. (1993). Drug therapy: Current state of the benzodiazepines, Part 2. New England Journal of Medicine, 309, 410–416.Google Scholar
  26. Herman, J. B., Brotman, A. W, Rosenbaum, J. F. (1987). Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines. Journal of Clinical Psychiatry 48 (10), 22–26.PubMedGoogle Scholar
  27. Hoffmann, N. G., Olofsson, O., Salen, B., & Wickstrom, L. (1995). Prevalence of abuse and dependency in chronic pain patients. International Journal of the Addictions, 30, 919–927.PubMedGoogle Scholar
  28. Iguchi, M. Y., Handelsman, L., Bickel, W. K., & Griffiths, R. R. (1993). Benzodiazepine and sedative use/abuse by methadone maintenance clients. Drug and Alcohol Dependence, 32, 257–266.PubMedCrossRefGoogle Scholar
  29. Janicak, P. G., Davis, J. M., Preskorn, S., & Ayd, F. (1993). Principles and practice of psvchopharmacotheropv (pp. 357–358, 405–442 ). Baltimore: Williams and Wilkens.Google Scholar
  30. Jinks, M. J., & Raschko, R. R. (1990). A profile of alcohol and prescription drug abuse in a high-risk community-based elderly population. Drug Intelligence and Clinical Pharmacology, 24, 971–975.Google Scholar
  31. Kales, A. (1990). Benzodiazepine hypnotics and insomnia. Hospital Practice Office Edition, 25 (Suppl. 3), 7–21; discussion 22–23.Google Scholar
  32. Khantzian, F. J. (1985). The self medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264.PubMedGoogle Scholar
  33. Kisnad, H. (1991). Sedatives-hypnotics. In N. Miller (Ed.), Comprehensive handbook of drug and alcohol addiction (pp. 405–426 ). New York: Dekker.Google Scholar
  34. Lader, M. (1991). History of benzodiazepine dependence. Journal of Substance Abuse Treatment, 8, 53–59.PubMedCrossRefGoogle Scholar
  35. Landry, M. J., Smith, D. E., McDuff, D. R., & Baughman, O. L. (1992). Benzodiazepine dependence and withdrawal: Identification and medical management [see comments]. Journal of the American Board of Family Practice, 5, 167–175.PubMedGoogle Scholar
  36. Mallick, J. L., Kirby, K. C., Martin, F., Philp, M., & Hennessy, M. J. (1993). A comparison of the amnesic effects of lorazepam in alcoholics and non-alcoholics. Psychopharmacology, 110, 181–186.PubMedCrossRefGoogle Scholar
  37. Mellinger, G. D., Batter, M. B., & Uhlenhuth, E. H. (1984). Prevalence and correlates of the long-term regular use of anxiolytics. Journal of the American Medical Association, 251 (3), 375–379.PubMedCrossRefGoogle Scholar
  38. Mendelson, W B. (1993). Insomnia and related sleep disorders. Psychiatric Clinics of North America, 16 (4), 841–851.PubMedGoogle Scholar
  39. Meyer, M. (Ed.). (1993). AMA-DE (Drug Evaluations). Chicago: American Medical Association, Division of Drugs and Toxicology.Google Scholar
  40. Morgan, W. W. (1990). Abuse liability of barbiturates and other sedative-hypnotics. Advances in Alcohol and Substance Abuse, 9, 67–82.CrossRefGoogle Scholar
  41. Mueller, T. 1., Goldenberg, I. M., Gordon, A. L., Keller, M. B., & Warshaw, M. G. (1996). Benzodiazepine use in anxiety disordered patients with and without a history of alcoholism. Journal of Clinical Psychiatry, 57, 83–89.Google Scholar
  42. Mumford, G. K., Evans, S. M., Fleishaker, J. C., & Griffiths, R. R. (1995). Alprazolam absorption kinetics affects abuse liability. Clinical Pharmacology Therapeutics, 57 (3), 356–365.CrossRefGoogle Scholar
  43. Nierenberg, A. A., Adler, L. A., Peselow, E., Zornberg, G., & Rosenthal, M. (1994). Trazodone for antidepressant-associated insomnia. American Journal of Psychiatry. 151, 1069–1072.PubMedGoogle Scholar
  44. Nishino, S., Mignot, E., & Dement, W. C. (1995). Sedative hypnotics. In A. F. Schatzberg & C. B. Nemeroff (Eds.), Textbook of psychopharmacology (pp. 405–413 ). Washington, DC: APA Press.Google Scholar
  45. Parrino, L., Spaggiari, M. C., Boselli, M., DiGiovanni, G., & Terzano, M. G. (1994). Clinical and polysomnographic effects of trazodone CR in chronic insomnia associated with dysthymia. Psychopharmacology (Berlin), 116, 389–395.Google Scholar
  46. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity and mental disorders with alcohol and other drug abuse. Journal of the American Medical Association, 264 (19), 2511–2518.CrossRefGoogle Scholar
  47. Roache, J. D., Meisch, R. A., Henningfield, J. E., Jaffe, J. H., Klein, S., & Sampson, A. (1995). Reinforcing effects of triazolam in sedative abusers: Correlation of drug liking and self-administration measures. Pharmacology, Biochemistry and Behavior, 50, 171–179.CrossRefGoogle Scholar
  48. Rosenbaum, J. F., & Gelenburg, A. J. (1991). Anxiety from the practitioners. In A. J. Gelenburg, F. L. Bassak, & S. C. Schoonover (Eds.), Guide to psychoactive drugs (pp. 179–218 ). New York: Plenum.CrossRefGoogle Scholar
  49. Rush, C. R., Higgins, S. T., Bickel, W. K., & Hughes, J. R. (1993). Abuse liability of alprazolam relative to other commonly used benzodiazepines: A review. Neuroscience and Biobehavioral Reviews, 17, 277–285.PubMedCrossRefGoogle Scholar
  50. San, L., Tato, J., Torrens, M., Castillo, C., Farre, M., & Cami, J. (1993). Flunitrazepam consumption among heroin addicts admitted for in-patient detoxification. Drug and Alcohol Dependence, 32, 281–286.PubMedCrossRefGoogle Scholar
  51. Sellers, E. M. (1988). Alcohol, barbiturate and benzodiazepine withdrawal syndromes: Clinical management. Canadian Medical Association Journal, 139, 113–120.PubMedGoogle Scholar
  52. Sellers, E. M., Schneiderman, J. F., Romach, M. K., Kaplan, H. L., & Somer, G. R. (1992). Comparative drug effects and abuse liability of lorazepam, buspironeGoogle Scholar
  53. and secobarbital in nondependent subjects. Journal of Clinical Psychopharmacology, 12(2),79–85.Google Scholar
  54. Sheehan, M. F., Sheehan, D. V., Torres, A., Coppola, A., & Francis, E. (1991). Snorting benzodiazepines. American Journal of Drug and Alcohol Abuse, 17, 457–468.PubMedCrossRefGoogle Scholar
  55. Smith, D. E., & Seymour, R. B. (1991). Benzodiazepines. In N. Miller (Ed.), Comprehensive handbook of drug and alcohol addiction (pp. 405–426 ). New York: Dekker.Google Scholar
  56. Sternbach, L. H. (1993). The benzodiazepine story. Journal of Psychoactive Drugs, 15, 15–17.CrossRefGoogle Scholar
  57. Stockwell, T., Bolt, L., Milner, I., Russell, G., Bolderston, H., & Pugh, P. (1991). Home detoxification from alcohol: Its safety and efficacy in comparison with inpatient care. Alcohol and Alcoholism, 26, 645–650.PubMedGoogle Scholar
  58. Sussman, N. (1993). Treating anxiety while minimizing abuse and dependence. Journal of Clinical Psychiatry, 54, 44–51.PubMedGoogle Scholar
  59. Taylor. C. B. (1995). Treatment of anxiety disorders. In A. F. Schatzberg & C. B. Nemeroff (Eds.), Benzodiazepines from textbook of psychopharmacology (pp. 641–651 ). Washington, DC: American Psychiatric Press.Google Scholar
  60. Vaillant, G. E. (1983). The natural history of alcoholism: Causes, patterns, and paths to recovery. Cambridge, MA: Harvard University Press.Google Scholar
  61. Walker, R. (1992). Substance abuse and B-cluster disorders I and II understanding and treating the dual diagnosis patient. Journal of Psychoactive Drugs, 24 (3), 223–241.PubMedCrossRefGoogle Scholar
  62. Warner, P. H., Peabody, C. A., Whiteford, H. A., & Hollister, L. (1988). Alprazolam as an antidepressant. Journal of Clinical Psychiatry, 49, 148–150.PubMedGoogle Scholar
  63. Weintraub, M., Singh, S., Byrne, L., Maharaj, K., & Guttmacher, L. (1993). Consequences of the 1989 New York State triplicate benzodiazepine prescription regulations (NIDA Research Monograph No. 131, pp. 279–293 ). Rockville, MD: National Institute on Drug Abuse.Google Scholar
  64. Wesson, D. R., Smith, D. E., & Seymour, M. A. (1992). Sedative, hypnotics and tricyclics. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. H. Langrod (Eds.), Substance abuse: A comprehensive textbook ( 2nd ed., pp. 271–278 ). Baltimore: Williams and Wilkens.Google Scholar
  65. Williams, D. H. (1993). Triplicate prescriptions in Washington State (NIDA Research Monograph No. 131, pp. 194–199 ). Rockville, MD: National Institute on Drug Abuse.Google Scholar
  66. Zweben, J. E., & Smith, D. E. (1989). Considerations in using psychotropic medication with dual diagnosis patients in recovery. Journal of Psychoactive Drugs, 21 (2), 221–228.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Wesley Sowers
    • 1
  1. 1.Center for Addictions Services, St. Francis Medical Center, and Department of PsychiatryUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations