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Drug and Alcohol Abuse pp 28–53Cite as

Central Nervous System Depressants

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Abstract

The classical CNS depressants include hypnotics, most antianxiety medications, and alcohol.1–7 This chapter focuses on the benzodiazepines and similar drugs as well as the barbiturates and barbituratelike medications, whereas alcohol is discussed in chapters 3 and 4. Several related compounds including kava and gamma-hydroxybutyric acid (GHB) are also briefly presented here, as their effects resemble those of the more classical drugs of this class.7–9

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References

  1. Hobbs, W. R., Roll, T. W., & Verndoorn, T. A. Hypnotics and sedatives: Ethanol. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 399–431.

    Google Scholar 

  2. O’Brien, C. P. Drug addiction and drug abuse. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 557–577.

    Google Scholar 

  3. Udhe, T. W., & Tancer, M. E. Benzodiazepine receptor agonists and antagonists. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry (6th ed.). Baltimore, MD: Williams and Wilkins, 1995, pp. 1933–1951.

    Google Scholar 

  4. Wesson, D. R., Smith, D. E., Ling, W., & Seymour, R. B. Sedative-hypnotics and tricyclics. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 223–230.

    Google Scholar 

  5. Clee, W. B. Warning about Zopiclone misuse. Addiction 91:1389–90, 1996.

    Article  PubMed  Google Scholar 

  6. Gillin, J. C., Buchsbaum, M. S., Valladares-Neto, D. C., et al. Effects of Zolpidem on local cerebral glucose metabolism during non-REM sleep in normal volunteers: A positron emission tomography study. Neuropsy-chopharmacology 15:302–313, 1996.

    Article  Google Scholar 

  7. Marshall, B. E., & Longnecker, D. E. General anesthetics. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 307–330.

    Google Scholar 

  8. Foo, H., & Lemon, J. Acute effects of kava, alone or in combination with alcohol, on subjective measures of impairment and intoxication and on cognitive performance. Drug and Alcohol Abuse 16:147–155, 1997.

    Article  Google Scholar 

  9. Galloway, G. P., Frederic, S. L., Staggers, F. E., et al. Gamma-hydroxybutyrate: An emergency drug of abuse. Addiction 92:89–96, 1997.

    Article  PubMed  Google Scholar 

  10. Nowell, P. D., Mazumdar, S., Buysse, D. J., et al. Benzodiazepines and Zolpidem for chronic insomnia: A meta-analysis of treatment efficacy. Journal of the American Medical Association 278:2170–2177, 1997.

    Article  PubMed  Google Scholar 

  11. Bloom, F. E. Neurotransmission and the central nervous system. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 267–295.

    Google Scholar 

  12. File, S. E. The pharmacology of benzodiazepine tolerance and withdrawal. Clinical Neuropharmacology 15:100A–101A, 1992.

    Article  PubMed  Google Scholar 

  13. Schuckit, M. A., & Klein, J. L. Correlations between drinking intensity and reactions to ethanol and diazepam in healthy young men. Neuropsychopharmacology 4:157–163, 1991.

    PubMed  Google Scholar 

  14. Saxon, L., Hjemdahl, P., Hiltunen, A. J., & Borg, S. Effects of flumazenil in the treatment of benzodiazepine withdrawal: A double-blind pilot study. Psychopharmacology 151:153–160, 1997.

    Article  Google Scholar 

  15. Littrell, R., Sage, T., & Miller, W. Meprobamate dependence secondary to carisoprodol (Soma) use. American Journal of Drug and Alcohol Abuse 19:133–134, 1993.

    Article  PubMed  Google Scholar 

  16. Miller, N. S., & Gold, M. S. Abuse, addiction, tolerance, and dependence to benzodiazepines in medical and nonmedical populations. American Journal of Drug and Alcohol Abuse 17:27–37, 1991.

    Article  PubMed  Google Scholar 

  17. Busto, U., Sellers, E. M., Naranjo, C. A., et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine 315:854–859, 1986.

    Article  PubMed  Google Scholar 

  18. Cammarano, W. B., Pittet, J. F., Weitz, S., Schlobohm, R. M., & Marks, J. D. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Critical Care Medicine 26:676–684, 1998.

    Article  PubMed  Google Scholar 

  19. Rickels, K., Case, W. G., Schweizer, E. E., et al. Low-dose dependence in chronic benzodiazepine users: A preliminary report on 119 patients. Psychopharmacology 22:407–415, 1986.

    Google Scholar 

  20. Lader, M., & Morton, S. Benzodiazepine problems. British Journal of Addiction 86:823–828, 1991.

    Article  PubMed  Google Scholar 

  21. American Psychiatric Association. The diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: American Psychiatric Press, 1994.

    Google Scholar 

  22. Lader, M. Iatrogenic sedative dependence and abuse—Have doctors learnt caution? Addiction 93:1133–1135, 1998.

    Article  PubMed  Google Scholar 

  23. Campbell, R., Schaffer, C. B., & Tupin, J. Catatonia associated with glutethimide withdrawal. Journal of Clinical Psychiatry 44:32–33, 1983.

    PubMed  Google Scholar 

  24. Lader, M., & Frcka, G. Subjective effects during administration and on discontinuation of zopiclone and temazepam in normal subjects. Pharmacopsychiatry 20:67–71, 1987.

    Article  PubMed  Google Scholar 

  25. Griffiths, R. R., & Weerts, E. M. Benzodiazepine self-administered in humans and laboratory animals: Implications for problems of long-term use and abuse. Psychopharmacology 134:1–37, 1997.

    Article  PubMed  Google Scholar 

  26. Anthenelli, R. M., & Schuckit, M. A. Alcohol and cerebral depressants. In I. B. Glass (Ed.), The international handbook of addictive behavior. London: Tavistock, 1991, pp. 57–63

    Google Scholar 

  27. Ancoli-Israel, S. All I want is a good night’s sleep. St. Louis, MO: Mosby Publishing Co., 1996.

    Google Scholar 

  28. McClusky, H. Y., Milby, J. B., Switzer, P. K., et al. Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia. American Journal of Psychiatry 148:121–126, 1991.

    PubMed  Google Scholar 

  29. Schuckit, M. A. A clinical review of medications used in the treatment of sleeping problems in persons with developmental disabilities. Developmental Disabilities: Clinical Insights 5, San Diego Regional Center for the Developmentally Disabled, 1998.

    Google Scholar 

  30. Schuckit, M. A. A clinical review of medications used in the treatment of anxiety disorders in persons with developmental disabilities. Developmental Disabilities: Clinical Insights 4, San Diego Regional Center for the Developmentally Disabled, 1998.

    Google Scholar 

  31. Schuckit, M. A. Treatment of anxiety in patients who abuse alcohol and drugs. In R. Noyes Jr., M. Roth, & G. D. Burrows (Eds.), Handbook of anxiety, Vol. 4: The treatment of anxiety. Amsterdam: Elsevier Science, 1990, pp. 461–480.

    Google Scholar 

  32. Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., & Shader, R. I. Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. New England Journal of Medicine 317:722–728, 1987.

    Article  PubMed  Google Scholar 

  33. Greenblatt, D. J., Harmatz, J. S., Engelhardt, N., & Shader, R. I. Pharmacokinetic determinants of dynamic differences among three benzodiazepine hypnotics. Archives of General Psychiatry 46:326–332, 1989.

    Article  PubMed  Google Scholar 

  34. Breier, A., & Paul, S. M. The GABA-A/benzodiazepine receptor: Implications for the molecular basis of anxiety. Journal of Psychiatric Research 24:91–104, 1990.

    Article  PubMed  Google Scholar 

  35. McCloy, R. F. Reversal of conscious sedation by flumazenil: Current status and future prospects. Acta Anaes-thesiologica Scandinavica 108:35–42, 1995.

    Article  Google Scholar 

  36. Whitwam, J. G., & Amrein, R. Pharmacology of flumazenil. Acta Anaesthesiologica Scandinavica 108:3–14, 1995.

    Article  PubMed  Google Scholar 

  37. Brunton, L. L. Agents affecting gastrointestinal water, flux, and mobility. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 917–936.

    Google Scholar 

  38. Malcolm, R., Anton, R. F., Randall, C. L., et al. A placebo-controlled trial of buspirone in anxious inpatient alcoholics. Alcoholism: Clinical and Experimental Research 16:1007–1013, 1992.

    Article  Google Scholar 

  39. Udhe, T. W., & Tancer, M. E. Buspirone. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry (6th ed.). Baltimore, MD: Williams and Wilkins, 1995, pp. 1957–1964.

    Google Scholar 

  40. Juergens, S. M. The pharmacology of sedative hypnotics. In A. W. Graham, T. K. Schultz, & B. B. Wilford (Eds.), Principles of addiction medicine (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine, 1998, pp. 117–129.

    Google Scholar 

  41. Schuckit, M. A. Kava. Vista Hill Foundation Drug Abuse and Alcoholism Newsletter, 18(2), 1989.

    Google Scholar 

  42. Swartz, M., Landerman, R., George, L. K., et al. Benzodiazepine antianxiety agents: Prevalence and correlates of use in a Southern community. American Journal of Public Health 81:592–596, 1991.

    Article  PubMed  Google Scholar 

  43. Busto, U., Sellers, E. M., Naranjo, C. A., et al. Patterns of benzodiazepine abuse and dependence. British Journal of Addictions 81:87–94, 1986.

    Article  Google Scholar 

  44. Boixet, M., Batlle, E., & Bolibar, I. Benzodiazepines in primary health care: a survey of general practitioners prescribing patterns. Addiction 91:549–556, 1996.

    Article  PubMed  Google Scholar 

  45. Rickels, K., Case, W. G., Schweizer, E., et al. Long-term benzodiazepine users 3 years after participation in a discontinuation program. American Journal of Psychiatry 148:757–761, 1991.

    PubMed  Google Scholar 

  46. Blennow, G., Romelsjö, A., Leifman, H., et al. Sedatives and hypnotics in Stockholm: Social factors and kinds of use. American Journal of Public Health 84:242–246, 1994.

    Article  PubMed  Google Scholar 

  47. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National household survey on drug abuse: Population estimates 1997. Rockville, MD: U.S. Department of Health and Human Services, 1998.

    Google Scholar 

  48. Johnston, L. D., O’Malley, P. M., & Bachman, J. G. National survey results on drug use from the Monitoring the Future Study, 1975–1997, Vol. I, Secondary School Students. Rockville, MD: National Institute on Drug Abuse, U.S. Department of Health and Human Services, 1998.

    Google Scholar 

  49. Royo-Bordonada, M. A., Cid-Ruzafa, J., Martin-Morena, J. M., & Guallar, E. Drug and alcohol use in Spain: Consumption habits, attitudes and opinions. Public Health 111:277–284, 1997.

    PubMed  Google Scholar 

  50. Mora, M. E., Villatoro, J., & Rojas, E. Drug use among students in Mexico’s northern border states. In the Department of Health and Human Services, Epidemiologic trends in drug abuse. Washington, DC: U.S. Government Printing Office, 1996, pp. 367–375.

    Google Scholar 

  51. Ross, J., Darke, S., & Hall, W. Transitions between routes of benzodiazepine administration among heroin users in Sydney. Addiction 92:697–705, 1995.

    Article  Google Scholar 

  52. Taylor, S., McCracken, C. F., Wilson, K. C., & Copeland, J. R. Extent and appropriateness of benzodiazepine use. Results from an elderly urban community. British Journal of Psychiatry 173:433–438, 1998.

    Article  PubMed  Google Scholar 

  53. Chang, G., & Kosten, T. R. Detoxification. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MA: Williams & Wilkins, 1996, pp. 377–383.

    Google Scholar 

  54. Weinbroum, A. A., Flaishon, R., Sorkine, P., et al. A risk-benefit assessment of flumazenil in the management of benzodiazepine overdose. Drug Safety 17:181–196, 1997.

    Article  PubMed  Google Scholar 

  55. Woods, S. W., Rosen, M. I., Price, L. H., et al. Rapid benzodiazepine detoxification using flumazenil. Paper presented at the ACNP Annual Meeting, San Juan, December 14, 1992.

    Google Scholar 

  56. Nutt, D., & Costello, M. Flumazenil and benzodiazepine withdrawal. Lancet 2:463, 1987.

    Article  Google Scholar 

  57. Boldy, D. A. R., Heath, A., Ruddock, S., et al. Activated charcoal for carbamazepine poisoning. Lancet 1:1027, 1987.

    Article  PubMed  Google Scholar 

  58. Editorial. Repeated oral activated charcoal in acute poisoning. Lancet 1:1013-1015, 1987.

    Google Scholar 

  59. Greenblatt, D. J., Miller, L. G., & Shader, R. I. Benzodiazepine discontinuation syndromes. Journal of Psychiatric Research 24:73–79, 1990.

    Article  PubMed  Google Scholar 

  60. Satel, S. L., Kosten, T. R., Schuckit, M. A., & Fischman, M. W. Should protracted withdrawal from drugs be included in DSM-IV? American Journal of Psychiatry 150:695–704, 1993.

    PubMed  Google Scholar 

  61. Salzman, C. The APA task force report on benzodiazepine dependence, toxicity, and abuse. American Journal of Psychiatry 148:151–152, 1991.

    PubMed  Google Scholar 

  62. Cowley, D. S., Roy-Byrne, P. P., Radant, A., et al. Benzodiazepine sensitivity in panic disorder: effects of chronic alprazolam treatment. Neuropsychopharmacology 12:147–157, 1995.

    Article  PubMed  Google Scholar 

  63. Cole, J. O., Haskell, D. S., & Orzack, M. H. Problems with the benzodiazepines: An assessment of the available evidence. McLean Hospital Journal 6:46–74, 1981.

    Google Scholar 

  64. Vinogradov, S., Reiss, A. L., & Csernansky, J. G. Clonidine therapy in withdrawal from high dose alprazolam treatment. American Journal of Psychiatry 143:1188, 1986.

    PubMed  Google Scholar 

  65. Rickels, K., Schwizer, E., Case, G., & Greenblatt, D. J. Long-term therapeutic use of benzodiazepines. Archives of General Psychiatry 47:899–907, 1990.

    Article  PubMed  Google Scholar 

  66. DuPont, R. L. A practical approach to benzodiazepine discontinuation. Journal of Psychiatric Research 24:81–90, 1990.

    Article  PubMed  Google Scholar 

  67. Preskorn, S. H., & Denner, L. J. Benzodiazepines and withdrawal psychosis. Journal of the American Medical Association 237:36–38, 1977.

    Article  PubMed  Google Scholar 

  68. Sapira, J. D., & Cherubin, C. E. Drug abuse: A guide for the clinician. Amsterdam: Excerpta Medica/New York: American Elsevier, 1975.

    Google Scholar 

  69. Smith, D. E., & Wesson, D. R. Phenobarbital technique for treatment of barbiturate dependence. Archives of General Psychiatry 24:56–60, 1971.

    Article  PubMed  Google Scholar 

  70. The medical letter. Diagnosis and Management of Reactions to Drug Abuse, New Rochelle, NY: Vol. 19, Feb. 1977.

    Google Scholar 

  71. Schweizer, E., Rickels, K., Case, W. G., & Greenblatt, D. J. Carbamazepine treatment in patients discontinuing long-term benzodiazepine therapy. Archives of General Psychiatry 48:448–452, 1991.

    Article  PubMed  Google Scholar 

  72. DeMaria, Jr., P. A., Gottheil, E., Serota, R., & Sterling, R. C. Phenobarbital vs. clonazepam in the outpatient sedative detoxification of methadone-maintained persons. American Journal on Addictions 5:167–173, 1996.

    Google Scholar 

  73. Greenblatt, D. J., Harmatz, J. S., Shapiro, L., et al. Sensitivity to triazolam in the elderly. New England Journal of Medicine 324:1691–1698, 1991.

    Article  PubMed  Google Scholar 

  74. Cummings, S. R., Nevitt, M. C., Browner, W. S., et al. Risk factors for hip fracture in white women. New England Journal of Medicine 332:767–773, 1995.

    Article  PubMed  Google Scholar 

  75. Hemmelgarn, B., Suissa, S., Huang, A., et al. Benzodiazepine use and the risk of motor vehicle crash in the elderly. Journal of the American Medical Association 278:27–31, 1997.

    Article  PubMed  Google Scholar 

  76. Gorissen, M. E., & Eling, P. A. Dual task performance after diazepam intake: can resource depletion explain the benzodiazepine-induce amnesia? Psychopharmacology 138:354–361, 1998.

    Article  PubMed  Google Scholar 

  77. Anthenelli, R. M., Monteiro, M. G., Blunt, B., & Schuckit, M. A. Amnestic effects of intravenous diazepam in healthy young men. American Journal of Drug and Alcohol Abuse 17:129–136, 1991.

    Article  PubMed  Google Scholar 

  78. Tönne, U., Hiltunen, A. J., Vikander, B., et al. Neuropsychological changes during steady-state drug use, withdrawal and abstinence in primary benzodiazepine-dependent patients. Acta Psychiatrica Scandinavica 91:299–304, 1995.

    Article  PubMed  Google Scholar 

  79. Fraser, A. A., & Ingram, I. M. Lorazepam dependence and chronic psychosis. British Journal of Psychiatry 147:211, 1985.

    Article  PubMed  Google Scholar 

  80. Martínez-Cano, H., de Iceta Ibáñez de Gauna, M., Vela-Bueno, A., & Wittchen, H. U. DSM-III-R co-morbidity in benzodiazepine dependence. Addiction 94:97–107, 1999.

    Article  PubMed  Google Scholar 

  81. Brown, S. A., Irwin, M., & Schuckit, M. A. Changes in anxiety among abstinent male alcoholics. Journal of Studies on Alcohol 52:55–61, 1991.

    PubMed  Google Scholar 

  82. Raimo, E. B., & Schuckit, M. A. Alcohol dependence and mood disorders. Addictive Behaviors 23:933–946, 1998.

    Article  PubMed  Google Scholar 

  83. Schuckit, M. A., Tipp, J. E., Bucholz, K. K., et al. The life time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction 92:1289–1304, 1997.

    Article  PubMed  Google Scholar 

  84. Schuckit, M. A., Tipp, J. E., Bergman, M., et al. Comparison of induced and independent major depressive disorders in 2,945 alcoholics. American Journal of Psychiatry 154:948–957, 1997.

    PubMed  Google Scholar 

  85. Kripke, D. F., Klauber, M. R., Wingard, D. L., et al. Mortality hazard associated with prescription hypnotics. Biological Psychiatry 43:687–693, 1998.

    Article  PubMed  Google Scholar 

  86. Grant, I., Adams, K. M., & Reed, R. Subacute organic mental disorders. In I. Grant (Ed.), Neuropsychiatric correlates of alcoholism. Washington, DC: American Psychiatric Press, 1986, pp. 37–60.

    Google Scholar 

  87. Anthenelli, R. M., Klein, J. L., Smith, T L., & Schuckit, M. A. Comparison of the subjective and amnestic effects of diazepam and amobarbital in healthy young men. The American Journal of Addictions 2:131–140, 1993.

    Google Scholar 

  88. Barbone, F., McMahon, A. D., Davey, P. G., et al. Association of road-traffic accidents with benzodiazepine use. Lancet 352:1331–1336, 1998.

    Article  PubMed  Google Scholar 

  89. Schuckit, M. A. A clinical review of interactions among medications. Developmental Disabilities: Clinical Insights 11, San Diego Regional Center for the Developmentally Disabled, 1998.

    Google Scholar 

  90. Bergman, U., Rosa, F. W., Baum, C., Wilhom, B. E., & Faich, G. A. Effects of exposure to benzodiazepine during fetal life. Lancet 340:694–696, 1992.

    Article  PubMed  Google Scholar 

  91. Laegreid, L. Abnormalities in children exposed to benzodiazepines in utero. Lancet 1:108–109, 1987.

    Article  PubMed  Google Scholar 

  92. Kellogg, C. K., Simmons, R. D., Miller, R. K., & Ison, J. R. Prenatal diazepam exposure in rats: Long-lasting functional changes in the offspring. Neurobehavioral Toxicology and Teratology 7:483–488, 1985.

    PubMed  Google Scholar 

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  1. University of California Medical School and Veterans Affairs San Diego Healthcare System, San Diego, California, USA

    Marc A. Schuckit M. D. (Professor of Psychiatry)

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Schuckit, M.A. (2000). Central Nervous System Depressants. In: Drug and Alcohol Abuse. Critical Issues in Psychiatry. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-3232-0_2

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