Anxiety and sleep disorders are two of the United States’ most common ailments. According to the National Institute of Health,22.8 percent of adults experience some form of anxiety. Sleep disorders are also very common in the U.S., with 60 million Americans suffering from some type of sleep disorder every year. To combat this, doctors have prescribed sleep-aids and anti-anxiety medication for years in the form of central nervous system depressants.
Barbiturates were one such depressant first synthesized in the late 1800s. The drug relieves anxiety, sleeplessness, and relaxes muscles but it also causes euphoria which has led people to abuse it. Barbiturates aren’t commonly prescribed today, because of some dangerous side effects but it is still sometimes used, for its intended purpose and for recreation.
Barbiturates are a class of drugs derived from the barbituric acid that act as central nervous system depressants. They were first used in the late 1800s and became a widely used remedy for anxiety, epilepsy, insomnia, and seizures. They work by affecting the same receptor in the brain as another central nervous system (CNS) depressants like alcohol. The gamma-Aminobutyric acid (GABA) neurotransmitter and receptors are the primary sources of neurotransmitter inhibition in people (and all mammals). GABA neurotransmitters are naturally released to calm you down, help you relax and sleep. If you suffer from anxiety disorders or insomnia, your natural CNS inhibitory chemicals may be in short supply. Through the therapeutic use of a prescribed depressant, these disorders might be corrected.
Like other medications, barbiturates and other depressants can be used to mimic the effects of natural brain chemistry. The medication, in high enough doses, acts as an agonist of a specific GABA receptor, which means that it binds to the receptor and activates its effects. When activated, these receptors in particular cause anxiolytic (anti-anxiety), anticonvulsant, sedative, hypnotic, and euphoric effects.
Barbituric acid, which was the precursor to barbiturates, was first synthesized in 1864. Its popularity grew into the 20th century and it was part of the movement toward marketing CNS depressants to women, and especially mothers. This marketing phenomenon was noted by the Rolling Stones in their song “Mother’s Little Helper.” It gained controversy when marketers were criticized for marketing barbiturates, benzodiazepines, and a drug called Miltown to otherwise healthy women.
By the 1950s, the adverse side effects of barbiturates started to be noticed by the public. The drug causes sedation by design but it can lead to a drunk-like state that is hazardous to people who are up and moving around, and it’s worse for older people. Not only are older adults at greater risk for falls and injury, they are also less able to process the drug.
As you age, you are less capable of purging your body of barbiturates. There is also an inherent risk of building tolerance and developing dependence if you take heavy doses or take it for too long. Like opioids, barbiturates can cause respiratory depression during overdoses.
A few years later, in 1955, the first benzodiazepine (benzos) was synthesized. Benzos are a central nervous system depressant with similar effects to barbiturates. Though they come with very similar side effects and potential for dependence, benzos have a lower risk of causing respiratory depression.
If you are worried that you might be developing a dependence on barbiturates or if you’re worried that a loved one may be addicted, there are a few telltale signs to look out for. The first indicator is a higher tolerance. If your normal doses no longer seem to be effective and it takes more frequent or heavier doses to achieve the same effects, you are building a tolerance. Next is dependence. If you can’t go for very long after skipping a dose without feeling uncomfortable symptoms that are out of the ordinary, you may be dependent on the drug. Barbiturates can sometimes make insomnia or anxiety symptoms worse through dependence. If you also feel shakiness, dizziness, or restless, it could point to withdrawal symptoms.
If you suspect that a friend or family member might be struggling with barbiturate addiction, there are some signs that you might be able to observe. Symptoms of barbiturate intoxication and withdrawal are common. However, addiction, in general, has some behavioral earmarks of its own. Here are some signs and symptoms that a loved one might have substance use disorder involving barbiturates:
If you or a loved one is struggling with addiction or dependence involving barbiturates or any other central nervous system depressant, it’s important to seek help immediately as both overdose and withdrawal can be life-threatening. Don’t quit abruptly without consulting a medical professional.
Addiction is a chronic and complex disease with a multitude of potential underlying factors and complications. Barbiturates carry a significant risk for both dependence and addiction when it is used for too long, used more frequently than directed, or used in high doses. Dependence occurs when your brain and body become used to the chemical action of the drug. In barbiturates, tolerance can build over time, causing you to need more and more of the drug to achieve the same effects. Your body is used to the influx of nervous system inhibitory chemicals that promote sleep and relaxation, so much so that you may have trouble with anxiety and insomnia without it.
To treat barbiturate dependence, you will need medical detox. In the American Society of Addiction Medicine’s continuum of care, medical detox, or medically managed intensive inpatient services are the highest level of care in addiction treatment. It involves 24-hours of medical treatment and monitoring. Because barbiturate withdrawal can lead to fatal symptoms of seizures and Delirium tremens, medical detox is necessary to avoid dangerous medical complications. Medical detox can also alleviate uncomfortable withdrawal symptoms and provides accountability to help you avoid relapse when you experience drug cravings.
Addiction and dependency, however, are not one and the same. Though they are closely related, addiction is a disease that affects a different part of the brain than dependence. Addiction primarily affects the brain’s reward center, which is also called the limbic system. This system is designed to help you survive by recognizing rewarding tasks and urging you to repeat them. Daily tasks often release neurochemicals that the limbic system uses to recognize a reward. However, addictive drugs often cause a release of many of those same rewarding chemicals. The calming, comfortable, and euphoric effects of barbiturates can trick your reward center into thinking that taking the drug is an activity vital to your survival like eating and drinking.
Then it passes the message on to your learning center. Subsequent cravings and compulsions can be powerful enough to cause you to keep using the drug despite consequences or the desire to stop, which is an earmark for addiction.
To treat this complicated disease of the limbic system, a long-term commitment to addiction recovery, and treatment services that answer your specific needs. After medical detox, you will continue to the next level of care that is appropriate for your needs. This is determined by several factors including your intake assessment and your personal input. Personalized treatment is so important that the National Institute on Drug Abuse recognizes it as one of the key principles of effective treatment. In order to facilitate a treatment plan that answers your needs, you will sit down with your therapist to talk about your history with drugs, medical history, family and social history, and any other topics that could contribute or be related to your substance use disorder.
There are a variety of treatment options and it’s rare that two treatment plans are exactly the same. But your treatment plan will most likely involve some form of behavioral therapy, especially the most recommended therapy for addiction: Cognitive-Behavioral Therapy (CBT). In CBT you will learn to identify situations that can likely lead to a relapse, which are called high-risk situations. These situations can come from outward triggers like stress over a bad day at work or internal triggers like anxiety. If you started to initially take barbiturates in order to treat an anxiety or sleep disorder, you may learn to cope with those stressors in more positive and effective ways than abusing drugs.
According to the cognitive-behavioral model, relapse occurs in the way you cognitively deal with a high-risk situation, long before you take the drug. Relapsing ineffective coping skills with effective ones can help you maintain lifelong sobriety and learn to cope with the disease affecting your reward center.
Other commonly helpful therapy options include family therapy, group counseling, individual therapy, contingency management interventions (rewards for meeting goals), and more.
After detox, there are three more levels of care with varying degrees of intensiveness. As you progress, you will move down the levels of care, decreasing the amount of time you spend in treatment each week. The goal is to give you all the support you need and ease you back into everyday life, equipped with a new skill that will help you prevent relapse and live a productive life. Here are the levels of care after detox:
This also includes residential services, 24-7 access to a team of clinicians, and 24 hours of medical monitoring every day. This level is ideal if you have significant medical, cognitive, or psychological needs. It’s also necessary if you are at risk for withdrawal symptoms. Barbiturate can cause serious withdrawal symptoms a few weeks after you stop using.
This level also includes partial hospitalization and involves nine hours of clinical services or more every week.
This level of care has the lowest intensiveness in addiction treatment (besides early intervention before addiction starts). Outpatient services involve less than nine hours of clinical services per week.
Barbiturates suppress the nervous system to facilitate sleep and relaxation but in situations involving overdose, older users, and dependence, barbiturates can have a number of dangerous consequences. Like many prescriptions, barbiturates have some adverse effects even when taken normally, including dizziness, headache, drowsiness, nausea, vomiting, and abdominal pain. The sedative effects have also led to accidental overdose when people, in a sedated and confused state, take extra doses. During an overdose, barbiturate can cause respiratory depression (slowed breathing), coma, and even death. The risk of a potentially fatal overdose is significantly increased when the drug is mixed with other central nervous system depressants like alcohol, z-drugs, and benzodiazepines.
After developing a dependence on barbiturates, there are additional risks that come with withdrawal. As tolerance to barbiturates grows, your body may produce more excitatory neurochemicals to counteract the excess of CNS depressant in your system. If you abruptly stop the use of barbiturates, your brain will be cut off from its supply of inhibitors and your nervous will rebound. The resulting increased activity of your CNS can cause:
Delirium tremens is among the most dangerous symptoms of barbiturate withdrawal. Without medical treatment, as many as 25 percent of cases may be fatal but with treatment that number drops to less than two percent. If you experience withdrawal symptoms, seek medical attention immediately.
If you or a loved one is suffering from addiction to barbiturates or any other central nervous system depressant, there is help available. Because depressant withdrawal symptoms are so dangerous, it’s important not to stop abruptly without medical supervision. In medical detox, you will be given the care you need to safely become remove your body’s dependence on barbiturates.
Addiction is a chronic disease that takes time and effort to overcome, but treatment is available that can help.