Ambien Abuse and Addiction


Ambien (generic name: zolpidem) is a sedative-hypnotic medication prescribed to treat insomnia. Ambien taken as directed for brief periods is relatively safe; however, this drug is not intended for long-term use due to the potential side effects and risks. Among the risks of Ambien is the potential for misuse and abuse. Someone with a history of drug abuse or addiction may be more likely to abuse Ambien.1

Ambien belongs to a class of drugs known as sedative-hypnotics, which includes benzodiazepines, “z-drugs” like zolpidem (Ambien) and zaleplon (Sonata), and barbiturates such as phenobarbital. Each of these medications. Ambien and other “z-drugs” were originally touted as being far safer and less addictive than other sedative-hypnotics; however, dangerous effects, such as complex sleep behaviors, and reports of abuse indicate that the drug may not be as safe as originally believed.2

How to Know if Someone Is Abusing Ambien

Woman taking pills for pain

It is difficult to tell if a person is abusing Ambien, particularly when they’ve been given a legitimate prescription from their doctor. However, there are signs of abuse of prescription drugs that may indicate someone who takes Ambien is abusing it:3,4,5

  • Taking Ambien in a way other than prescribed, such as crushing and snorting the pills.
  • Taking Ambien that was prescribed to someone else.
  • Taking more Ambien than prescribed or taking it more often than directed.
  • Appearing overly sleepy or looking “drugged” during the day.
  • Frequently requesting refills on the prescription or “doctor-shopping” to get more prescriptions for Ambien.
  • Lying about their Ambien use.
  • Noticeable changes in behavior.
  • Financial problems or requests for money with no good reason.

Abuse of Ambien often occurs in conjunction with abuse of other drugs. For example, someone abusing a stimulant drug like cocaine may take Ambien to counteract the stimulant effects with Ambien’s sedating effects. One of the biggest red flags for Ambien abuse is taking the drug in conjunction with other mind-altering substances.

Side Effects of Ambien Abuse

The side effects of Ambien may occur with both prescription use and with abuse. Someone who is abusing the drug may be more likely to experience a greater number of side effects of experience them in greater severity.

Potential side effects of this drug range from mild symptoms such as dry mouth and headache to more severe symptoms including insomnia, confusion, and worsening of depression or suicidal thoughts.1

One of the most concerning side effects is the risk of the patient engaging in complex sleep behaviors such as driving or cooking while asleep, which could lead to serious injury of oneself or others.1

Ambien Abuse Statistics

The National Survey on Drug Use and Health gathers information on substance misuse in America. In the survey, they looked at Americans’ misuse of tranquilizers and sedatives, including zolpidem (Ambien). They found that, in 2018:6,7

  • An estimated 46,000 adolescents between 12 and 17 years old misused prescription tranquilizers or sedatives in the previous year.
  • The numbers increased for young adults between 18 and 25, with 1.7 million abusing these drugs in the same period.
  • Adults over the age of 25 misused prescription tranquilizers or sedatives in even greater numbers, with 4.3 million adults admitting to doing so in the prior year.
  • 741,000 Americans age 12 or older abused zolpidem, specifically, in 2018.

Ambien Addiction Signs

According to Ambien’s FDA-approved label, those who have a history of substance abuse or substance use disorders are at increased risk of developing problems with Ambien abuse. While addiction to Ambien alone is relatively rare, it is more common for Ambien abuse to be part of a larger pattern of polysubstance abuse and addiction.8

If you’re worried about yourself or someone you love, watch out for the signs. The following are the criteria for a sedative use disorder, as outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):9

  • Taking more of a sedative or taking the medication for longer than you meant to.
  • Trying to control or stop your sedative use without success.
  • Spending a lot of time in trying to get, use, or recover from sedatives.
  • Failing to attend to professional, academic, or personal obligations due to sedative use.
  • Overwhelming urges to use sedatives.
  • Continuing to use sedatives knowing that your use causes problems in your interpersonal relationships.
  • Giving up hobbies and activities that were once important to you in favor of using sedatives.
  • Using sedatives in situations where doing so could put you in danger, such as before driving or operating machinery.
  • Using sedatives even knowing that it is causing or has the potential to cause physical and psychological health problems.
  • Needing to increase your sedative use to achieve the desired effects (tolerance).
  • Going through withdrawal when not using a sedative or reducing the dose significantly (dependence).

If you recognize some or all of the following signs in yourself or someone you love, it may be time for addiction treatment.

What Is Ambien Dependence?

Someone on Ambien may experience withdrawal symptoms when trying to come off of Ambien, but this does not mean they are addicted. Physiological dependence only refers to the body and brain’s adaptation to Ambien’s presence and does not reflect the compulsive use indicative of an addiction.10

Dependence is a sign of addiction, but it is not the same as addiction. 9,10 If you’re dependent on Ambien but you are not compulsively using the drug in a way that would indicate an addiction, you may simply need some medical assistance in withdrawing from the drug safely. However, if you are displaying the criteria for a sedative use disorder as described above, you may need both withdrawal management (detox) and ongoing drug rehabilitation.

Your need for withdrawal management may increase if you’ve been abusing Ambien along with other drugs, especially other CNS depressants.11 Alcohol and benzodiazepines, for example, have very dangerous withdrawal symptoms that can certainly complicate Ambien detox.11 Speak to a doctor or addiction treatment professional about recommendations for detox and rehab if you’re struggling with Ambien and/or polysubstance abuse.

Ambien Addiction Treatment: Detox and Rehab

Help for Ambien withdrawal may be necessary for those abuse Ambien along with alcohol or other drugs and who are physiologically dependent on one or more substances. Those who have been abusing and/or addicted to Ambien, and especially those experiencing polysubstance dependence, may have more severe symptoms and may require a period of medical detox prior to initiating inpatient or outpatient therapy for addiction.

Ambien Withdrawal Symptoms

Sedative-hypnotic withdrawal symptoms may include:1, 8,12

  • Fatigue.
  • Nervousness.
  • Panic.
  • Uncontrollable crying.
  • Flushing of the skin.
  • Nausea/vomiting.
  • Stomach cramps.
  • Seizures.

Sedative-hypnotic addiction cannot be treated with detox alone. Addiction treatment involves much more than overcoming physical dependence. Through rehabilitation, be it inpatient or outpatient, you’ll learn the skills you need to live in recovery and work through the issues that may have led you to abuse Ambien in the first place.

Treating Co-Occurring Insomnia and Ambien Abuse

Insomnia

Insomnia has many potential causes and may be a symptom of an underlying mental health disorder .13 Anxiety and depression both have insomnia as an associated symptom, for example.14,15 Other risk factors for insomnia include a sedentary lifestyle, use of caffeine or nicotine, or working the night shift.13 Insomnia may also arise from lifestyle changes, stress, brief emotional disturbances, or a number of other issues.13,16

Insomnia may be a result of a substance use disorder (e.g., a person addicted to a stimulant like cocaine or meth may have difficulty sleeping) or a person’s battle with insomnia may lead to addiction to a CNS depressant such as alcohol, benzodiazepines or a non-benzodiazepine, such as Ambien.9

With so many potential causes for insomnia, it is important to work with a physician to uncover the contributing factors behind the insomnia and develop an appropriate treatment plan. Of course, the same applies for a substance use disorder. Success is much more likely when the underlying causes of the problem are addressed and not only the surface symptoms.11

For someone who has been struggling with insomnia and a substance use disorder, it’s important that, during rehab, the treatment plan identifies the cause of and addresses insomnia as in an appropriate manner. Insomnia as a result of a substance use disorder will focus more on treatment of the SUD, substance use disorder as a result of an insomnia disorder will primarily focus on treating the insomnia.17

Therapy, especially cognitive behavioral therapy, is an evidence-based treatment that has been proven effective for many mental, behavioral, and substance abuse issues, and it has been shown helpful in treating insomnia, too.18 Research further shows that CBT for insomnia has as much benefit as Ambien and other sleep drugs in the short term and an even greater lasting benefit.18 CBT is central to our therapeutic approach at Laguna Treatment Hospital. To learn more about our program and our co-occurring treatment approach, give us a call at 949-565-2377. Our admissions navigators are available any time of day or night to discuss your options for the treatment of Ambien abuse.

References:

  1. Sanofi-aventis. (2014). Ambien: Highlights of Prescribing Information.
  2. Weaver M. F. (2015). Prescription Sedative Misuse and AbuseThe Yale journal of biology and medicine88(3), 247–256.
  3. U.S. National Library of Medicine. (2020). Prescription Drug Misuse.
  4. United States Drug Enforcement Administration. (2018). Prescription for Disaster: How Teens Misuse Medicine.
  5. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs.
  6. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  7. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.
  8. Victorri-Vigneau, C., Dailly, E., Veyrac, G., & Jolliet, P. (2007). Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network surveyBritish journal of clinical pharmacology64(2), 198–209.
  9. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  10. National Institute on Drug Abuse. (2011). Research Report Series: Prescription Drug Abuse.
  11. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
  12. Haji Seyed Javadi, S. A., Hajiali, F., & Nassiri-Asl, M. (2014). Zolpidem dependency and withdrawal seizure: a case report studyIranian Red Crescent medical journal16(11), e19926.
  13. National Institutes of Health. (2019).
  14. Anxiety and Depression Association of America. (n.d.). Sleep disorders.
  15. Franzen, P. L., & Buysse, D. J. (2008). Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implicationsDialogues in clinical neuroscience10(4), 473–481.
  16. U.S. National Library of Medicine. (2020). Insomnia.
  17. National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders Research Report: Why is there comorbidity between substance use disorders and mental illnesses?
  18. Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an updateWorld psychiatry : official journal of the World Psychiatric Association (WPA)18(3), 337–352.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in... Read More


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