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Dec 6, 2023

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Sydney Tolleson Grand Canyon University PCN-150 Psychopharmacology in Treatment of Addiction and Substance Use Disorders Dr. Salvucci July 13, 2023 1

Introduction Benzodiazepines are a relatively new class of drugs that were developed as a safer alternative to barbiturates to treat anxiety, sleep, and other mood disorders. These types of drugs are also known as anxiolytics, hypnotics, muscle relaxants, anticonvulsants, and even amnestic medicines (Kuebler, 2023). The first benzodiazepines, chlordiazepoxide and diazepam, were introduced in the late 1950’s and then more were introduced to the United States in 1975, branded as anxiolytics (2023). The discovery of these drugs seemed to be a game changer in the medical field to help treat a variety of mental health disorders, however the long-term effects and risk of abuse were not researched and made known until more recent years. Benzodiazepines have been used for many years to treat anxiety and sleep disorders due to their ability to stimulate the GABA receptors in the brain, however, their use has now been associated with many issues including addiction, dependence, and withdrawal, increasing the need for counseling and medical help due to addiction and to discontinue use after only a short amount of time. This has proven to be challenging for not only prescribers, but also for professionals in the counseling field as well. History and Neurobiology Benzodiazepines are also known as anxiolytics, hypnotics, muscle relaxants, anticonvulsants, and amnestic medications and have been used for decades to treat conditions such as anxiety, insomnia, muscle spasms, seizures, agitation, and even alcohol withdrawal (Kuebler, 2023). The first in this group of drugs, chlordiazepoxide and diazepam, emerged in the 1950’s. After a short time, research concluded that extreme dependence, tolerance, social dislocation and hard to manage withdrawals were effects of long-term use of diazepam (2023). Clonazepam and lorazepam were introduced to the United States in 1975, branded as anxiolytics because people 2

could take a lower dose of these medications and achieve the same results, masking their initial potency (2023). Today, the three most prescribed benzodiazepines, alprazolam, clonazepam, and lorazepam, are anywhere from 10 to 20 times more potent than the original drug, diazepam (2023). As the number of prescriptions and the use of these types of drugs has increased, so has the number of overdoses resulting in death. Within the human brain, specifically the central nervous system, gamma-aminobutyric acid, also referred to as GABA, is considerably one of the most important inhibitory neurotransmitters (Ellen, et. al., 2008). GABA controls the state of excitability in all areas of the brain by binding to the GABA receptor complexes found in the brain, spinal cord, and retina (2008). When the GABA receptors are stimulated, there is an increase in chloride ion permeability, resulting in the hyperpolarization of the neuromembrane (2008). The balance between excitatory inputs and GABA is what essentially regulations the neuronal activity in the central nervous system, which is crucial to the entire brain and body to function. When the balance is skewed toward GABA, the effects of benzodiazepines such as sedation and relaxation prevail, and when the balance is skewed against GABA conditions such as insomnia and restlessness appear. Benzodiazepines work by mimicking GABA and binding to the receptors to produce the effects of sedation, helping relieve the symptoms of conditions like anxiety and insomnia. Current Trends and Issues Anxiety is the body’s natural reaction to stressful or dangerous situations and is felt by apprehension and nervousness when in those types of situations (Hancock & McKim, 2018). In recent years, there has been a significant increase in the number of patients being diagnosed with anxiety disorder, PTSD, insomnia, and other mental health disorders that can be treated with 3

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