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How Addictive Is Ativan (Lorazepam)?

Ativan prescription drugs

Ativan (lorazepam) belongs to a class of drugs known as benzodiazepines. Benzodiazepines are some of the most commonly prescribed drugs in America, with over 15 different drugs in the class, including Valium and Xanax.

Benzodiazepines like Ativan are primarily used in the treatment of anxiety disorders; however, they are often used for the treatment of other conditions. Taking the drug Ativan will produce several possible effects that include:

  • A reduction in feelings of nervousness or anxiety
  • An increase in feelings of relaxation that may be accompanied by fewer behavioral inhibitions
  • A reduction in the potential to experience seizures

The major therapeutic uses of Ativan include the treatment of anxiety disorders, as an aid for sleep, as a muscle relaxant, as an anticonvulsant medication, and as a pre-anesthetic drug used in surgical procedures.

Anxiety disorders include psychological disorders, such as phobias (severe fears); panic disorder (where a person experiences repetitive panic attacks); agoraphobia (where people have a severe fear or anxiety associated with being in open places and may not be able to leave their homes); and social anxiety disorder (where individuals have severe anxiety associated with situations where they have to interact with others). As a pre-anesthetic, Ativan helps relax individuals before they are given general anesthesia prior to surgery.

Ativan may also be used in conjunction with other medications for individuals who experience depression (especially individuals who experience depression with accompanying irritability, restlessness, and insomnia), to help relax individuals who may be experiencing pain from some other medical condition, and in the treatment of certain neurological disorders such as tremor. Thus, Ativan has a variety of potential therapeutic uses.

How Does Ativan Work?

Benzodiazepines like Ativan are classified as positive allosteric modulators that affect neurons in the brain that use a neurotransmitter called gamma-aminobutyric acid (GABA). GABA is the primary inhibitory neurotransmitter found throughout all areas of the brain and spinal cord (the central nervous system, or CNS). These factors influence how Ativan works in the brain:

  • A positive allosteric modulator indirectly acts on a neurotransmitter in the brain.
  • An inhibitory neurotransmitter reduces the activity of other neurons in the brain when it is released and results in the brain working more slowly.
  • Ativan is a GABA agonist, meaning that it binds to the neurons in the brain that have receptors for GABA, and this binding stimulates the release of GABA from other neurons in the CNS (this is the indirect action).
  • The release of GABA in the brain decreases the firing of all the other neurons in the brain, producing an overall reduction in activity in the CNS (this is the CNS depressant action).
  • This action results in one feeling less anxious, more relaxed, and may also increase feelings of sedation (this is the anti-anxiety action).
  • Moreover, the particular GABA receptor that is affected by benzodiazepines like Ativan is found in high concentrations throughout the brain, so the effects are all-encompassing.
  • All functions become affected in the same manner, including other cognitive functions (e.g., attention, memory, etc.) and physical functions (e.g., reaction time).

Because of its chemical properties, relatively smaller doses of Ativan have the same effect as higher doses of other benzodiazepines such as Xanax. Moreover, Ativan tends to stay in the system longer than Xanax. While an individual may feel the maximum effects of Xanax quicker than with Ativan, the effects of Xanax do not last as long, and the individual may feel the need to take Xanax more frequently than they do with Ativan.  Thus, Xanax may be used to treat panic attacks that appear to come out of the blue or insomnia because these require more immediate attention, whereas Ativan can be used for situations that require longer-term attention.

How Is Ativan Legally Classified?

Ativan can only be purchased legally with a prescription from a physician. Ativan is listed by the United States Drug Enforcement Agency as a Schedule IV drug. This means that it is believed to have a low potential for abuse or physical addiction relative to drugs such as heroin or cocaine.  However, just because Ativan is not considered to be as physically addictive as heroin, this does not mean it is not a drug that carries potential for abuse and/or addiction.

Is Ativan Addictive?

All benzodiazepines have a high potential for physical dependence, abuse, and addiction. Because of Ativan’s chemical structure, it has specific therapeutic uses; however, its chemical structure also makes it a high-risk drug for both physical dependence and addiction.

Like with all benzodiazepines, when one takes the drug, there are feelings of mild euphoria and a pleasant sense of wellbeing. Ativan has a higher potency than many other benzodiazepines, and this higher potency can result in an individual developing tolerance to Ativan much faster than with other lower-potency benzodiazepines.

Because Ativan has a high potency, it can result in more extreme cravings when it is discontinued than other benzodiazepines. These extreme cravings may result in individuals using more Ativan than prescribed, using Ativan for longer periods than needed, and attempting to obtain Ativan from other doctors (doctor shopping) or other individuals. This can result in severe abuse and addiction.

Issues with Ativan

Using Ativan to treat psychological disorders, such as anxiety, depression, or issues with sleep, should not be a long-term strategy. Despite its therapeutic usefulness, there are several downsides to the use of Ativan.

Tolerance develops rapidly. What this means is that individuals who take Ativan for any significant period of time will inevitably need a higher dosage of the drug to achieve the same effects initially experienced. As a person takes more and more of the drug, the body becomes physically dependent on it. With continued use, it becomes more likely that withdrawal symptoms will occur when use is stopped or the dosage is lowered. These withdrawal symptoms may include:

  • Nausea and vomiting
  • Tachycardia (faster than normal heart rate)
  • Loss of appetite
  • Dizziness
  • Flulike symptoms
  • Numbness and tingling of hands, feet, fingers, or toes
  • Insomnia, irritability, and restlessness
  • Increased feelings of anxiety
  • Increased feelings of depression

These symptoms mimic many of the same symptoms individuals with anxiety disorders experience, and such symptoms may be misinterpreted as a return of anxiety. Individuals who take Ativan for anxiety-related issues or depression may end up believing that their psychological disorder is returning once they stop using the drug. In fact, they may actually be experiencing withdrawal symptoms, and they may often simply attempt to renew the prescription or take more of the drug. This can result in the beginning of Ativan abuse for individuals who initially took the drug for therapeutic reasons.

Substance Abuse Referrals

Other individuals may get access to Ativan illegally, such as from a friend who has a prescription, or they may buy it on the street. These individuals may use it to self-medicate their own issues with anxiety or for the euphoric effects it produces.

Individuals who abuse benzodiazepines like Ativan tend to use them with other drugs, such as alcohol or narcotic pain medications. When people do this, the effects of all substances are enhanced, and this increases the likelihood of addiction and overdose.

Government statistics indicate that between 2000 and 2010, referrals for substance abuse treatment for benzodiazepines in conjunction with abuse of other medication increased substantially compared to other types of referrals. Thus, benzodiazepine abuse and addiction have become major health issues in United States

Signs of Addiction to Ativan

There are several signs that may indicate someone may be abusing Ativan.

First, individuals who use or abuse Ativan may some other comorbid (co-occurring) disorder that could include:

  • Depression or an anxiety disorder, such as panic disorder, phobias, or other anxiety disorder
  • A sleep disorder, such as insomnia
  • Some other issue with substance use or abuse, such as alcohol abuse, narcotic pain medication abuse, stimulant abuse, or other illicit drug abuse
  • A seizure disorder
  • Post-traumatic stress disorder

An individual with one of these disorders who is prescribed Ativan and uses it for lengthy period of time may be at risk for abuse. It is important that the individual’s physician monitor use of the drug, as Ativan should not be used for long periods in most cases. Individuals who use other drugs or substances in addition to taking Ativan are at a particularly high risk of abusing the drug. Other signs and symptoms of Ativan abuse include:

  • The person begins to neglect responsibilities.
  • The person demonstrates declining performance at school or work.
  • The person begins to use more Ativan than prescribed or take it more often than prescribed.
  • The individual takes Ativan in ways that are not prescribed.
  • The individual begins doctor shopping to get more Ativan.
  • The individual is obtaining Ativan from illegal sources.
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Because Ativan abuse or addiction results in significant physical dependence, individuals who attempt to stop using Ativan will likely experience withdrawal symptoms. These withdrawal symptoms can be relatively severe, depending on the level of abuse or addiction. Thus, individuals who are attempting to recover from Ativan abuse or addiction will need to do so under the supervision of a physician who will oversee the withdrawal process. Treatment for Ativan abuse or addiction will typically consist of the following components:

  • Medical detox, where the symptoms of withdrawal from Ativan are supervised and managed, is required.
  • During the detox process, the person will begin a program of therapy to address underlying issues that led to Ativan abuse.
  • Following detox, the individual will continue in therapy to develop coping skills and strategies to prevent relapse.
  • Most individuals with substance abuse issues or addiction will need long-term aftercare to allow them to continue to grow, develop social support, and reduce the risk for relapse.
  • Individuals with co-occurring mental health issues will need to get simultaneous treatment for these issues.

All treatment must be catered to each individual client. There is no one-size-fits-all solution to addiction treatment.

Conclusions

  • Ativan is a benzodiazepine that has useful therapeutic properties; however, it is also a drug that carries a definite risk for abuse and addiction.
  • In the majority of cases, Ativan should only be prescribed for temporary use due to its high potential for the development of tolerance and subsequent abuse.
  • There are some specific indicators that may suggest that an individual is either abusing or addicted to Ativan.
  • A person who has developed an addiction to Ativan will initially need treatment that is supervised by a physician (medical detox) and need to undergo intensive treatment.
  • Individuals who abuse Ativan often have co-occurring mental health issues that need to be assessed and addressed.
  • Individuals can successfully recover from Ativan abuse or addiction and go on to lead fulfilling lives in recovery.
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