Overview

Zolpidem, also known as “Ambien” is one of the most common drugs used as a sleep aid in America, and functions as a hypnotic sedative. Ambien is classified as a nonbenzodiazepine, a class of drugs that mimics some of the effects of benzodiazepines but with a smaller capacity for dependency and abuse. Despite this, Ambien is still abused intentionally for its hallucinogenic properties when taken without sleeping, as well as unintentionally due to its high capacity for building tolerance. Sleeping pills are a common threat in the U.S, with 30,149 hospitalizations reported due to sleeping pills in the U.S. in 2011 alone.¹ Ambien is both effective and dangerous due to its effect on GABA receptors in the brain, which control a wide variety of neurological functioning. The primary danger behind Ambien is how easy it is to build a tolerance to it, as well as withdrawals that come from overuse of the drug, which can lead to seizures. Ambien exhibits short-term effects similar to other sleeping pills including drowsiness, relaxation, heavy limbs, and loss of coordination. Long term abuse of Ambien can lead to a variety of physiological and mental ailments including depression, digestive problems, anxiety, and neurological decay. Recovery from Ambien can be effective through the use of various medications to minimize the need for such potent sleeping pills as well as therapeutic treatments. Rehabilitation facilities also offer extensive resources for recovering from Ambien addiction in a safe, stable, and comfortable manner.

What is Ambien?

Zolpidem, a drug often known by its brand name “Ambien” is a legal prescription hypnotic sedative that is traditionally prescribed for severe sleep disorders such as insomnia. Ambien is perhaps known best for its ability to produce potent delirium, dissociation, and hallucinations if taken without falling asleep quickly enough – a characteristic that is sometimes abused as a high. Zolpidem is similar to many other prescription sleeping pills, which includes Amobarbital, Eszopiclone, and Zaleplon, among many others. These drugs are similar due to their similar physical and mental effects, as well as their classification as nonbenzodiazepines. Nonbenzodiazepines are a drug class primarily characterized by their psychoactive properties which closely mimic those of benzodiazepines. Sleeping pills are a severely understated danger due to their potential for abuse, addictiveness, ease of overdosing, and dangerous effects when combined with other drugs. In 2011 there were a reported 30,149 hospitalizations in the United States attributed to sleeping pills, including Ambien. With over 8.6 million Americans regularly using prescription sleeping pills, this presents a serious risk.² Ambien is classified as a Schedule IV drug Controlled Substances Act (CSA), meaning that Ambien is classified as having a low potential for abuse as well as accepted medicinal usage in the U.S.

How Does Ambien Addiction Work?

Ambien’s effectiveness as a sleep aid can primarily be attributed to its interaction with GABA, a common inhibitory neurotransmitter that is responsible for a large amount of various neurological functioning. Ambien is classified as a selective GABA medicine, meaning that Ambien won’t have an effect on other essential GABA functions such as muscle control, but will instead only utilize its tranquilizing effect on GABA receptors responsible for sleep. These selective GABA medicines are particularly good at functioning as sleep aids because they have a much faster onset and are metabolized by the body much quicker, allowing them to quickly promote sleep while being completely metabolized before waking up, which greatly reduces side effects of less selective medications. In addition, the selective properties of Ambien makes it less prone to physical dependency and addiction than less selective sleeping pills, as well as  other nonbenzodiazepine and benzodiazepine drugs. However, Ambien is still notable for its potential for psychological dependency, as well as its potential to be abused recreationally.

Short and Long Term Effects

Ambien is taken orally in the form of compressed tablets or capsule pills. Onset is relatively quick for being taken orally, and can begin to take effect in around 20-30 minutes. Remaining awake after onset can result in a variety of hallucinogenic and other psychoactive effects.

When remaining awake after ingestion, users report short-term mental effects such as feelings of:

• Euphoria
• Hallucinations
• Reduced inhibitions
• Depersonalization
• Derealization
• Relaxation

And physical effects such as:

• Sleep walking and other activities performed while sleeping
• Drowsiness
• Loss of coordination
• Heaviness of limbs

Repeated long-term use of Ambien leads to physical side effects such as:

• Neurological damage – Frequent abuse of nonbenzodiazepines as well as other GABAeffecting drugs such as benzodiazepines through Ambien can lead to distinct cognitive impairment when abused. This can manifest in effects such as memory loss, sleep disturbances, anhedonia, and disorientation.
• Diminished digestive health – Digestive health is noticeably diminished in the body of a frequent Ambien user due to a reduction in digestive activity. This can lead to weakened gut fauna, cramping, nausea, constipation, and diarrhea.
• Muscle problems – Because Ambien functions as a sedative, prolonged use of Ambien can result in coordination and muscular difficulties. This can include a general loss of motor coordination, muscle cramping and pain, and chronic muscle fatigue.
• Insomnia – Due to frequent interruptions in ordinary circadian activity and damage done to GABA receptors with repeated abuse, Ambien users often experience worsening sleeping problems, developing into insomnia even in those who originally took Ambien to treat insomnia.

Long-term use of Ambien also carries several mental side effects including:

• Addiction – Although nonbenzodiazepine drugs are used as a comparatively less addictive alternative to benzodiazepines, Ambien still maintains a risk of both physical and psychological dependency. If abused for its high, Ambien can quickly become addictive.
• Depression – Due to overstimulation of GABA receptors, Ambien frequently leads to depression due to the brain’s inability to properly manage its circadian rhythm and GABA receptors.
• Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in Ambien abuse due to external factors such as family or friends finding out, and internal factors from the chemistry of the drug itself. This can compound and develop into chronic paranoia.

Other risks posed by Ambien abuse include:

• Allergic reaction – Allergic reactions to Ambien are not uncommon, and can result in a variety of different side effects that can become fatal in the cases of severe allergic reaction. Symptoms of allergic reaction to Ambien include difficulty breathing, chest pain, skin rash, and hives.
• Risk of overdose – Ambien holds a surprising potential for overdose for a variety of reasons. The most common cause of overdose is the tolerance that can build with frequent Ambien use. Even when taken as prescribed for sleeping problems, Ambien can still lose its effectiveness over time and no longer prove beneficial, which may lead some people to increase their dosage until it is effective again, which can often result in accidental overdose. Death by respiratory failure is common and predicated by signs of extreme disorientation and drowsiness, and survivors are at risk of permanent neurological damage.
• Tolerance – Ambien as well as other sleeping pills are notorious for their quick ability to quickly build a physical tolerance in individuals with frequent usage. This can result in the drug no longer functioning as well as it did before, leading some users to either increase their dosage or develop a dependency on the drug from frequent usage.

Ambien withdrawal is a difficult process to go through, and includes withdrawal symptoms such as:

• Anxiety
• Uncontrollable shaking and shivering
• Fatigue
• Nausea and vomiting
• Sweating
• Elevated heart rate
• Depression
• Muscle aches and cramps
• Insomnia

Methods of Treatment

Pharmacological:

Treatment for addiction to sleeping pills is particularly important to be done under careful supervision and with the right environment, as withdrawal from chronic sleeping pill usage faces the risk of seizures. As such, pharmaceutical treatment first begins with a tapered detoxification, usually under the supervision of a physician, so as to allow the body to safely rid itself of the drug. Only once the body has fully detoxified itself can treatment, pharmaceutical or therapeutic, be safely administered. While there are no drugs currently in use specifically for Ambien addiction, there are many drugs that are able to both treat symptoms of withdrawal as well as more importantly treating the sleep problems that led to Ambien addiction in the first place. In conjunction with important lifestyle changes that promote better healthier sleep, some may find it beneficial to gradually wean off of sleeping pills by using progressively less and less potent pills, with the goal of eventually using harmless more natural alternatives like melatonin. Melatonin is a hormone naturally produced by the pineal gland in the brain as one of the primary chemicals that promotes and regulated wakefulness and sleep. Melatonin is completely nontoxic and non-addictive, and is an excellent replacement for stronger sleeping pills. In addition, there are a wide variety of natural supplements that can be used to promote sleep, including drinks such as chamomile tea, pills such as powdered valerian root, and even foods such as turkey that contain tryptophan.

Therapeutic:

Other forms of treatment for Ambien addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as Ambien addiction as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings. The twelve-step program, which is utilized by Alcoholic Anonymous, is a long-established method of treating drug and alcohol addiction. The twelve-step program works as a gradual method of guiding principles and pragmatic steps that can be taken to go from the depths of addiction and unhealthy habits to sobriety. These twelve steps are aimed at effectively recovering from compulsive and addictive behaviors, and addressing mental and behavioral problems that led to addiction in the first place. These twelve steps include both internal and external actions aimed at making amends for past mistakes, accepting responsibility for the actions that led to addiction, and moving forward to establish healthy habits and a positive mindset.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting Ambien addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

References

1. Ruiz, P., & Strain, E. (2011) Substance Abuse: A Comprehensive Textbook, Fifth Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
2. Aleccia, Jonel. “Sleepless in the States: Nearly 9 Million Pop Pills for Shut-Eye.” NBCNews.com, NBCUniversal News Group, 29 Aug. 2013, www.nbcnews.com/health/sleepless-states-nearly-9million-pop-pills-shut-eye-study-8C11026819.