Overview

Amobarbital, also known as “Amytal” is an uncommon drug sometimes used as a sleep aid in America, and functions as a hypnotic sedative. Amytal is classified as a barbiturate, a class of drugs that is noted for its potent sedating effects. Despite the rarity of Amytal as well as its known dangers in both dependency and withdrawal, it is still abused intentionally for its sedating properties that are particularly strong due to its intravenous use, 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 Amytal 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 Amytal 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 the life-threatening condition delirium tremens. Amytal exhibits short-term effects similar to other barbiturates including drowsiness, relaxation, heavy limbs, and loss of coordination. Long term abuse of Amytal can lead to a variety of physiological and mental ailments including depression, digestive problems, anxiety, and neurological decay. Recovery from Amytal can be effective through the use of various medications to minimize the need for such potent sleep aids as well as therapeutic treatments. Rehabilitation facilities also offer extensive resources for recovering from Amytal addiction in a safe, stable, and comfortable manner.

What is Amytal?

Amobarbital, a drug often known by its brand name “Amytal” is a legal prescription hypnotic sedative that is traditionally prescribed for severe sleep disorders such as insomnia. Amytal is perhaps known for its unusually addictive properties for a sleep aid, as well as its potent withdrawal which can mimic the dangerous effects of alcohol withdrawal. Amobarbital is distinct from other prescription sleeping pills such as Ambien, Eszopiclone, and Zaleplon, because it is a barbiturate derivative rather than a nonbenzodiazepine. Nonbenzodiazepines are a drug class primarily characterized by their psychoactive properties which closely mimic those of benzodiazepines without many of the dangerous effects of traditional benzodiazepines. As a barbiturate, Amytal’s sedating effects may be stronger than other sleep aids, while also containing more side effects. Sleep aids 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 sleep aids, including Amytal. With over 8.6 million Americans regularly using prescription sleeping pills, this presents a serious risk.² Amytal is classified as a Schedule II drug Controlled Substances Act (CSA), meaning that Amytal is classified as having a high potential for abuse as well as accepted medicinal usage in the U.S.

How Does Amytal Addiction Work?

Amytal’s effectiveness as a sleep aid can primarily be attributed to its interaction with GABA as a barbiturate, a common inhibitory neurotransmitter that is responsible for a large amount of various neurological functioning. Amytal is classified as a GABA enhancer, meaning that Amytal will increase the production and functioning of GABA in the brain, including its sedating effects. Generally selective GABA medicines are better recommended as sleep aids because they have a much faster onset and are metabolized by the body much quicker, while also not effecting undesirable GABA functions like muscle control. However, Amytal may be beneficial in those who are already taking barbiturates, or with those with more severe insomnia who have been unable to be treated with more common sleep aids. Because amobarbital is not selective, as well as being a barbiturate, Amytal runs a higher risk of both physical and psychological dependency than other sleep aids, and may respond more severely to previous underlying conditions such as depression or liver damage.

Short and Long Term Effects

Because amobarbital comes most commonly in the form of Amytal Sodium, it is administered intravenously. By being injected, Amytal has a much stronger and more rapid onset than other sleep aids, and may take effect in as little as under 10 minutes.

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

• Confusion
• Anxiety
• Dizziness
• Drowsiness
• Delirium
• Relaxation

And physical effects such as:

• Slowed breathing
• Headache
• Loss of coordination
• Heaviness of limbs
• Ataxia

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

• Neurological damage – Frequent abuse of GABA-effecting drugs such as through Amytal 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 Amytal user due to a reduction in digestive activity. This can lead to weakened gut fauna, cramping, nausea, constipation, and diarrhea.
• Muscle problems – Because Amytal functions as a sedative, prolonged use of Amytal 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, Amytal users often experience worsening sleeping problems, developing into insomnia even in those who originally took Amytal to treat insomnia.

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

• Addiction – Although nonbenzodiazepine drugs are used as a comparatively less addictive alternative to benzodiazepines, Amytal still maintains a risk of both physical and psychological dependency. If abused for its high, Amytal can quickly become addictive.
• Depression – Due to overstimulation of GABA receptors, Amytal 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 Amytal 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 Amytal abuse include:

• Allergic reaction – Allergic reactions to Amytal 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 Amytal include difficulty breathing, chest pain, skin rash, and hives.
• Risk of overdose – Amytal 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 Amytal use. Even when taken as prescribed for sleeping problems, Amytal 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 – Amytal 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. Amytal is particularly susceptible for this, and is generally recommended to be taken for no longer than two week periods to avoid tolerance build up.

Amytal 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 sleep aids is particularly important to be done under careful supervision and with the right environment, as withdrawal from chronic sleep aid 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. Detoxification is a particularly important step for Amytal withdrawal due to its ability to mimic delirium tremens, a series of symptoms generally associated with alcohol withdrawal that may become life threatening. 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 Amytal 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 Amytal 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 Amytal 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 Amytal 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 Amytal 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.