Lorazepam is the active generic ingredient in the branded drug Ativan. Lorazepam is a short-acting benzodiazepine. In the US, the Food and Drug Administration has only approved 15 benzodiazepines, which are sedatives. This type of drug was first chemically created in 1955. Today, benzodiazepines are the most prescribed psychotropic drug in the country.
Benzodiazepines are GABA agonists, which means they increase the amount of the neurotransmitter GABA in the brain. GABA is involved in slowing down activity in the brain. It is not surprising, therefore, that benzodiazepines (like alcohol) are central nervous system depressants. Lorazepam is indicated for the treatment of the following conditions:
- Anxiety disorder
- Anxiety as a feature of depression
- Symptoms of irritable bowel syndrome (IBS)
- Symptoms associated with withdrawal from alcohol
- Side effects, such as nausea and vomiting, after cancer treatment
While the medicinal benefits of lorazepam are well observed, there are downsides to use of this drug, including its addiction potential. On the one hand, individuals with a lawful prescription for lorazepam are not likely to develop an addiction to this drug if they strictly follow the prescribing doctor’s instructions for use. However, there are numerous ways individuals may begin to take too much of a drug, and may not even have an abuse intention when they do so. Since lorazepam is addiction-forming, individuals can get started on the path to addiction as soon as they start to take more lorazepam than needed. The risk of abuse is always present when a person takes an addiction-forming drug.
Lorazepam: Physical Dependence and Addiction
As the National Institute on Drug Abuse explains, although physical dependence and addiction are interrelated, there are differences between these two biological states. A discussion about these two states is especially relevant to lorazepam, because it is a prescription medication. Physical dependence is a natural biological state that arises when a person regularly takes a habit forming drug. For example, a person who takes lorazepam lawfully, for a diagnosed medical condition, will become physically dependent on this drug at some point along the timeline of regular use. Some doctors may insist on only prescribing this drug in the short-term, to avoid the onset of physical dependence in the patient. As noted, if the patient follows the doctor’s orders regarding the use of lorazepam, physical dependence may set in but it is unlikely the patient will become addicted. The two main biological features of physical dependence are tolerance and withdrawal.
Both prescribed lorazepam users and recreational lorazepam users face a risk of addiction to this prescription sedative if they take too much. One of the factors influencing lorazepam addiction can be its availability. There are numerous way that a person may obtain lorazepam, including but not limited to:
- Doctor shopping: A prescribed user may go to more than one doctor to get prescriptions. The person may use insurance with one doctor and pharmacy, and pay out of pocket for the other visits and prescriptions. This practice can be costly, and it involves lying and being secretive. Doctor shopping is an example of the power a drug can have over individuals, causing them to act uncharacteristically and engage in an illegal activity.
- Getting pills from family and friends: Individuals who are experiencing lorazepam abuse may ask friends and family who have a prescription to share pills. It is never advisable to share pills, but the bonds between family members and friends can impair a person’s judgment in this respect.
- Buying pills from a street drug dealer: An added danger here is that street dealers, eager to make money and keep customers, may offer a person an even more dangerous alternative to lorazepam if they do not have a supply of this drug. The person could not only become addicted to the new drug, but also add it to the lorazepam abuse and become a polydrug user. Polydrug use increases the risk of fatal overdose and various side effects.
- Buying pills from a person with a prescription: A person may be able to buy lorazepam, or other drugs, online directly from illegal pharmacies or from people who use bulletin board sites, such as Craigslist, to sell their prescriptions.
To recap, a person can become physically dependent on lorazepam without being addicting, but the reverse proposition is not true. Physical dependence on lorazepam is a biological component of addiction. When individuals become addicted to lorazepam, in addition to being subject to tolerance and withdrawal, they will show psychological symptoms and signs of addiction. Addiction to lorazepam involves a compulsion to use this drug. As some psychologists may describe it, a person is in emotion mind. For instance, when in emotion mind, individuals may feel anxious (an example of a drug use cue) and as if the brain is an automatic setting. They use lorazepam even if they may really want to stop doing so.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, May 2013, publication of the American Psychiatric Association) implemented new language to replace reliance on the terms physical dependence and addiction. The term now in clinical use is substance use disorder. In the case of a person who has an abusive relationship to lorazepam, the clinical description would be that the person has a sedative use disorder.
The DSM-5 sets forth 11 indicators of a use disorder. In order to be diagnosed with a use disorder, a person must demonstrate at least two symptoms within the same 12-month period. The use disorder may be graded as mild, moderate, or severe. The severity grading increases with the number of criteria present. The 11 criteria identified are the product of years of clinical research and observations. The criteria include tolerance, withdrawal, as well as psychological and behavioral indicators of substance abuse.
Symptoms and Signs of Lorazepam Addiction
Symptoms and signs are related but different. A person who abuses lorazepam will experience symptoms of abuse whereas an onlooker would see signs of abuse. For instance, a person may feel nauseous after taking too much lorazepam (a symptom), and an onlooker may see the person vomit (a sign).
Symptoms and signs emerge at different points during lorazepam abuse, such as immediately after use, during withdrawal, or as a result of chronic use (i.e., long-term side-effects). WebMD identifies some of the symptoms and signs that may emerge after a person takes too much lorazepam in a short period of time (can also be looked at as symptoms of an overdose):
- Slurred speech
- Blurred vision
- Poor coordination
- Difficulty breathing
Before discussing the symptoms and signs of lorazepam withdrawal, it is critical to note that there is a general advisement that individuals should not suddenly stop taking this drug after a period of abuse or regular use. Doing so can trigger the onset of severe withdrawal symptoms. This hazard and how treatment can help are discussed later. To avoid a dangerous situation, or get help if one arises, it is necessary to know about some of the physical and psychological symptoms and signs that may emerge during withdrawal from lorazepam.
Mental Health Daily identifies the following symptoms and signs associated with lorazepam withdrawal:
Psychological symptoms and signs
- Panic attacks
- Problems with concentration
- Memory problems
- Mood swings
- Suicidal thinking
Physical symptoms and signs:
- Sleep problems
- Heart palpitations
There has been some research on the long-term consequences of benzodiazepine abuse. There appears to be a connection between diminished mental health and long-term benzodiazepine abuse. Chronic users may experience personality changes, diminished social skills, ongoing depression, and phobias. As noted earlier, lorazepam is a GABA drug. Research into how benzodiazepines impact GABA in the brain may illuminate the long-term consequences of lorazepam abuse. It is known that a reduction in GABA can cause a host of physical and psychological problems, including but not limited to alcohol and other drug abuse, insomnia, anxiety, panic attacks, depression, and post-traumatic stress disorder.
Treatment for Lorazepam Abuse
The way in which lorazepam, and benzodiazepines, interact with brain complexes and neurochemicals (such as GABA receptors and the neurotransmitter GABA) makes for a dangerous withdrawal process. This may come as a surprise because benzodiazepines are sedatives, and it seems logical to think of them as benign. However, benzodiazepines are some of the most dangerous drugs to abuse. The medical community advises individuals who are seeking to recover from benzodiazepine abuse to undergo medical detoxification at a rehab center, detox facility, hospital, or other qualified clinical setting. As will be discussed, detoxification involves a tapering process.
As the National Institute on Drug Abuse notes, the following are some of the benefits of a medical detoxification:
- Helps to ensure safety in the withdrawal process: Medical detox can prevent severe withdrawal symptoms from emerging and safely manage the symptoms that do arise.
- Supervision that can help to prevent relapse: During a cold turkey detox (never advisable for lorazepam), a person may succumb to drug cravings or feel overwhelmed by uncomfortable or painful withdrawal symptoms. In the face of these symptoms, the person may relapse if alone in the process.
- Psychological support from the attending doctor and addiction team: Individuals who attempt to detox on their own may not have adequate social support to safely get through the process.
- A smooth transition to comprehensive treatment: After medical detox, the recovering person can transition into primary care treatment for the addiction. It is well established in the addiction treatment field that detox (including a benzodiazepine taper) is necessary but never sufficient to address the many layers of addiction.
The tapering process is designed to prevent the onset of severe withdrawal symptoms, such as seizures or coma. The attending doctor will induct the recovering person into the taper, using a benzodiazepine that is deemed safe for the process. In other words, a benzodiazepine (rather than a different drug type) is used to wean a person off lorazepam. This process recognizes that a brain that is addicted to lorazepam cannot suddenly be deprived of this drug. However, a taper works with the mechanisms in the brain that safely allow for a gradual reduction in the volume of lorazepam in the brain. This gradual reduction helps to ensure that the withdrawal process is safe.
As benzodiazepine withdrawal expert Dr. Heather Ashton explains, there is no one-size-fits-all or single protocol used in a benzodiazepine taper. The attending doctor and addiction treatment team will determine the correct dosing for the taper along each step of the process. Depending on individual factors, a taper can take weeks, months, or a year or more. Dr. Ashton advises that she works with the realities of a patient’s brain chemistry. If a person has been addicted to benzodiazepines, the goal is to safely and effectively wean that person off the drug rather than to rush to a full detoxification. A full detoxification is the end result rather than a goal.
Additional Treatments for Lorazepam Abuse
After recovering individuals are safely stabilized on a taper at a drug rehab center, they will immediately receive a host of recovery services. These services are aimed at addressing the thoughts, emotions, and behaviors involved in lorazepam abuse. For this reason, therapy (individual and group) is a staple of treatment at rehab centers. The counselors at a rehab facility typically use research-based therapies in their individual and group sessions with recovering individuals.
There are numerous therapy approaches in practice throughout the US, but some have proven more effective than others in the addiction treatment context. Such therapies include but are not limited to:
While therapy is a primary treatment service for lorazepam (and other drugs) addiction at drug rehab centers, there are a host of supportive services available (depending on the center). Most all rehab centers have group recovery meetings onsite or, as in an outpatient program, require clients to attend local meetings off-site as part of the program. Peer support meetings are considered a staple of the recovery process. There are different groups, but two main ones are Alcoholics Anonymous (and all its sister groups, such as Narcotics Anonymous, all of which are faith-based) and SMART Recovery (which is not faith-based). These organizations make extensive literature available to the public through their websites as well as at their meetings.
After primary services and recovery groups, the next rung of recovery services relates to the recovering person’s wellness. The availability and type of wellness services at a rehab will depend on the center. Wellness services include but are not limited to yoga, acupuncture, massage, nutritional counseling, and animal therapies (e.g., equine-assisted therapy). Rehab centers that provide wellness services are essentially taking a two-pronged approach to healing addiction. Medical detox (including a benzodiazepine taper) and therapy target the addiction whereas wellness services are holistic. Supporting the overall health of a person aids the recovery process.
Although benzodiazepine abuse can subject a person to a host of physical and psychological symptoms, recovery can reverse many, if not all, of these health problems. The benefits of rehab are not limited to how it can help a person to safely achieve abstinence; a rehab program can teach a person how to build a new, drug-free life that supports long-term abstinence.