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Ativan (lorazepam) is a member of a class of drugs that are known as benzodiazepines. According to the textbook Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, benzodiazepines are a rather large class of drugs that are primarily used to treat anxiety disorders, to reduce seizures, as sleep aids, and as muscle relaxants. In some instances, they are also used as presurgical drugs to relax individuals prior to receiving formal anesthesia.
All of the drugs classified as benzodiazepines are potential drugs of abuse and have been classified as Schedule IV controlled substances by the DEA. This classification means that all of these drugs have a moderate potential for abuse, the development of physical dependence (a syndrome that consists of both tolerance and withdrawal symptoms), and can only be legally obtained via a prescription from a physician.
Ativan, like other benzodiazepines, primarily acts in the central nervous system by increasing the actions of the major inhibitory neurotransmitter in the brain, gamma-aminobutyric acid (which is often just abbreviated as GABA). When the actions of GABA are increased, this results in a corresponding decrease in the action of other brain and body processes and a reduction in the actions produced by other neurotransmitters. Thus, benzodiazepines are often referred to as central nervous system depressants, because they reduce or depress the actions that occur in the central nervous system. They do not necessarily make people become depressed but instead slow down the mental and physical actions of the brain and body. The actions produced by Ativan and other benzodiazepines result in their ability to treat anxiety, quell seizure activity, and induce sedation and relaxation in individuals. However, the actions of Ativan also produce a significant feeling of euphoria and wellbeing, and a reduction in inhibitions. They also interact with other drugs to increase or dampen their effects. These factors result in Ativan and other benzodiazepines being significant target as drugs of abuse and addiction.
There are several factors that contribute to Ativan having a particularly high potential for the development of abuse and addiction:
Consequently, Ativan abuse becomes a vicious cycle of an individual needing to take more Ativan to avoid the negative effects that are associated with taking more and more Ativan. Many individuals will potentially take very high amounts of Ativan that are associated with severe potential health issues.
These factors make Ativan abuse a particularly difficult situation to overcome. Individuals become trapped in the cycle of using the drug to avoid withdrawal symptoms and physically needing more of the drug as a result of abusing it. In addition, benzodiazepines are often abused with other drugs, such as alcohol, narcotic pain medications, and even stimulant drugs like cocaine. This type of polydrug abuse complicates the entire situation and has potential dangerous and even fatal consequences.
Empirical research investigating withdrawal from benzodiazepines like Ativan indicates that the process is one that occurs in stages, and that withdrawal from a serious Ativan use disorder can be potentially fatal due to the development of seizures.
It is generally accepted that Ativan withdrawal occurs in two stages:
The acute phase of withdrawal will typically last between 5 days and 4 weeks. Symptoms will typically peak within 2 weeks and then begin to decrease in intensity.
In some cases, individuals experience a return of severe anxiety following protracted withdrawal. When there is a significant return of anxiety following protracted withdrawal, some researchers label this is as third phase of the withdrawal process from Ativan and other benzodiazepines. In addition, a subset of individuals may continue to experience issues with decreased motivation, apathy, mood swings, and other psychological issues for months or years after they have stopped taking Ativan (sometimes, this is referred to as post-acute withdrawal syndrome).
The major issue with trying to discontinue Ativan or any other benzodiazepine once a person has developed a substance use disorder to this class of drugs is the inevitable experience of the withdrawal syndrome. Because one of the quickest ways to stop the withdrawal symptoms is to take more Ativan, it becomes extremely difficult for many individuals to negotiate the early stages of recovery from an Ativan use disorder. The negative withdrawal symptoms and increased cravings for Ativan result in individuals relapsing rather quickly. The chances of success in recovery from an Ativan use disorder are greatly increase by utilizing a formal treatment approach that includes a medically assisted detox program.
The major components of a successful recovery program from an Ativan use disorder will typically include the following:
Even though the development of physical dependency on Ativan is inevitable for individuals who develop Ativan use disorders, simply negotiating the withdrawal process and going through a medical detox program is not sufficient to ensure recovery. Professional organizations, such as the American Society of Addiction Medicine, formally recognize that getting through the withdrawal phase is only the first step in the addiction recovery process. Individuals who simply go through detox and do not then invest their time in a formal recovery program are at a very high risk for relapse following detox. A substance use disorder has many components and only one of these components is the actual substance use or abuse. In order for recovery to have a chance of being successful and sustained, individuals need to address the underlying reasons for their substance use disorder and continue to maintain some type of long-term involvement in recovery.