Anxiety and insomnia are stressful conditions that affect tens of millions of people. Ativan is a drug that can help people cope with these disorders, and it is among one of the most popular forms of medication in the country, but it can have very undesirable effects. For people desperate to find relief, or people who seek the pleasant state induced by these drugs, becoming dependent on Ativan is a real problem. But how does an Ativan addiction start? What are its warning signs? And how can Ativan addiction be treated?
How Does Ativan Work?
Ativan’s effectiveness at treating insomnia, panic attacks, anxiety, and tension derives from it being a benzodiazepine. This class of drugs works by enhancing the effect of the GABA neurotransmitter, which in turn reduces the activity of the neurons that cause anxiety and stress. The GABA neurotransmitter’s role is to calm the central nervous system, but some people have conditions that prevent GABA from doing its job. These conditions are usually (but not limited to) mental health disorders that affect mood, meaning that these people are unable to regulate their feelings or control their actions based on those feelings. The benzodiazepine class is responsible for boosting the GABA neurotransmitter, resulting in individuals feeling better, calmer, and happier after taking their medications.
Ativan (the brand name of the drug lorazepam) is especially popular because, unlike other benzodiazepines, it can be used to treat seizures. Additionally, it is used to treat nausea and vomiting, making it commonly used for patients undergoing chemotherapy as part of cancer treatment
According to Psych Central, Ativan was the fifth most prescribed psychiatric prescription medication in the United States in 2013, with almost 28 million prescriptions written. Since 2005, it has never dropped below the fifth position. While Ativan is undeniably popular among people with insomnia and anxiety, and among harried doctors with a long list of patients, its effects at treating very common and often misunderstood conditions have also made it attractive to people who don’t want to go through the trouble of getting a prescription.
Why take Ativan this way? Ativan’s renown for treating clinical disorders has given it a reputation for being able to make any stress- or insomnia-related problem go away, regardless of actual medical approval or legitimacy. In New York Magazine, a woman writes of how she dealt with the anxiety of her mother’s impending death by taking an Ativan, even though it is not an over-the-counter drug (in that it should be taken only with a prescription). The New York Times carries the story of a man who won’t even take Tylenol for a headache, but pops a couple of Ativan before he boards a plane. In the same way that Ativan is used to help chemotherapy patients overcome nausea, it could also prove attractive for fliers afraid of airsickness. With concerns arising about long lines at airports and the fear of hijackings, as well as a general discomfort regarding air travel, the trend is to take painkillers and anti-anxiety medications like they’re candy, in the words of a professional therapist and former pilot.
And it seems to be a very popular trend. In 2005, the Drug and Alcohol Dependence journal said that Ativan was one of the benzodiazepines most abused by American college students. While only 1.8 percent reported taking Ativan for nonmedical reasons, the rate had increased to 4.5 percent in 2001.
Taking Ativan Nonmedically
Are there “nonmedical reasons” to take Ativan? If the pleasant daze induced by the drug makes it worth borrowing from friends and family, even if there is no legitimate mental health concern that would be alleviated by its consumption, or faking symptoms in order to get a prescription, then Ativan can be taken for nonmedical reasons. To that effect, Ativan is on the National Institute on Drug Abuse’s list of most commonly abused drugs, and the U.S. Drug Enforcement Administration placed lorazepam (the generic name of Ativan) on its list of Schedule IV controlled substances.
While Schedule I and II are reserved for drugs that have the least medical value (or no medical value at all) and the highest likelihood of causing physical and psychological dependence, the relatively lower Schedule IV drugs have to meet three criteria:
- There has to be a low potential for abuse.
- Abusing the drug can cause limited physical or mental dependence, when compared to drugs in higher schedules.
- The drugs must be currently accepted for legitimate medical use.
Therefore, notwithstanding the myriad concerns and problems for which a single Ativan tablet may seem like a good idea, there is a considerable danger that taking Ativan without a doctor’s oversight can cause a person to become dependent on the drug.
A doctor’s oversight is important, because before writing the prescription, a diligent doctor will consider whether or not there are factors that can make a person addicted to the Ativan. Such factors may include:
- A history of substance abuse in the family, as addiction has a genetic component
- Whether or not the patient is taking other medications
- Whether the patient’s home (and/or work) environment is conducive to fostering a healthy frame of mental health
- Whether the patient is prone to risky or impulsive behavior (such as consuming alcohol, which should never be mixed with medication)
If a doctor suspects a patient might not clear these hurdles, then an alternative to Ativan may be prescribed. However, someone “borrowing” Ativan from a well-meaning friend or family member will likely not take these factors into account when deciding to consume a powerful prescription medication without a prescription. Hence, such off-label use can jumpstart an Ativan addiction.
Becoming Dependent on Ativan
The reality is that, like other benzodiazepines (like Xanax and Valium), Ativan can cause physical dependence if taken in excessive doses, if taken too frequently in a given time period, or if other chemical substances are present in a person’s body at the time of administration. Ativan works by boosting the GABA neurotransmitter, which regardless of a person’s mental health, feels good. It makes the person feel relaxed, calm, happy, pleasured, and even rewarded for the action. For someone struggling with anxiety and insomnia, this might be worth taking an extra pill. For someone without such concerns (or a person who is merely feeling down), Ativan is a perk, a pick-me-up that, because it’s legal and given out by a doctor (as opposed to being surreptitiously paid for on a street corner), people feel can’t be all that harmful.
There is a reason Ativan prescriptions are typically written for only three or four months at a time. Ativan is powerful, and if taken beyond the point when it should be discontinued, an addiction might easily take hold.
For example, while Ativan is usually used to restore good moods (or simply to induce a balanced mood), a person addicted to the medication might find that it becomes harder and harder to feel comfortable, relaxed, and settled without it. Being on an Ativan buzz becomes the norm. Since being off Ativan means that tension, anxiety, and insomnia return, why not keep popping pills?
Signs of an Ativan Addiction
Whether people are experiencing legitimate mental health disorders (and unilaterally upping their doses), or whether people just enjoy the kick that comes from boosting an already settled mood, Ativan addiction is already working its way through the brain. In a matter of weeks, people think nothing about a quick Ativan hit before a long commute to work, an extra Ativan before bed to ensure a good night’s rest, an Ativan after an argument with a spouse, an Ativan because they are bored and feeling glum, or any trivial excuse to taste that same pleasurable bliss that comes when GABA neurotransmitters are boosted.
As a result of this, the warning signs of dependence are either ignored or not even noticed at all. Some of them include:
- Increased tolerance: As the body becomes acclimated to the constant influx of Ativan going to the brain, an individual has to consume increasingly larger amounts of Ativan to feel the standard effect. Eventually, even two tablets of Ativan will fail to induce the satisfaction that one tablet did, compelling the individual to move to three tablets (and so on).
- Trying to get more Ativan: A person may do this by faking symptoms of anxiety and insomnia, forging prescriptions, securing prescriptions from multiple doctors, or buying Ativan off the black market (usually online). This extends to using money intended for other purposes to buy Ativan.
- An inability to function without Ativan: While Ativan was once a way to take the edge off a rough day, a person may not be able to think clearly, sleep properly, or get anything done without being on Ativan constantly.
- Hiding the evidence of off-label Ativan use: A person who is taking Ativan as part of a prescription has nothing to hide. However, someone knowingly and willfully abusing Ativan will likely attempt to conceal the behavior, in order for the addiction to proceed unimpeded. This may entail destroying any paperwork related to extraneous Ativan purchasing, using only cash to pay for prescriptions, hiding extra Ativan tablets in other bottles, etc.
Withdrawing from Ativan
One key sign of an Ativan addiction is that any attempt to stop taking the drug, even for a short period of time, causes the individual’s body to react very negatively and painfully to the sudden absence of the drug. This is because the brain has become so dependent on Ativan that the body’s basic systems are thrown into disarray without it. The results can include:
- Nausea and vomiting
- Muscle aches and cramps
- Anxiety and depression
- Craving more Ativan
Those taking Ativan per doctors’ prescriptions will likely experience similar effects if they scale back their use, but not to the same degree of severity as those who have been abusing Ativan. Discontinuing Ativan after a period of just 4-6 weeks of regular use can cause withdrawal symptoms, according to the British Journal of General Practice.
The length and nature of these withdrawal effects depends on how long the Ativan had been abused, how much Ativan was being taken, as well as other risk factors, such as the level of stress in the environment, age, gender, genetics, and if the person was taking other drugs at the same time.
Of course, the start of ending an Ativan addiction (after acknowledging that the addiction exists) is to stop taking the drug. For someone who has become dependent on the drug, this is much easier said than done. Gradually weaning off the supply becomes a test of endurance and resistance to excruciating temptation, and going “cold turkey” – abruptly discontinuing Ativan intake – can exacerbate withdrawal symptoms, to the point where relapse becomes highly likely.
Treating an Ativan Addiction
This is why proper and effective treatment for Ativan addiction should be conducted at a hospital, or a specialized treatment facility, where doctors and nurses are on hand to ensure that withdrawal symptoms are controlled and managed (a process known as medical detox). This may be done with the use of carefully selected anti-anxiety medications, administered very gradually, to ensure the client’s vulnerable systems do not become addicted to the new medications. Diazepam is a popular choice, given intravenously, because it is a slow-acting benzodiazepine that cannot be absorbed too quickly. This means that it can help calm and settle a client without causing any of the euphoric highs that faster-acting drugs do.
If there are no complications, detox usually takes 10-14 days to complete (although longer durations are not unheard of), according to Addiction. The process is often physically and mentally draining for clients, but at the end of it, they will have overcome their physical need for Ativan. However, the mental damage done by addiction needs to be addressed, which is where a therapy program will come into play.
In therapy, a psychologist works with clients to examine the psychological reasons behind the start of the Ativan addiction, looking at issues of mental and emotional health, as well as social and environmental factors that may have contributed to the development of the addiction. Insights gained can be applied to hypothetical real-world situations, where the temptation to pop an Ativan tablet to help with an episode of anxiety or a sleepless night can be countered and suppressed with non-pharmacological strategies, such as changing harmful thought patterns into positive and productive ways of approaching stressful scenarios. In this way, Ativan addiction can be managed.