Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

Sedatives/Hypnoticsand BenzodiazepinesCHAPTER 10ROBERT L. DUPONTCAROLINE M. DUPONTThe sedatives and the hypnotics, especially the benzodiazepines, are widelyused in medical practice in the treatment of anxiety, insomnia, epilepsy, and forseveral other indications (Baldessarini, 2001). The combination of abuse byalcoholics and drug addicts, and the withdrawal symptoms on discontinuationleads to the view that these are “addictive” drugs (DuPont, 2000; Juergens &Cowley, 2003). The pharmacology and the epidemiology of sedatives andhypnotics are reviewed in this chapter, which focuses on the needs of the clinician.A sedative lowers excitement and calms the awake patient, whereas a hypnoticproduces drowsiness and promotes sleep. The nonbenzodiazepine sedativesgenerally depress central nervous system (CNS) activity in a continuum,depending on the dose, beginning with calming and extending progressively tosleep, unconsciousness, coma, surgical aesthesia, and, ultimately, to fatal respiratoryand cardiovascular depression. Sedatives share this spectrum of effectswith many other compounds, including general anesthetic agents, a variety ofaliphatic alcohols, and ethyl alcohol. At lower doses, sedatives can causeimpaired cognitive and motor functioning (including staggering and slurredspeech). Sedation is a side effect of many other medicines, including antihistaminesand neuroleptics.The benzodiazepines resemble the other sedatives, except that they do notproduce surgical anesthesia, coma, or death, even at high doses, except when219