Ambien Addiction: Understanding What’s Happening in Your Brain
Take enough Ambien to get dependent and addicted and you'll change the structure and workings of your brain in lasting ways. That’s the bad news - and that’s why most people struggle when trying to quit.
Fortunately, the brain has an incredible ability to adapt and repair – as long as you give it the healing time it requires.
You can quit and get your pre-Ambien self back again. It may take a little time, but research shows that people who recover from sedative addictions make enormous thinking and psychomotor gains – so happily, the payoff very likely justifies the effort involved.1
Ambien Addiction vs. Ambien Dependence
To get started, choose which of the following best describes your situation:
- I am not addicted to or dependent on Ambien
- I am dependent on but not addicted to Ambien
- I am dependent on and addicted to Ambien
Not sure? Then read on for a quick explanation of the important differences between Ambien dependence and Ambien addiction.
If you take Ambien as directed (never misusing it) you may become dependent on Ambien but you are unlikely to get addicted to it.
- Your brain adapts to chronic Ambien use by changing the structure and function of certain neurochemical systems.
- Once your brain has adapted in this way, you will experience specific withdrawal symptoms if you suddenly stop taking this medication.
You can also become physically dependent on non-intoxicating drugs like beta blockers – a form of blood pressure medication. However, since these types of drugs have no psychoactive effects (they can't get you high) they, unlike Ambien, are not addictive.
People who misuse Ambien are at risk to become addicted. Examples of misuse include:
- taking more than prescribed
- taking it more frequently than recommended
- taking it for reasons other than what it was prescribed for
- taking it with other drugs or alcohol or taking it recreationally, etc.
At recommended doses you may develop a physical dependency, but you aren’t likely to develop an addiction. This is because at low doses, Ambien doesn’t induce pleasurable intoxication… it only makes you sleepy.
At higher doses, however, Ambien starts to stimulate a wider array of GABBA-Benzodiazepine receptors and it starts to feel a lot like any other benzodiazepine – and since benzodiazepines are extremely addictive, it’s not surprising that higher doses of Ambien can also induce addiction.
Symptoms of Ambien addiction include:
- Losing control over how much you take (being unable to manage your supply between prescriptions, for example).
- Craving Ambien
- Compulsive use, and feeling preoccupied with getting and taking this medication
- Continuing to abuse this drug even though you know you’re doing yourself physical or mental harm
You can be addicted to Ambien without being dependent on it, but in most cases, people addicted to this medication are also physically dependent on it.2
Tapering or Tapering + Addiction Treatment?
Whether you are dependent only, or dependent and addicted, you should not stop taking your pills very suddenly (this can result in dangerous withdrawal symptoms)
- If you are dependent on Ambien, you will need to gradually taper down your daily dosage
- If you are dependent on and addicted to Ambien, you will need to taper your daily dosage and you will likely need some form of addiction treatment (to learn to manage your cravings, to learn ways to minimize relapse, to learn better anger and stress management skills, etc.).
In most cases, you can find the treatment you need on an outpatient basis, but people unable to manage a successful tapering program may need residential care and managed dosing, or a rapid detoxification protocol, to achieve successful tapering.
Ambien Dependence – What Happens in the Brain?
The brain is homeostatic – it likes to return to its basic ways of functioning, and if you try to change its functioning through the chronic use of drugs like Ambien, it will adapt in predictable ways to offset the effects of the drugs. When this happens you develop a tolerance and when you start to require a regular dose of your medication just to feel ‘normal’ – you have reached a state of physical dependency.3
Ambien increases the activity of the neurotransmitter GABA in the brain. GABA is an inhibitory chemical that quiets other neurotransmitters in the brain, so by upping GABA, you reduce physical and mental excitement and induce drowsiness and sleep (and at higher doses, reduce anxiety, etc.)
Once dependent, your brain adapts by:
- Becoming less responsive to GABA (it takes more of it to produce the same results)
- Becoming less responsive to the medication – it requires more of the medication to up GABA in the brain
So after you develop a dependency, you start to require a certain amount of medication just to maintain normal functioning, never-mind to induce drowsiness.
- Once the brain adapts to the continual presence of the medication, suddenly stopping causes GABA levels to crash.
- This causes a corresponding spike in the activity of excitatory chemicals in the brain - it’s as if the brakes came off - and this causes a host of unpleasant withdrawal symptoms.
By tapering down slowly you allow your brain time to readapt to a drug-free state, and you avoid the worst of the withdrawal symptoms.
Although Zolpidem is a very different looking chemical than any of the Benzodiazepines (Xanax, Valium, etc.) they all bind to some of the same receptors (such as GABA A) in the brain.
Ambien Addiction – What Happens in the Brain?
So once Ambien dependent, a person needs to taper down slowly to avoid dangerous withdrawal symptoms.
Problematically, a person who is both Ambien dependent and Ambien addicted is going to have a very hard time controlling their use to manage a steady daily reduction.
Why is this?
Well, in addition to the neural adaptations seen with Ambien tolerance and dependence, Ambien addiction causes a number of additional brain changes and these changes make it very difficult for a person to control their consumption.
Areas of the brain altered by addiction include:
- The frontal cortex
- The amygdala
- The nucleus accumbens
- The hippocampus
- The ventral pallidum
These structural changes cause:
- Concentration and memory problems
- Intense drug cue-related memories
- A decreased ability to resist impulses
- A hijacked reward system, that causes a strong drive to seek drug intoxication
Brain changes that lead to frequent intense cravings, altered memories and diminished impulse control reduce a person’s ability to manage a tapering plan.
Fortunately, your brain will heal, and while it does, you can compensate by making use of strategies to reduce your exposure to temptation and craving and by learning skills that help you manage cravings that do arise.
You can learn the skills you need in an addiction treatment program.
Is Ambien Addiction the Same as Benzo Addiction?
At low doses Ambien is a more selective GABA-receptor stimulator and therefore may be a medication with less risk of abuse and adverse consequences than the Benzodiazepines (see below).
However, at higher doses, Ambien activates a similar array of GABA-Benzodiazepine receptors as other benzos and causes very similar effects and alterations in the brain.
So for most functional purposes, an Ambien addiction is extremely similar to a Benzo addiction.
- The changes in the brain are similar
- Both types of drugs cause very similar adverse cognitive effects4
- Both types of drugs seem to be as risky for older users (both cause a similar increase in hip fractures among the elderly)
Factors That Increase the Risk of Addiction
1. Higher doses
At low-therapeutic doses (within the recommended dosage range) Ambien mostly targets the alpha1 subunit of the GABA A receptors in the brain, and this causes sleep promotion.
At higher doses, Zolpidem also targets the Alpha 2, 3, and 5 receptor subunits. These subunits are those targeted by Benzodiazepines to induce anxiolytic (feel good) effects.5
When studying the abuse potential of Zolpidem, researchers found that former drug abusers couldn’t differentiate between the effects 40mgs of Zolpidem and 20 mgs of Diazepam (Valium…a very addictive drug). In contrast, this same group of users couldn’t differentiate between 10mgs of Zolpidem and a placebo pill (no-medication).6
So taking higher doses of Zolpidem transforms the medication from one that mostly just makes you sleepy, to one that also makes you feel very pleasantly relaxed. Therefore higher doses of Zolpidem are much more likely to cause addiction than lower doses.
2. Your sex
Women do not metabolize Ambien as efficiently as men and this can result in plasma concentrations that are as much as 50% higher than an equivalent dose/kg for men.
3. A history of drug abuse or alcoholism
4. Heavy alcohol use
5. Psychiatric illness7
Ambien and Increased Risk of Premature Death?
If you abuse Ambien your life will likely improve after you stop using and give your brain a little time to heal and revert back to normal functioning.
But if that’s not enough incentive to get you moving, would an increased risk of early death scare you into action?
In a correlational study published in BMJ Open, researchers found that even after controlling for factors like pre-occurring disease, people prescribed sedatives like Ambien were far more likely to die over a 2.5 year study period than matched control subjects.
- People prescribed 18 or fewer pills per year were 3.6 times more likely to die over the 2.5 year period
- People prescribed between 18 and 132 pills per year were 4.43 times more likely to die
- People prescribed more than 132 pills per year were 5.32 times more likely to die8
Particular Risks for Women
In January of this year (2013) the FDA ordered a reduction on the recommended dosage of Zolpidem for sleep disorders.
Under these new guidelines, women are advised to start with 5 mgs of the instant release or 6.5 mgs of the extended release formulation.
Women metabolize and eliminate the drug more slowly than men, and at higher doses, especially for women, there is a significant risk of next-morning impairment and next-morning impaired driving.
Worryingly, next-morning impairment, such as decreased alertness, can often go unnoticed, since it can occur even when users don’t feel especially sleepy.
Are you at risk of a morning accident?
If you’ve been using Zolpidem for a while, you’re very likely using more than 5 – 6.5 mgs per night, and thus you may be at risk of next-morning driving impairment.
- Benzodiazepines and the Elderly a Review of Potential Problems
- Medline: Zolpidem
- Zolpidem: the Risk of Tolerance and Dependence According to Case Reports
- The Z Drugs
- Seizure following Sudden Zolpidem Withdrawal
- Zolpidem Dependence Risk
- Zolpidem Dependence Risk Factors
- Hypnotics' Association with Mortality
- Medpage: FDA Lowers Ambien Dosages
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