Ativan is the brand name for a benzodiazepine medication, lorazepam, that is used to treat several disorders, including anxiety, epilepsy, alcohol withdrawal, gastrointestinal disorders associated with alcohol detox, and nausea or vomiting due to cancer treatment. The family of benzodiazepine medications is commonly used to treat these kinds of disorders, since they are central nervous system (CNS) depressants that work by binding to the gamma-aminobutyric acid (GABA) receptors in the brain and calming transmission between neurons. This can help prevent seizures and reduce anxiety; however, since their original debut as prescription medications in the 1950s, the recommended prescription course for any benzodiazepine treatment, including Ativan, has been reduced to between two weeks and one month. The brain can easily become dependent on these medications to control the release and uptake of the GABA neurotransmitters.
In some cases, Ativan and other benzodiazepines can also stimulate the reward system in the brain, which can lead to addiction as well as dependence. Although these substances are potentially addictive and easy for the body to become dependent on, the Drug Enforcement Administration (DEA) classifies Ativan and other benzodiazepines as Schedule IV substances since they also have important medical applications. The World Health Organization (WHO) lists Ativan as one of the essential medications for hospitals and other medical organizations to keep available.
How Is Ativan Prescribed, and What Are the Side Effects?Ativan is one of the top 100 most prescribed medications in the world. Even when a person takes this benzodiazepine as prescribed, they can experience side effects. However, side effects are more likely to occur, or get worse, if the individual has become addicted to Ativan and begins to take larger doses. Lorazepam and other benzodiazepines can cause several side effects, on both a short-term and long-term basis. Some of these include:
- Dizziness or unsteadiness
- Physical weakness
- Excessive sleepiness
- Shortness of breath, rapid breathing, or depressed breathing
- Low blood pressure
- Rebound anxiety or insomnia
People who take Ativan for insomnia may experience parasomnias, which include sleepwalking, sleep-eating, sleep-driving, or having conversations while asleep.
Who Abuses Ativan?People who receive prescriptions for Ativan are more likely to become addicted to or dependent on these substances, in part due to exposure to the medication and in part due to the concurrence of substance use disorders and mental health issues like anxiety. People who have struggled with substance abuse problems in the past are more likely to struggle with abuse of benzodiazepines like Ativan. This is especially true for people who struggled with alcohol use disorders, since benzodiazepines have similar effects as alcohol and are prescribed to reduce alcohol withdrawal symptoms. A 2009 survey, published in Pharmacoepidemiology and Drug Safety, found that many doctors who prescribed medications like Ativan for off-label use had a misunderstanding about what the Food and Drug Administration (FDA) had approved the drugs to treat. Ativan and other benzodiazepines can be prescribed off-label to treat seizure disorders and alcohol withdrawal, although they may not be approved for this purpose. The survey found that doctors thought Ativan had been approved for long-term treatment of chronic anxiety, when in fact the short-acting benzodiazepine has been found to be addictive, or to lead to physical dependence, after a few weeks of use. This fundamental misunderstanding on the part of doctors can, unfortunately, lead to less oversight of patients who can become addicted to these substances. Ativan is a short-acting benzodiazepine, meaning that effects of the medication peak about two hours after the dose is ingested, and the substance is completely gone from the body after one day. Since the euphoric and relaxing effects dissipate after two hours, people who take this substance may become anxious again and feel the need to take another dose. This can lead to a cycle of abuse and addiction more quickly than with long-acting benzodiazepines like diazepam (Valium).
People who abuse Ativan for nonmedical reasons rarely take this substance alone to get high. One study found that about
80 percent of benzodiazepine abuse, including Ativan, was related to polydrug abuse, most commonly in combination with opioid medications.
The National Institute on Drug Abuse (NIDA) found that up to 15 percent of heroin users also took benzodiazepines, including Ativan, for over a year, both as a prescription to manage anxiety or insomnia and as a way to enhance the effects of heroin. Other studies found that people who struggled with alcohol use disorder concurrently abused Ativan and other benzodiazepines – between 3 and 41 percent of people who were dependent on alcohol also abused Ativan and other benzodiazepine medications. In many cases, this abuse began as an attempt to modulate alcohol withdrawal symptoms.
Since Ativan is a CNS depressant, people who abuse other CNS depressants, especially alcohol and opioid drugs like heroin or oxycodone, might take this benzodiazepine to enhance the effects of the other intoxicating substances. This is dangerous and can quickly lead to overdose and physical complications.
Signs of Ativan Abuse and Addiction
When a person struggles with addiction to any drug, including Ativan or other benzodiazepines, they will exhibit several symptoms, including changes in behavior and physical side effects. When they attempt to stop taking the medication, either on their doctor’s recommendation or because they wish to end their dependence on the substance, they can experience withdrawal symptoms. The effects of long-term abuse of Ativan can include:
- Cognitive impairment, including amnesia or memory loss
- Muscle weakness
- Slurred speech or other symptoms like alcohol intoxication
Because tolerance and dependence can develop within weeks of taking the prescription, these symptoms may not be as apparent, nor will the person feel the effects of their benzodiazepine as effectively. This may mean that the person taking Ativan will increase their dose, either with or without their doctor’s consent. Withdrawal symptoms can also develop after weeks or months of abuse and get worse when a person attempts to abruptly stop taking their medication.Ativan withdrawal symptoms can include:
- Rebound anxiety, insomnia, or seizures
- Confusion and irritability
- Numbing or tingling in extremities
- Abdominal cramps or discomfort
- Heart palpitations or tachycardia
- Memory loss
- Panic attacks
If the person stops taking Ativan “cold turkey,” or all of a sudden, the most intense physical withdrawal symptoms can take up to 10 days to vanish. This is never recommended, and individuals should only attempt to stop taking Ativan under medical supervision.
In some cases, benzodiazepine withdrawal syndrome (BWS), which is a protracted experience of withdrawal, can last for months and lead to serious problems like cognitive decline, seizures, and paranoia. BWS can be serious and requires medical supervision. In addition, the discomfort from withdrawal, combined with psychological cravings for the drug, can lead to relapse. Medical detox is always required for benzodiazepine withdrawal.Behavioral changes that can indicate an addiction to Ativan include:
- Intense cravings for Ativan
- Obsession with the next dose of Ativan or where the next dose will come from
- Needing more of the substance to achieve the original euphoria
- Choosing to take the substance instead of participating in other activities, including school, work, family, or social functions
- Lying about how much Ativan is taken
- Stealing to get more Ativan or doctor shopping to get multiple prescriptions
- Refilling prescription early or very often
- Spending more money acquiring Ativan
- Irritability, aggression, mood swings, depression, and avoidance when questioned about Ativan ingestion
For people who struggle with an addiction to Ativan, it is very important to get help to overcome this condition. Long-term physical effects can lead to poor health, and behavioral changes can lead to a loss of social support and various negative life effects.
Taking Ativan has not been shown to be helpful in long-term treatment of anxiety or insomnia. The medication can help to stop the cycle of anxiety, or help a person struggling with insomnia to finally get some needed rest, but most physicians and psychologists now believe that Ativan is a good short-term intervention that should then be replaced by other therapies. If this never happens, the underlying condition causing anxiety or insomnia is not being addressed properly, so it can actually make the cycle of abuse or addiction worse.
Treatment for Ativan Addiction
The best treatment to end an addiction to Ativan is to taper the dose of this medication under medical supervision until the body is no longer dependent on the substance and then participate in a comprehensive rehabilitation program. Although tapering can take several weeks, the body’s dependence on Ativan must be safely reduced, so that withdrawal symptoms do not trigger BWS and the brain can relearn to manage GABA without a substance to help. In some cases, a longer-acting benzodiazepine like diazepam may be prescribed, then tapered, to ease the withdrawal process. Oftentimes, therapy begins during the detox process.
Ativan Addiction and Anxiety: Co-Occurring Disorders
Since benzodiazepines like Ativan are widely prescribed to treat anxiety or insomnia, co-occurring mental health and substance abuse issues commonly co-occur. With co-occurring disorders, treatment for both disorders should be delivered concurrently. This results in the most effective long-term recovery outcomes.Medical professionals will learn more about the client, like their family history of both anxiety and substance abuse, whether anxiety symptoms occurred before or after substance abuse, and if mental health issues reappear during periods of sobriety or abstinence from drugs. This can indicate whether the mental health issue triggered the substance abuse or if the addiction led to a chemical imbalance that triggered a mental health issue. Either way, comprehensive treatment will address both disorders.