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Guide to Ativan Abuse & Treatment
What Is Ativan?
Ativan is a brand name of the benzodiazepine lorazepam. It is available by prescription for the treatment of anxiety disorders and anxiety related to other mental health disorders, such as depression.1 Like other benzodiazepines, Ativan works to increase inhibitory signaling throughout the central nervous system—in other words, it diminishes anxiety by slowing certain brain processes.
Other benzodiazepines include the antianxiety drugs Xanax (generic name: alprazolam), Valium (generic name: diazepam), and Librium (generic name: chlordiazepoxide). Sometimes referred to simply as “benzos,” these medications are categorized as Schedule IV drugs by the Controlled Substances Act.2 Though they may not be considered as addictive as some opioid painkillers or illicit drugs, they do have a potential for abuse and are not recommended for long-term use due to their ability to cause significant physical and psychological dependence.
Ativan is one of the most frequently prescribed medications in the country. A 2016 survey on drug use in the U.S. found that:3
- 7.3 million people aged 12 and older received a prescription for Ativan or lorazepam in the past year.
- Nearly 786,000 people over the age of 12 reported misusing Ativan or lorazepam during the same time frame.
These numbers are actually lower than those reported in 2015, possibly due to a corresponding rise in Xanax prescriptions and abuse during the same time period.3
Ativan is one of the most frequently prescribed medications in the country.
What Are the Effects?
Ativan activates the brain’s reward system by causing a rapid and substantial release of dopamine, a neurotransmitter associated with feelings of pleasure and reward.4 Though achieved through somewhat different mechanisms, a similar increase in dopamine activity is associated with development of compulsive misuses of other drugs such as opioids and stimulants.4
Drugs that trigger a surge of dopamine activity in the brain tend to be highly addictive, and people may seek to use these drugs in greater quantities or with greater frequency in order to repeatedly achieve the pleasurable sensations brought on by the drug. This can in turn fuel the onset of drug tolerance and dependence, which may precede the development of drug addiction.
When taken as prescribed, the primary therapeutic benefit of Ativan is due to its tranquilizing effects on the nervous system. In the short term, doctors may prescribe Ativan to treat insomnia so patients have an easier time falling asleep. Though it remains an approved use for the drug, this practice is becoming increasingly rare because of the marked abuse liability and the fact that benzodiazepines may actually cause a reduction in quality and duration of sleep.5
People who abuse Ativan for recreational purposes often seek its pleasurable side effects, including euphoria and pronounced feelings of calm and relaxation.6
Ativan can also cause a variety of negative side effects, which vary depending on the user and dosage. Some of these effects include:1,7,8
- Slurred speech.
- Blurred vision.
- Frequent urination, or constipation.
- Changes in appetite.
- Changes in sex drive.
- Slowed breathing, which can turn dangerous or fatal in cases of overdose.
Dangers of Mixing
Recreational users might mix Ativan with alcohol or other drugs to enhance the effects they seek, but users may be unaware of the dangers inherent in this practice.
Ativan slows activity in the central nervous system (CNS), so mixing it with other substances that depress CNS activity can dangerously compound these effects. Mixing Ativan with cannabis, sleeping pills, alcohol, heroin, and other opioids is especially dangerous and can cause the user to have difficulty:9
- Thinking clearly.
- Controlling bodily movements or functions.
- Maintaining consciousness.
Without proper medical care, the result can be death from overdose if the person is unable to regain consciousness and resume normal breathing.
Taking too much Ativan may result in several of the drug’s adverse side effects, like slowed heart rate and respiratory depression, reaching dangerous and potentially deadly levels. The risk of overdose and death may be further increased when Ativan is combined with alcohol or other drugs.7
There were nearly 1 million emergency department visits between 2005 and 2011 that were related to benzodiazepine use—either alone or in combination with alcohol or opioids.10 Of those visits, the patients treated for a combination of benzos and opioids and/or alcohol were significantly more likely to experience serious outcomes such as hospitalization or death in the ED.10
In large doses, or in combination with other drugs, Ativan can cause the CNS to slow to the point of coma or death. A mild overdose can result in observable symptoms including:1
- Mental confusion.
- Slurred or slowed speech.
In cases of serious overdose, observable symptoms may include:1,9
- Loss of bodily control.
- Muscle weakness.
- Cold or clammy skin.
- Bluish lips.
- Slowed heartrate, or no detectable pulse at all.
- Slow, shallow breathing, or breathing stopped altogether.
If a person who has taken Ativan collapses and is not responding or you are unable to revive them, call 911 immediately.
While waiting for emergency services to arrive, you should:9
- Stay calm and remain on the phone with the 911 dispatcher. They can help talk you through performing CPR, and can also relay important information to medical crews while they’re en route.
- Try to keep the person awake and alert by talking to them and asking them questions.
- Perform rescue breathing if you feel comfortable doing so.
- Stay until help arrives and be available to answer any questions from emergency personnel. Provide information regarding the type of drug(s) and amount taken by the person. Do not worry about getting in legal trouble for your own drug use or for contributing to the overdosing person’s drug use—crews are only there to keep your friend alive.
When prescribed for medical purposes, Ativan is not recommended to be used on a long-term basis because of its potential for abuse and dependence as well as several long-term physical and psychological side effects. These long-term risks may be even more pronounced for people who abuse the drug without a prescription, especially in high doses.
Potential negative effects of chronic Ativan use include:9,11
- Cognitive impairment, such as drowsiness, delayed reactions, or memory loss.
- Irritable mood.
- Lack of energy.
- Loss of interest in previously enjoyed activities.
- Menstrual problems in women.
- Increased appetite.
In addition, the loss of motor control brought about by Ativan use can cause long-term users to experience a greater risk of injury due to accidents. For instance, older adults may be more likely to fracture hips or other bones in falls around the home. People under the influence of Ativan are also at increased risk of motor vehicle accidents. An article in the journal American Family Physician reports that the risk of driving while under the influence of benzodiazepines is about the same as driving with a blood alcohol content (BAC) between .05% and .079%, with a BAC of .08% being the legal limit in all states.11
Generally speaking, most benzodiazepines are meant to be used on a short-term basis, with around 2 to 4 weeks being the recommended time frame.1 When used for longer periods of time or in higher doses than advised, people risk becoming tolerant, dependent, and, potentially, addicted to Ativan.
Tolerance means that a person requires higher or more frequent doses of Ativan to achieve previous effects. This cycle of increasing use can speed the development of significant physical dependence, meaning the body has become accustomed to the presence of the drug in the system.
When someone becomes dependent, they may need to use Ativan just to feel normal. Dependence can be accompanied by intense cravings to use the drug, and the experience of withdrawal symptoms when the person stops using it.
Benzodiazepines like Ativan are known to cause particularly distressing withdrawal symptoms. These may include:1
- Excessive sweating.
- Rapid heartbeat.
- Hand tremors or involuntary movements.
- Extreme agitation, restlessness, or dysphoria.
- Hypersensitivity to light, sound, or physical touch.
- Nausea, diarrhea, vomiting, and stomach cramps.
People who experience withdrawal symptoms may start using the drug again just to alleviate their discomfort. Seeking assistance from a professional rehab or detox center is the best way to help effectively deal with these potentially dangerous symptoms and ensure that you are as safe and comfortable as possible during the withdrawal period.
What Is Addiction?
The term addiction refers to a chronic condition in which a person continues to use a psychoactive substance despite experiencing detrimental physical, psychological, social, and professional consequences.
Addiction to a drug like Ativan impairs a person’s ability to function at work, home, or school; they experience distress and reduced feelings of well-being as a result of their drug use. Some factors that medical professionals may look for to determine if a person is addicted to Ativan include:12
Addiction to a drug like Ativan impairs a person’s ability to function at work, home, or school.
- Taking Ativan for a longer time or in higher doses than originally intended.
- Unsuccessful attempts to stop or cut down on Ativan use, despite a strong desire to do so.
- Spending a lot of time and energy trying to obtain Ativan.
- Feeling strong cravings to use the drug.
- Failing to meet obligations at work, school, or home due to Ativan use.
- Continuing to use Ativan despite the negative interpersonal or social problems caused by drug use.
- Giving up previously enjoyed activities in order to use Ativan.
- Repeatedly using Ativan in physically dangerous situations, such as while driving or operating machinery.
- Continuing to use despite knowing that you have a physical or psychological problem that is caused or made worse by Ativan use.
- Experiencing tolerance, dependence, and withdrawal symptoms.
Entering a drug addiction treatment center can be an effective way to stop using Ativan and to help your body and mind adapt to life without the need to abuse drugs. Generally speaking, rehab treatment for benzodiazepines like Ativan will begin with a detoxification period, or detox.
Detox is a process whereby a person is assisted through withdrawal until the last traces of the drug are cleared from the body. The medical professionals at rehab centers or detox facilities may prescribe medications to help ease the symptoms of Ativan withdrawal. In most cases, people are advised to gradually taper off Ativan when they have been taking the medication for 2 weeks or longer. The exact tapering schedule depends on the amount of drug being used.
People who have been taking therapeutic doses of Ativan (i.e., as prescribed by a doctor) are usually tapered off at a reduction rate of 25% per week. People who have been taking higher amounts than used for medical purposes are advised to reduce their dosage by 25-30% at the beginning, and then a daily to weekly reduction between 5% and 10%.13
In addition to medication, detox facilities offer support and medical supervision to help treat withdrawal symptoms as well as any accompanying symptoms that may occur due to co-occurring medical or psychiatric problems. Inpatient detox centers offer round-the-clock care and are therefore ideal for people who have a risk of serious withdrawal symptoms or who require more intensive care. Outpatient detox facilities are not equipped to provide all-day supervision and are therefore best suited for those with relatively less severe addictions, or for those who are not at risk of experiencing severe withdrawal.
After detox, the real work of rehab occurs. This time is dedicated to help patients address the issues that led to their addiction, develop a plan to prevent relapse, and ensure their best chances of staying clean and sober. There are a wide range of treatment facilities to choose from based on your particular needs and preferences, including:
- Inpatient rehab: Patients live at the treatment center, which provides 24/7 care. In many cases, people who attend inpatient treatment stay in rehab for 30 to 90 days and then step down to a less intensive form of treatment.
- Partial hospitalization program (PHP): Patients live at home but attend treatment sessions at the rehab center most days of the week. People usually attend treatment for 6 hours per day, 5 days per week. PHP is often used as a step down for those who have recently completed inpatient treatment.
- Intensive outpatient program (IOP): Patients live at home but attend treatment at a facility, typically 3 times per week for 3 hours per day.
- Standard outpatient program: Patients live at home and attend treatment for 1 or 2 days or evenings per week for an hour or two, depending on their specific needs.
Whether treatment occurs in an inpatient or outpatient setting, patients participate in a wide range of therapies during the rehab process, including:14,15
- Cognitive-behavioral therapy (CBT): This form of therapy is based on changing dysfunctional thoughts and behaviors and replacing them with more realistic ones. Patients learn to identify their triggers to use drugs, learn strategies to avoid using, and develop healthier coping skills.
- Motivational interviewing: Many people experience ambivalence about engaging in substance abuse treatment, especially if it is mandated by a court as punishment for a crime. Motivational interviewing addresses any uncertainty and discomfort the patient may feel about engaging in rehab. Patients learn to identify and rely on their own internal motivation to make positive changes.
- Contingency management: Another form of behavioral therapy, contingency management is based on the incentive model, in which people are given tangible rewards (like vouchers for movie passes) for positive behaviors, such as periods of abstinence or turning in a negative drug test.
Rehab patients also receive additional support during and after treatment, consisting of components such as:
- Group therapy: In addition to individual counseling, groups are one of the cornerstones of substance abuse treatment. Under the guidance of a trained group leader, patients participate in regular therapy sessions with others in the treatment program. Group members may discuss relapse prevention and recovery strategies, or just share their experiences and provide encouragement to others in the group.
- Support groups: This can include 12-step groups such as Narcotics Anonymous, which is based on the 12 steps of recovery originally outlined by Alcoholics Anonymous. Participants submit to a higher power and work through the steps with the assistance of a sponsor and the support of the group. There are non-12-step groups as well, such as SMART Recovery, which has a secular approach and is based on the concept of individual empowerment.
- Relapse prevention planning: During rehab, patients discuss strategies with their counselor and in group therapy that are useful for preventing relapse. As treatment comes to a close, counselors help patients develop an aftercare plan to follow once they leave the program.
- Aftercare: Recovery doesn’t end once you complete rehab treatment. Aftercare is a broad term used to describe a number of strategies people may use to help prevent relapse, including attending 12-step meetings or engaging in ongoing individual or group counseling.
Where to Start
Ativan addiction doesn’t have to control your life. You can take the necessary steps to turn your life around today. If you or a loved one is addicted to Ativan, know that help is available. You don’t have to struggle with addiction and withdrawal on your own. Recovery is possible if you make the commitment to stop using and seek the assistance of a professional rehabilitation program.
- U.S. Food and Drug Administration. (2016). Ativan C-IV.
- U.S. Drug Enforcement Administration. (n.d.). Drug Scheduling.
- Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- National Institute on Drug Abuse. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
- Harvard Health Publications. (2011). Overcoming insomnia.
- Weaver, M. (2015). Prescription Sedative Misuse and Abuse. Yale Journal of Biology and Medicine, 88(3), 247–256.
- National Institute on Drug Abuse for Teens. (2017). Prescription Depressant Medications.
- U.S. National Library of Medicine. (2017). Lorazepam.
- NSW Government Health. (2013). Benzodiazepines.
- Substance Abuse and Mental Health Services Administration. (2014). Drug Abuse Warning Network, 2014: Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes.
- Johnson, B., Streltzer, J. (2013). Risks Associated with Long-Term Benzodiazepine Use. American Family Physician, 88(4), 225–226.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5h ed.). Arlington, VA: American Psychiatric Publishing.
- National Center for PTSD. (2013). Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines.
- National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).