Treating Zolpidem Dependence
It can be difficult to figure out whether someone you care about is struggling with an addiction, and if so, how you can best help them. If your loved one has a prescription for zolpidem, it can be even more difficult to identify whether there’s a problem and how to help.
As a relatively commonly used sleeping medication, zolpidem (brand name: Ambien) is often seen as non-addictive and harmless. However, numerous case reports and reviews have identified that the drug can indeed lead to abuse, dependence, and severe withdrawal symptoms 2, 4-6, 8, 10-11.
Is Zolpidem Dangerous?
Worried someone you love is abusing zolpidem? Listen for street names such as “forget-me pill” “no-go pills,” “zombie pills,” and “A-minus.”
Zolpidem is a central nervous system (CNS) depressant, so the effects can be devastating if taken in higher doses or when combined with other CNS depressants such as alcohol, opioid painkillers, or muscle relaxers1. Many users have also experienced significant withdrawal symptoms upon discontinuing the medication, including anxiety, cravings, insomnia, and seizures 1, 8.
Even taking the drug as prescribed carries some risks. For example, zolpidem can lead to severe drowsiness, increasing the risk of accidents and bodily injury. This risk is great enough that in 2013 the FDA modified the label to recommend avoidance of activities that require a high degree of mental alertness, such as driving, even the day after taking the drug3.
People have also been known to engage in activities while under the influence of zolpidem that they have no recollection of the next day. These activities can range from mild (eating or having conversations) to risky or outright dangerous (having sex or driving) 1,12. According to The Drug Abuse Warning Network (DAWN), emergency room visits related to adverse reactions from zolpidem increased by almost 220% from 2005 to 2010 9.
What Are the Signs of Addiction?
The following signs and symptoms may indicate a problem with zolpidem addiction.
- Showing changes in behavior such as increased depression or irritability, or conspicuously reacting to unusual experiences such as hallucinating.
- Not remembering conversations they have had with you.
- Misusing the medication (taking it in higher doses or for reasons other than what the original prescription was intended for).
- Starting to take zolpidem a little earlier every night to experience the calming and sedative effects.
- Experiencing symptoms of withdrawal when they do not take the drug or run out of it.
- Trying to keep themselves awake after taking it so that they can experience the potential euphoric effects.
- Visiting multiple doctors to try and get additional prescriptions.
Also, be aware that the risk of addiction to zolpidem is heightened in individuals who have a history of alcohol or drug abuse or dependence, or who have psychiatric diagnoses.
Helping Someone with an Addiction
When you have decided that your loved one may be dealing with an addiction to zolpidem, figuring out how you can best help them can feel daunting. However, there are some steps you can take to help both your loved one and yourself:
- Educate yourself and note any symptoms and behavior changes. Broadening your knowledge of zolpidem, as well as addiction in general, will allow you to approach your loved one with your concerns from a more understanding and informed position. Also noting behavior changes will help to better address someone in denial about their drug abuse. It is important to note however that any evidence of behavior changes or symptoms is solely to provide examples of your concerns in the interest of helping them, not to shame them.
- Prepare what you are going to say and how you are going to say it. When approaching a loved one about treatment, it is best to go in prepared so that you can clearly articulate your thoughts and feelings in a caring manner. This will increase the chances that your loved one will open to what you have to say. For example, try to stay calm and focus on their behaviors rather than making general statements about their character.
- Have a plan. Having a plan enables you to avoid unproductive, spontaneous confrontations that can deter your loved one from getting help. You may want to consider the options listed below. This can include taking your loved one to see a doctor or addiction specialist, planning an intervention, or utilizing the community reinforcement and family training (CRAFT) approach.
- Get Support for Yourself. The healthier you are, the better you will be able to support your loved one. You may want to consider pursuing your own personal individual counseling or joining a support or assistance group such as Nar-Anon, a 12-step group intended to support the friends and family of those struggling with an addiction.
See a Doctor or Addiction Specialist. Taking your loved one to see a care provider who can assess their condition and influence them to get help can go a long way. For teens and young adults, The National Institute on Drug Abuse (NIDA) advises using incentives to get them to see a doctor since they may be more prone to listen to a professional than a family member 13.
Hold an intervention. An approach by intervention is a focused way of approaching your loved one and encouraging them to seek help. It involves gathering together a group of people in the addict’s life who share the same concerns and commitment to helping them recover. During the intervention, the concerned individuals take the opportunity to express to their loved one what they have observed, how it has impacted their own lives, and what they would like the addict to do for help, as well as the potential consequences of refusing to get help. Those seeking to hold an intervention often choose to employ the help of a professional who has experience in the field of addiction and can help make sure those involved confront the individual in the most effective manner.
Participate in Community Reinforcement and Family Training (CRAFT). CRAFT is an evidence-based approach that helps you figure out changes you can make to both motivate your loved one to seek treatment while addressing any personal issues you may be experiencing that are related to their addiction. This approach involves less confrontation than holding an intervention and instead harnesses the power of positive rewards and natural consequences to influence behavior change 7.
Addiction Treatment Options
There are several options an individual can take once they have committed to treatment. These include:
- Detoxification. Due to the potential for significant withdrawal symptoms, many people look for medical and doctoral assistance for a safe and comfortable zolpidem detox. This is often the first step before treatment, and it can occur within an inpatient setting or before starting an outpatient program. It will begin with a taper to gradually remove the drug from the body. A benzodiazepine or selective serotonin reuptake inhibitor (SSRI) may be utilized to minimize discomfort 10.
- Inpatient Treatment. Inpatient care provides not only a general environment supportive of recovery, but the structure can also help establish healthy sleeping behaviors and patterns. This can be especially important for people suffering from rebound insomnia after detox. Private rooms may be available to further minimize issues with sleep, depending on the center. During inpatient treatment, the individual will also be given a consistent and focused opportunity to deal with any issues that may have led them to abuse zolpidem, such as a co-occurring disorder like anxiety.
- Outpatient Treatment. After successful detoxification and/or completion of an inpatient program, the recovering individual may consider beginning an outpatient treatment program that offers many benefits as inpatient programs, but in a non-residential setting and with more flexibility. This option is relatively less intensive but still generally entails participating in individual and group therapy to address both underlying issues as well as learn behaviors consistent with recovery such as good sleep hygiene.
- U.S. Food and Drug Administration. (2008). Ambien (Zolpidem Tartrate) Tablets. (2008)..
- Correas Lauffer, J., Braquehais Conesa, D., Barbudo Del Cura, E., & Ochoa Mangada, E. (2002). [Abuse, tolerance and dependence of zolpidem: three case reports]. Actas Espan?olas De Psiquiatri?a, 30(4), 259-262.
- U.S. Food and Drug Administration. (2013). FDA Drug Safety Communication: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR..
- Hajak, G., Muller, W., Wittchen, H., Pittrow, D., & Kirch, W. (2003). REVIEW Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction, 98(10), 1371.
- Liappas, I., Malitas, P., Dimopoulos, N., Gitsa, O., Liappas, A., Nikolaou, C., & Christodoulou, G. (2002). A zolpidem and cocaine abuse case report. International Journal Of Psychiatry In Clinical Practice, 6(4), 217.
- Pourshams, M., & Malakouti, S. K. (2014). Zolpidem abuse and dependency in an elderly patient with major depressive disorder: a case report. Daru, 22(7), 1-3.
- Robert J. Meyers, Ph.D. (2014). CRAFT.
- Sellami, R., Messedi, N., Feki, I., Baati, I., Zahaf, A., & Masmoudi, J. (2016). Zolpidem abuse: About a case. European Psychiatry, 33S372-S373.
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 1, 2013).Emergency Department Visits for Adverse Reactions Involving the Insomnia Medication Zolpidem. Rockville, MD.
- Victorri-Vigneau, C., Dailly, E., Veyrac, G., & Jolliet, P. (2007). Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. British Journal Of Clinical Pharmacology, 64(2), 198-209.
- Victorri-Vigneau, C., Gérardin, M., Rousselet, M., Guerlais, M., Grall-Bronnec, M., & Jolliet, P. (2014). An Update on Zolpidem Abuse and Dependence. Journal Of Addictive Diseases, 33(1), 15.
- National Library of Medicine - PubMed Health. (2016). Zolpidem (Oral route)..
- National Institute on Drug Abuse. (2016). What to Do If Your Teen or Young Adult Has a Problem with Drugs..