Ambien is a prescription sleep aid containing zolpidem tartrate, which is marketed as an alternative to the more regularly abused and addictive benzodiazepine sedatives. It is considered a “z-drug.”
Mayo Clinic reports that Ambien is less likely to cause physical dependence than Xanax (alprazolam) is. It is, however, listed by the US Food and Drug Administration (FDA) as a short-term solution for insomnia, and it is therefore not recommended to be taken for longer than 7-10 days. If the drug is abused, or used for longer or in higher doses than recommended, the American Journal on Addictions warns that zolpidem can lead to physical dependence as it is inherently similar to benzodiazepine drugs, which are considered to be highly addictive.
The Drug Abuse Warning Network (DAWN) records emergency department (ED) visits for adverse reactions involving the nonmedical use of many drugs. This information is useful in measuring how often a drug may be abused. DAWN reports that in 2011, there were more than 30,000 ED visits involving the misuse of zolpidem. The more often someone abuses a drug like Ambien, the more likely they are to develop an addiction involving the drug. In short, if an individual takes Ambien outside of a legitimate prescription and without medical need, and continues to do so for a long period of time, dependence and addiction may soon follow.
Physical Dependence and Withdrawal
Most drugs enhance levels of dopamine in the brain, one of the brain’s naturally occurring neurotransmitters related to feelings of happiness. When drug use is then perpetuated over time, normal levels of dopamine may be disrupted, and the brain’s chemical makeup may become imbalanced without the drug. Ambien, like benzodiazepine drugs, is a central nervous system depressant that slows down autonomic functions like blood pressure, respiration, and heart rate to decrease hyperactivity of nerve firings and promote sleep and relaxation. The inhibitory neurotransmitter GABA, gamma-aminobutyric acid, is a natural sedative occurring in the brain. The presence of Ambien increases GABA activity in the brain. When its use, and especially its abuse, is perpetuated, these disruptions become more fixed.
Drug dependence is a physical occurrence that happens when someone takes a drug regularly, and brain chemistry and some of the circuitry are altered. Addiction is a brain disease that involves both physical dependence and emotional and behavioral side effects. Physical dependence can occur outside of addiction; however, dependence almost always accompanies addiction.
Physical addiction therefore involves the regions of the brain related to how a person feels pleasure, controls impulses, makes decisions, regulates moods, and forms new memories, and it can have both psychological and health-related side effects. Withdrawal symptoms after a drug wears off, as well as drug cravings, are common consequences of physical drug dependence and reported to be present after long-term Ambien use.
The FDA reports that Ambien withdrawal symptoms are similar to those of benzodiazepine drugs, which can be intense and significant, and start within 12-20 hours of the last dose of the drug. The National Highway Traffic Safety Association (NHTSA) publishes that insomnia, muscle cramps, stomach discomfort, fatigue, lightheadedness, vomiting, sweating, tremors, convulsions, nervousness, flushing, and panic attacks may be signs of zolpidem withdrawal. These side effects may occur as the brain experiences a kind of rebound effect after some of the nerve firings were dampened by Ambien, and without the drug, they may become hyperactive.
The Journal of Medical Toxicology reports that rebound insomnia is also a common side effect of taking high levels of zolpidem. Other significant withdrawal symptoms may include delirium, anxiety, seizures, heart palpitations, drug cravings, and even psychotic symptoms. Ambien should not be stopped suddenly as withdrawal may be unpredictable and even potentially dangerous.
Why Some People Suffer from Addiction to Ambien at Higher Rates than Others
There are many different factors involved in what makes one person more susceptible to drug dependence and even addiction than another. Both biological and environmental aspects may play a role. Someone with a family history of addiction, for example, is likely more prone to developing an addiction involving Ambien than someone without this history, for instance. This is not to say that just because someone battles addiction that all direct family members will too, however.
Addiction is thought be related to both genes and environmental influences, the National Institute on Drug Abuse (NIDA) estimates. Exposure to trauma and high levels of stress at a young age are environmental factors that may enhance the likelihood that a person will struggle with addiction as an adult, as is early drug use. While the brain is developing, in childhood and adolescence, some of the same parts of the brain that drug use impacts are not fully formed; therefore, they may be more malleable. Drugs can disrupt this normal brain formation, potentially increasing the risk for problematic drug use and addiction down the line. Additionally, the severity of withdrawal symptoms may make a person want to continue taking Ambien in an attempt to avoid the symptoms, which can perpetuate addiction.
In general, some of the things that increase the risk for developing physical dependence on Ambien include:
- Any use of the drug without a necessary and legitimate prescription
- Taking higher doses of Ambien than prescribed or taking it after a prescription has run out
- Taking other drugs, either licit or prescription, or consuming alcohol when taking Ambien
- Altering Ambien or taking it in a way other than how it was intended, like chewing pills, crushing pills and then snorting the powder, smoking crushed pills, or dissolving crushed pills in liquid and injecting the resulting liquid
- The presence of a co-occurring medical condition or mental health disorder