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Abstract
Benzodiazepines are a controlled substance obtained from
a physician for stress, anxiety, muscle spasms, and insomnia. If abused
benzodiazepines can kill or leave lasting effects in the abuser’s brain, as
well as, in the fetus of a pregnant user. In the following article, addiction,
dependency, effects, withdrawals, and conditioning will be discussed in length;
informing the reader of the dangers that come with taking and abusing
benzodiazepines. In addition, the author makes sure to stress to the reader
that there is help, and sobriety is possible.
Benzodiazepines:
Silent Killers
When we hear the names Elvis Presley, Michael Jackson,
and Anna Nicole Smith, fame, fortune, and notoriety instantly come to mind;
but, they have another stigma to their names, ‘drug overdose’. In August of
1977, it was reported that Elvis died from cardiac arrest; however, later
reports divulged that he died due to constipation induced by narcotics.
“According to Dr. [Nickopoulos], the autopsy revealed that Presley’s colon was
5 to 6 inches in diameter (whereas the normal width is 2 to 3 inches) and
instead of being the standard 4 to 5 feet long, his colon was 8 to 9 feet in
length” (McKay, 2010). One of the main complaints from patients on benzodiazepines
is constipation that is hard to relieve; an embarrassing subject to discuss
with
the
doctor, that if not addressed will cause further illness and possibly death.
Similarly, on June 25 2011, Michael Jackson was rushed
from his luxurious home to UCLA Medical Center in LA from an apparent drug
overdose; he was pronounced dead a short time later from what authorities
called, “acute propofol intoxication” given to help Jackson sleep (Duke, 2010).
CNN first reported Jackson’s death because of cardiac arrest (CNN, 2010),
which, is a common misdiagnosis among overdose cases. Additionally, five months
after Anna Nicole Smith’s son died of a drug overdose, Anna followed; dying in
February of 2007 of an overdose of sleeping medication and eight other prescription
drugs- included in them was the drugs lorazapam and diazepam (Anna Nicole,
2007). Benzodiazepines are not to be mixed with other sedatives or depressants,
the outcome can obviously be deadly.
Benzodiazepines are considered a controlled substance and
can only be obtained legally through a prescription from the doctor. “Benzodiazepines
are a class of drugs primarily classified as anti-anxiety, sedatives, or
hypnotics” (Classification, 2011). There are many names for
benzodiazepines, some of these include:
- Xanax,
also known as Alprazolam - Librium,
also called Chlordiazepoxide - Klonopin,
also called Clonazepam - Valium,
also called Diazepam - Rohypnol,
also called Flunitrazepam (Date rare
drug) - Ativan,
also called Lorazapam - Restoril,
also called Temazepam
(Classification, 2011)
Although
different in some aspects, these medications are the same in one way, if
misused or abused they will kill. Rohypnol has made headlines for a different
misuse, it has been crowned the king of date rape drugs; leaving the victim
docile and powerless against an offender. For this reason, patrons are advised
not to leave drinks unattended at a bar or restaurant. Additionally, do not ask
a stranger for an ‘aspirin’ or any other drugs at a bar, party, or event; this
can leave you open to unknowingly being drugged, putting your safety and virtue
at risk.
Dependency
and Addiction:
Addiction is a noun, defined by the American Heritage
Dictionary as, “to devote or surrender (oneself) to something habitually or
obsessively” (Why Can’t I Stop, 2011). People can become addicted to most
anything; gambling, food, drugs, tobacco, and alcohol just to name a few. According
to studies, there are several factors that create an addiction, as well as,
different levels of abuse. “Dr. Arthur Horvath, Ph.D., at the Center for
Cognitive Therapy in California [suggests] there are four primary phases in a
negative addiction”:
- “Experimentation (urges arise out of
curiosity)” - “Expected Enjoyment (urges arise out of
fond memories of past enjoyment)” - “Doing it to Cope (urges arise primarily
in response to stress)” - “Doing it to Survive (urges are
frequent)” (Why Can’t I Stop, 2011)
These patterns may vary according to how
long the addiction has been present in the person’s life. Additionally, there
are many other things that influence the severity of the addiction, and age of
onset. Studies have shown repeatedly that family history plays a significant
role in a person’s risk for addictive behavior, in addition too, peer-pressure,
stress, low self-worth, and environment. In other words, if a person’s father
or mother was an addict, friends encourage it and the addiction is easily
accessible, and a person feels as if their life is worthless, the risk of
addiction goes up significantly. In addition, getting help for addiction is
complicated since most addicts are in denial of the addiction (Why Can’t I
Stop, 2011).
The first thing that family and friends need to know is
that, an addict cannot be helped until they accept their addiction as a problem
not a solution. There are several ways to detect that a person is an addict;
the person stops doing things that normally brings them pleasure, their only
interest is in the substance or activity, aggressive behavior, lying, and
disassociation from social activities. Additionally, addicts will make choices
and display behaviors normally out of character for them. “The crucial factor
is that addiction has profound effects on people in the immediate social
network or family” (Holtzman, 2000). Family and friends suffer greatly for the
addictions of the one’s they love, often feeling helpless in their efforts.
Conditioning
and Learning:
There are three great paradigms of learning and
conditioning; these are classical conditioning, operant conditioning, and what
will be discussed first, social learning; for the purpose of this discussion,
only social learning and operant conditioning will be referred. “[The] Social
learning theory focuses on the learning that occurs within a social concept…it
considers that people learn from one another, including such concepts as
observational learning, imitation, and modeling” (Social Learning, 2011). In
other words, we learn from observing others behavior; however, this does not
always mean a change will occur. The social learning theory also exerts that
“cognition plays a role in learning”, learning through “observation”, and that,
“learning can occur without a change in behavior” (Social Learning, 2011).
Maybe this is why we tend to be ‘people watchers’; we learn while laughing.
The more modern theory of social learning suggests that,
“reinforcement and punishment have direct and indirect effects on learning”,
also that, “reinforcement and punishment influence the extent to which an
individual exhibits a behavior that has been learned”, and finally, “the
expectation of reinforcement influences cognitive processes that promote
learning” (Social Learning, 2011). In a sense we learn from observing others
successes and failures. Does this mean if someone does something wrong and pays
horrible consequences, that we will not make the same mistake because we have learned
from their behavior; no, the reason being that, there is always another person
who will reinforce that bad behavior, still leaving us to make our own choice.
We choose from whom we want to learn from, or model.
On that note, most addicts’ report getting high for the
first time with someone else, a friend, family member, or mate. One former
addict states, “the first joint I smoked or pill that I took came from my
mother…forty some years later, I am still an addict, fighting for sobriety”
(Anonymous, personal correspondence, 2011). Whether a person does drugs with
someone they know, or someone they just met, this behavior is socially learned;
for instance, now day’s teenagers are having pill parties, cleaning out their
parent’s medicine cabinet, putting the pills in a bowl and everyone takes a
handful. Despite the fact that research proves (not to mention the overdoses),
that drugs, especially benzodiazepines, are dangerous and addictive more
Americans are dying from abusing these medications.
Many Americans have been arrested and imprisoned due to
benzodiazepines, and as discussed in the first couple of paragraphs, many
people have also died. Moreover, still people use, abuse, and sell drugs; this
proves not that the social learning theory is wrong, but, just the opposite, we
learn from others behavior- good or bad. Although, we learn from others
behavior, we have the ability to decide what behaviors we will mimic and the
ones we will not. Many factors determine
how competent a person is to make decisions; some people do not have the
capacity to make good choices.
Operant
Conditioning:
Reinforcement roughly means, forced strengthening; “A
reinforce is anything that strengthens the desired response” (Operant
Conditioning, 2011). Skinner suggests that there are three kinds of responses
or operant that follows actions, these being:
- “Neutral Operant: responses from the
environment that neither increase nor decrease the probability of a behavior
being repeated”. - “[Reinforcement]: Responses
from the environment that increase the probability of a behavior being
repeated. [Reinforcement] can be either positive or negative”. - “Punishers: Response
from the environment that decrease the likelihood of a behavior being repeated.
Punishment weakens behavior” (B.F Skinner, 2011).
If a person thinks logically, it is
easy to see how this process works; by using positive reinforcement, we
strengthen the desired behavior. If, for example, a child comes home from
school raving about a straight A’s on a report card, the parent would give
praise and a reward to the child, if the parent wants that behavior to
continue. Additionally, if the parent does not give positive reinforcement, the
child will most likely start failing school, hoping that will get them
attention. Then what happens is the parent will have to punish the child for
wrongful behavior. Relearning adults however, is a bit more complicated.
Take drug addicts for example, if a person that abuses
drugs tells their friends and family they have quit using, and the friends and
family are excited about the news and offer their help, it is likely that the
addict will succeed in sobriety. However, if the same scenario occurs and the
friends and family take an attitude of, “we have heard that before” not
offering help, then it is likely the addict will not be successful in sobriety.
What happens then is, the addict is arrested; or eventually overdosing, or, the
addict will continue with that behavior until positive reinforcement comes
along in some form.
If the addict ends up in jail, the system will use the
same theory in correcting the behavior of the addicted offender. Prisons and jails
have good rehabilitation programs for addicts of all kinds; the belief is that
if counseling and positive reinforcement, combined with punishment, and absent
of negative reinforcements applied properly reduces the addicts’ chance at
relapse. Despite the efforts of family, friends, jail, and prison officials,
some addicts never change; there are just as many negative reinforcements as
positive, both incarcerated and loved ones. These negative reinforcements are
present from cradle to grave, and only the strong and determined will stay on
the path of sobriety.
Short
Term and Long Term Effects of Benzodiazepines:
Some of the effects of benzodiazepines are obvious,
drowsiness, constipation, nausea, with alcohol increasing their effect;
addiction, although, long lasting, can occur with short-term use. We will
concentrate on the long-term effects of benzodiazepines, and withdrawal
symptoms for this discussion. Primarily, addiction and dependency are the most
common long-term effects of benzodiazepines; abusers’ lose jobs, friends,
money, self-respect, and sometimes their freedom and children. All of these
things can be replaced are regained in most situations, however, some effects
of benzodiazepines cannot be undone.
The one important effect of benzodiazepines, these
medications, especially if taken in high doses, can build up in the fatty
tissues in the body; making long-term use more dangerous than assumed. “The
symptoms of over-sedation may not appear for a few days…some include”:
- “Impaired thinking, memory, and
judgment - Disorientation
- Confusion
- Slurred speech
- Muscle weakness, lack of
coordination (CESAR, 2011)
Still, these symptoms
can be corrected, whereas, brain damage cannot. In the late 1970s, David Knott
(a doctor at the University of Tennessee) stated, “I am very convinced that
Valium, Librium, and other drugs of that class cause damage to the brain…I have
seen damage to the cerebral cortex that I believe is due to the use of these
drugs…”(Lane, 2010). Permanent brain damage is a stiff penalty for relaxation
or entertainment.
If pregnant, benzodiazepines do not just affect the
mother; babies born to addicts are usually addicted as well. “Benzodiazepines
generally carry FDA ratings of “X-contraindicated in pregnancy” or “D-positive
evidence of risk…there have been case reports of anatomical birth defects (BJC,
2011). This classification in effect means that taking benzodiazepines while
pregnant will cause birth defects. The mother runs a risk through the entire
pregnancy; “the first and second trimesters are commonly sensitive for
teratogenic effects…the last trimester is particularly sensitive for brain effects-
apoptotic degeneration of neurons- with life-long impact” (BJC, 2011). What is
shocking is that even given the proven effect, mothers’ still will take drugs
during pregnancy.
As non-addicts, we can make judgments about why people,
pregnant or not, take benzodiazepines; but there are always underlying issue
when someone turns to drugs for comfort. Things such as, low self-esteem,
stress, insomnia, pressure from work, troubles in a relationship, as well as an
array of other discomforts; one particular reason is withdrawals. Withdrawals
are excruciating at best. “Professor Lader declared, in a 1999 interview on BBC
Radio 4, “It is more difficult to withdrawal people from benzodiazepines than
it is from heroin” (Lane, 2010). Lader’s statement is enough to scare anyone
from taking that first step toward sobriety, moreover, the first 5 days into
detox will burn it into the psyche.
Many addicts reported relapsing several times before
finally getting sober. As stated, withdrawals are devastating, and the symptoms
can start with just a slight change of the dosage. It starts with skin
crawling, shaking, the trots, sweating, with added symptoms by the minute. There
are however, some things that can be done to ease the intensity of the
symptoms. Two particular ways to ease the symptoms of withdrawal would be
tapper off the medication slowly, or take a Benadryl every 4 to 6 hours to ease
the discomfort; although, speaking with the doctor is the best advice. Make
sure to drink plenty of water, sweating during the detoxification period can
cause dehydration; furthermore, it will help clear out the system.
Whatever the method used to get through withdrawals, make
sure there is other support available to give “positive reinforcement”; it can
be easy to relapse when alone. Many programs exist to prevent a person from
relapsing. If a person was not able to find a mental health facility, ask the
doctor for a referral to a specialist. The very first risk to eliminate is the
‘party friends’ and the “negative reinforcements”; many times addicts’ quit
taking drugs, but, still hang out with the same crowd they partied with. When a person does not rid themselves of the
negative reinforcements that enabled the addiction in the first place, the
person’s sobriety is destined to fail.
In conclusion, benzodiazepines are an addictive substance
that can cause death if abused. Additionally, benzodiazepines can leave
life-long effects in the user’s brain, as well as, in the fetus of a pregnant
user. These medications should only be taken under strict observation from a
physician in extreme cases only. If a person does become dependent or addicted
to benzodiazepines, there are programs and positive reinforcers’ to assist in
recovery and relapse. An addict must rid themselves of all negative reinforcers
to succeed at sobriety and change. Finally, it does not matter if a person’s
conditioning is wrongfully learned, with the correct support, a will for
change, and positive reinforcement addiction can be overcome.
References
Anna Nicole. (2007,
March 26). Anna Nicole Smith’s death due to accidental overdose. Fox
News. http://www.foxnews.com/story/0%2C2933%2C611160%2C00.htm
B.F. Skinner. (2011,
May 7). Skinner- Operant conditioning and reinforcement. Simply
Psychology. http:// www.simplypsychology.org/operant-conditioning.html
BJC. (2011, May 9). Benzodiazepines.
BJC behavioral health. BJC Health Care.
http://www.bjcbehavioralhealth.org/behavioralhealth+print.aspx?=1891&template=/behav
CESAR. (2011, May 6).
Benzodiazepines: Profile. Center for substance abuse research.
http://www.cesar.umd.edu/cesar/drugs/benzos.asp>
Classification. (2011,
January 19). Benzodiazepines drug information: Classification. Redwood
Toxicology Laboratory.
http://www.redwoodtoxicology.com/resourses/drug_info/benzodiazepines.html>
CNN. (2010, June 25). Michael
Jackson dead at 50 after cardiac arrest. CNN Entertainment.
http://articles.cnn.com/entertainment/michael.jacks
Duke, Alan. (2010,
February 9). Corner releases new details about Jackson’s death. CNN
Justice. http://articles.cnn/2010-02-09/justice/michael.jackson.auto
Holtzman, Elizabeth. (2000,
August 19). Addictive behaviors, compulsions, and habits: A
Spectrum of need intensity. http://www.umass.edu/fsap/articles/addictive.html
Lane, Christopher.
(2010 November 18). Brain damage from benzodiazepines: The
Troubling facts, risks, and history of
minor tranquilizers. Psychology Today.
http://www.psychologytoday.com/print/50664?page=2
McKay, Hollie. (2010,
May 5). Exclusive: Elvis Presley’s doctor claims he died of an
Embarrassing case of constipation. Fox
News.
http://www.foxnews.com/entertainment/2010/05/05/exclusive-el
Operant Conditioning.
(2011, May 8). Operant conditioning (B.F. Skinner). Psychology.com.
http://tip.psychology.org/skinner.html
Social Learning. (2011,
May 7). Social learning theory. University of Texas.
http://teachnet.edb.utexas.edu/~lynda_abbott/Social.html
Why Can’t I Stop?
(2011, May 10). Why can’t I stop? Dealing with addictive behavior.
http://mtnviewhospital.com/PDF%@)Files/Addictive%20Behavior.pdf