Benzodiazepines and other sedative-hypnotics

Abstract Chapter 14 of Addiction Medicine covers the range of sedative-hypnotic drugs, principally the benzodiazepines but also the barbiturates and ‘z’ drugs. The clinical indications for these drugs are fewer nowadays, given the concern about their abuse and dependence risks but up to 10% of adults take them. Guidelines on their (more limited) indications in modern medical practice are outlined. The chapter covers the pharmacology of different benzodiazepines and ‘z’ drugs, with information on half-lives and dosage equivalents. The clinical features of overdose, dependence (addiction), and withdrawal are outlined, together with the cognitive and other neuropsychiatric complications. Management approaches are outlined including brief intervention approaches, management of overdose/intoxication, and management of acute withdrawal states. Approaches to elective detoxification using tapering diazepam regimens (for benzodiazepine dependence) are presented in detail. The principles of prevention of abuse and dependence are described.