Ativan Addiction: Causes, Symptoms & Treatment

Ativan is a medication that is used to treat anxiety. 

Its use can be habit-forming, and there are a range of symptoms that can indicate an addiction. However, Ativan addiction is treatable with the right help and support.

What Is Ativan?

This drug belongs to a class of medications known as benzodiazepines, which function by enhancing the activity of the neurotransmitter gamma-aminobutyric acid (GABA), resulting in a decline in activity of the central nervous system. The result is a calming effect that can assist in the alleviation of symptoms of anxiety disorders and other conditions that cause hyperactivity of the central nervous system. 

Ativan drug has a sedative, hypnotic, anxiolytic, and anticonvulsant effect. It is commonly used to treat medical conditions that produce symptoms of hyperactivity, anxiety, sleeplessness, and convulsions. 

Why Is Ativan Prescribed?

Ativan is used to treat conditions that result in hyperactivity, anxiety, convulsions, and generally heightened central nervous system activity. The following conditions may be treated with Ativan:

• Anxiety disorders
• Panic disorder
• Symptoms of alcohol withdrawal
• Psychosis related to alcohol withdrawal
• Muscle spasms
• Sleep disorders
• Nausea and vomiting related to cancer treatment
• Bipolar disorder
• Restlessness (such as restless legs syndrome)

Quick Facts About Ativan

Ativan (known generically as lorazepam) was developed by Wyeth Pharmaceuticals in 1977. Specifically, the drug was created by D. J. Richards who was president of research for the company at the time. The original patent on the drug has since expired. 

Ativan is used medically to treat the aforementioned conditions, but it has also been linked to problematic recreational use. It is one of the drugs that is frequently mentioned in discussions of substance misuse. 

Important Statistics

• In 2020, there were an estimated 2,492,279 patients who were prescribed Ativan in the United States.
• The total number of Ativan prescriptions in 2020 in the United States was 10,559,374.
• Ativan costs approximately $13.45 and $4.19 out of pocket for the average patient. 
• In 2020, Ativan was the fourth most commonly prescribed medication compared to alternative medications in its drug class. 

Does Your Body Build Tolerance to Ativan?

Ativan is habit-forming, and your body can develop both a physiological and psychological dependence on it. This dependence follows the development of tolerance for the drug. 

Tolerance refers to the tendency for the body to require higher doses of a drug to achieve the same original effect. Because of this phenomenon, which results from a disruption in the body’s homeostasis and a subsequent adaptation, Ativan can become addictive. 

The number of people who are addicted to Ativan in the United States is unknown, but Ativan is one of the main drugs mentioned in discussions of prescription drug addictions and the prescription drug addiction crisis. 

What Are the Signs & Symptoms of Ativan Addiction?

An addiction is not always easy to notice. Symptoms of a physiological or psychological dependence are sometimes latent, or signs and symptoms may not appear until weeks or even months after the addiction has begun. 

Still, there are some indicators to look for that may represent a dependence on Ativan. These indicators typically take place in the form of a change, ranging from small to severe, in physical, mental, or behavioral state. 

Physical Symptoms

Physical symptoms of an addiction to Ativan can include the following:

• Drowsiness
• Pain or stiffness in the muscles
• Blurred vision
• Difficulty breathing or abnormal respiratory patterns
• Constipation
• Seizures and coma in the event of a severe overdose

Mental Symptoms

Mental symptoms and signs of Ativan abuse include the following:

• Confusion

• Loss of interest in previously enjoyable activities

• Irritability

• Anxiety

Behavioral Symptoms

Behavioral symptoms of Ativan addiction refer to changes in your typical activities and mannerisms. Some examples of these changes may include the following:

• Neglecting family responsibilities
• Showing up late to work or missing days of work
• Isolating self from family and friends
• Experiencing financial difficulties due to use of Ativan
• Searching the internet for access to Ativan
• Asking friends, family, or coworkers for their Ativan medication

Understanding Ativan & Dependence 

A dependence on Ativan forms in the same way that it does with many other substances. The consumption of the drug impacts the brain’s dopaminergic reward system. The homeostasis of the production and reuptake of neurotransmitters that regulate mood and effect is disrupted, and one does not feel physically or mentally well without consuming the substance. 

However, there are some distinctions that exist between Ativan and other drugs based on the way in which it specifically affects the brain’s neurotransmitters. 

How It Works

If Ativan is misused (such as by consuming greater quantities of Ativan that differ from what is listed on the prescription or consuming Ativan more frequently than prescribed), one is at risk of becoming dependent on the drug.

Ativan consumption triggers the release of endorphins, which can mute or stifle perceptions of pain and enhance your sense of well-being temporarily. When the dosage wears off, you may find yourself wanting to reproduce those good feelings, which is the first step to developing an addiction. 

Why Dependence Forms

Over time, as the brain seeks to achieve homeostasis, a learned effect occurs in which neurotransmitter and endorphin production in the brain is altered to account for the continual consumption of Ativan. Thus, more Ativan becomes necessary in order to produce the same sense of euphoria and well-being that you may have experienced initially when taking the drug. This combines with the altered neurochemical production that has occurred, which has become insufficient to regulate mood in the absence of the drug. 

Over time, if a dependence has formed, you may require Ativan just to feel normal, and the drug may ultimately become incapable of producing a state of euphoria. This is why many individuals who become addicted to prescription drugs like Ativan eventually turn to stronger, often illicit, and potentially dangerous drugs like heroin. 

Ativan & Other Drugs

Ativan depresses the central nervous system. When paired with other depressants, such as alcohol or sedatives, a potentially dangerous interaction can occur. Additionally, when paired with opioids, Ativan can increase the risk of severe sedation, depression of the respiratory system, coma, and even death. 

Concomitant use of Ativan and clozapine can lead to severe sedation, heavy salivation, and ataxia. When combined with haloperidol, reports of heart arrest, bradycardia, coma, and death have been documented. 

The combined use of Ativan and valproate may increase plasma concentrations and reduce clearance of Ativan from the circulatory system. When combined with probenecid, a longer or more rapid onset of Ativan may occur because of the increased half-life of the drug and decreased system clearance. 

Can You Overdose on Ativan?

Yes, you can overdose on Ativan. However, toxic levels of Ativan are not necessarily responsible for a fatal overdose. 

The main cause of death from an Ativan toxicity is a failure to receive treatment. An overdose can occur if you take more than 10 mg of Ativan per day, or any dose and/or schedule that differs from what has been prescribed by your doctor. 

Combining Ativan with other substances of abuse, such as alcohol or opioids, makes overdose much more likely.

Overdose Symptoms

These are two of the most common symptoms of an Ativan overdose:

• Depression of the respiratory system, often signified by  slow and heavy breathing
• Hypoxia, occurring when there is insufficient oxygen delivery to the brain, which can result in brain damage

Dangers of Withdrawal

Benzodiazepine withdrawal can be dangerous. Heavy dependence, such as in cases of higher and/or more prolonged use, is linked with more severe withdrawal symptoms. In some cases, withdrawal can produce seizure-like activity, and this can be life-threatening. 

As a result, you should never suddenly stop taking Ativan on your own. Medical supervision is needed for safe benzodiazepine withdrawal. A doctor will design and oversee a tapering schedule, so your dosage of Ativan will be gradually reduced over time.

Protracted withdrawal systems can result in mental health issues, such as depression and anxiety, so it’s important to remain under a doctor’s care. 

Treatment Options for Ativan Addiction

Medical detox usually involves the tapering schedule described above. You may be prescribed certain medications to address specific symptoms of withdrawal or any co-occurring mental health issues, such as antidepressants or anti-anxiety medications.

Following medically managed detox, a comprehensive addiction treatment plan is optimal. In therapy, you’ll address the reasons that led to your Ativan abuse, and you’ll begin to build a healthier life in recovery. 

Depending on the intensity of your addiction, inpatient or outpatient treatment may be appropriate. Inpatient care requires that you live in a treatment facility, where you will receive medical attention and support around the clock. 

Outpatient rehabilitation involves a continuation of care within your home environment. It  also typically consists of individual and group counseling sessions to provide psychological and social support. 

These are some of the therapeutic interactions that are typically offered as part of outpatient care for Ativan addiction:

• Relapse prevention skills: Treatment professionals help you identify relapse triggers and teach you how to cope with them and avoid them when possible.
• Motivational interviewing: This is a therapy designed to resolve ambivalence to engage in recovery. 
• Contingency management: This form of therapy offers rewards for meeting recovery goals.
• Cognitive behavioral therapy: This is a psychological and behavioral intervention that teaches you to identify how thoughts underpin behaviors and how to think in more productive and realistic ways. 

Support groups are often a key part of addiction recovery. Many people participate in 12-step groups, such as Narcotics Anonymous, but there are also many non-12-step alternatives that can also offer support and ongoing encouragement.

References

Lorazepam: Drug Usage Statistics, United States, 2013-2020. (September 2021). ClinCalc. 

Prescribing Where There Is a Comorbid Presentation of Anxiety and Depression: A Case Study. (August 2020). Journal of Prescribing Practice. 

Sudden Cardiac Death With Clozapine and Lorazepam Combination. (January 2005). Jefferson Journal of Psychiatry.

Ativan (Lorazepam). (May 2012). Journal of Addictions Nursing.

Management of Benzodiazepine Misuse and Dependence. (October 2015). Australian Prescriber.

Effect of Dopamine Agonists and Antagonists on the Lorazepam Withdrawal Syndrome in Rats. (May 2000). Clinical and Experimental Pharmacology and Physiology.

High-Dose Benzodiazepine Dependence: A Qualitative Study of Patients’ Perceptions on Initiation, Reasons for Use, and Obtainment. (November 2015). PLOS ONE.

Pharmacokinetic Interactions Between Valproic Acid and Lorazepam (PIVOtAL Study): A Review of Site-Specific Practices. (June 2017). The Canadian Journal of Hospital Pharmacy.