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Sedative#Disinhibition and crime

{{Short description|Drug that reduces excitement without inducing sleep}}

{{redirect|Tranquilizer}}

{{more citations needed|date=July 2021}}

{{Use dmy dates|date=March 2023}}

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| Caption = Herbal sedative.

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A sedative or tranquilliser{{notetag|Also spelled tranquillizer (Oxford spelling) and tranquilizer (US spelling); see spelling differences}} is a substance that induces sedation by reducing irritability{{cite web |url=http://www.hopkinscoloncancercenter.org/index.cfm?cID=194&CFID=1128737&CFTOKEN=20842936 |title=Johns Hopkins Colon Cancer Center – Glossary S |access-date=1 January 2009 |archive-date=1 December 2017 |archive-url=https://web.archive.org/web/20171201034840/http://www.hopkinscoloncancercenter.org/index.cfm?cID=194&CFID=1128737&CFTOKEN=20842936 |url-status=dead }} or excitement.{{DorlandsDict|seven/000095557|sedative}} They are central nervous system (CNS) depressants and interact with brain activity, causing its deceleration. Various kinds of sedatives can be distinguished, but the majority of them affect the neurotransmitter gamma-aminobutyric acid (GABA). Most sedatives produce relaxing effects by increasing GABA activity.{{Cite web|url=https://www.psychologytoday.com/conditions/sedatives|title=Sedatives {{!}} Psychology Today|website=Psychology Today|language=en|access-date=2017-11-20}}

This group is related to hypnotics. The term sedative describes drugs that serve to calm or relieve anxiety, whereas the term hypnotic describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging from anxiolysis to loss of consciousness), they are often referred to collectively as sedative–hypnotic drugs.{{cite book|last1=Brunton |first1=Laurence L. |last2=Lazo |first2=John S. |last3=Lazo Parker |first3=Keith L. |title=Goodman & Gilman's The Pharmacological Basis of Therapeutics |publisher=The McGraw-Hill Companies, Inc. |year=2006 |edition=11th |chapter-url=http://accessmedicine.mhmedical.com/content.aspx?bookid=374§ionid=41266223 |chapter=17: Hypnotics and Sedatives |isbn=978-0-07-146804-6 |access-date=2014-02-06}}

Terminology

There is some overlap between the terms "sedative" and "hypnotic".

Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects:

= "Chemical cosh" =

The term "chemical cosh" (cosh being a term for a blunt weapon such as a club) is sometimes used colloquially for a strong sedative, particularly for:

  • Widespread dispensation of antipsychotic drugs in residential care to make people with dementia easier to manage.{{cite news|url=https://www.telegraph.co.uk/health/elderhealth/8086614/Chemical-cosh-will-be-cut-for-dementia-sufferers.html|archive-url=https://web.archive.org/web/20101028225208/http://www.telegraph.co.uk/health/elderhealth/8086614/Chemical-cosh-will-be-cut-for-dementia-sufferers.html|url-status=dead|archive-date=28 October 2010|title='Chemical cosh' will be cut for dementia sufferers|date=25 October 2010|work=Telegraph.co.uk|access-date=12 September 2015|last1=Smith|first1=Rebecca}}

=Types of sedatives=

{{Citation needed|date=January 2025}}{{columns-list|colwidth=22em|

Therapeutic use

Doctors and veterinarians often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization, endoscopy, colonoscopy.{{citation needed|date=March 2023}}

Risks

=Sedative dependence=

Some sedatives can cause psychological and physical dependence when taken regularly over a period of time, even at therapeutic doses.{{cite journal | vauthors = Yi PL, Tsai CH, Chen YC, Chang FC | title = Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration | journal = Journal of Biomedical Science | volume = 14 | issue = 2 | pages = 285–97 | date = March 2007 | pmid = 17151826 | doi = 10.1007/s11373-006-9137-z }}{{cite journal | vauthors = Ebert B, Wafford KA, Deacon S | title = Treating insomnia: Current and investigational pharmacological approaches | journal = Pharmacology & Therapeutics | volume = 112 | issue = 3 | pages = 612–29 | date = December 2006 | pmid = 16876255 | doi = 10.1016/j.pharmthera.2005.04.014 }}{{cite journal | vauthors = Sarrecchia C, Sordillo P, Conte G, Rocchi G | title = [Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication] | language = it | journal = Annali Italiani di Medicina Interna | volume = 13 | issue = 4 | pages = 237–9 | year = 1998 | pmid = 10349206 }}{{cite journal | vauthors = Proudfoot H, Teesson M | title = Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 37 | issue = 10 | pages = 451–6 | date = October 2002 | pmid = 12242622 | doi = 10.1007/s00127-002-0576-1 | s2cid = 33089344 }} Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependencies, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy.{{citation needed|date=March 2023}}

=Misuse=

{{Main article|Drug overdose}}

{{Further|Combined drug intoxication}}

{{See also|Benzodiazepine overdose|Barbiturate overdose}}

Many sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Some heroin users may take them either to supplement their drug or to substitute for it. Stimulant users may take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Benzodiazepines comparatively have a wider margin of safety and rarely result in overdose unless mixed with other CNS depressants.{{Citation |last=Kang |first=Michael |title=Benzodiazepine Toxicity |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK482238/ |access-date=2024-05-08 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29489152 |last2=Galuska |first2=Michael A. |last3=Ghassemzadeh |first3=Sassan}} Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol.

A study from the United States found that in 2011, sedatives and hypnotics were a leading source of adverse drug events (ADEs) seen in the hospital setting: Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug.Weiss AJ, Elixhauser A. Origin of Adverse Drug Events in U.S. Hospitals, 2011. HCUP Statistical Brief #158. Agency for Healthcare Research and Quality, Rockville, MD. July 2013. [http://hcup-us.ahrq.gov/reports/statbriefs/sb158.jsp] A second study noted that a total of 70,982 sedative exposures were reported to U.S. poison control centers in 1998, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.{{Cite web | url = http://emedicine.medscape.com/article/818430-overview | title = Toxicity, Sedatives | access-date = 18 December 2008 | author = Professor Jeffrey S Cooper | date = 10 December 2007 | publisher = eemedicine | location = USA}}

There are also serious paradoxical reactions that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.{{cite web|url=http://www.benzo.org.uk/paradox.htm|title=benzo.org.uk - Benzodiazepines: Paradoxical Reactions and Long-Term Side-Effects|access-date=12 September 2015}}

=Dangers of combining sedatives and alcohol=

{{Further|Combined Drug Intoxication}}

Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions and this combination can prove fatal.

= Worsening of psychiatric symptoms =

The long-term use of benzodiazepines may have a similar effect on the brain as alcohol, and are also implicated in depression, anxiety, post-traumatic stress disorder (PTSD), mania, psychosis, sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders (including benzodiazepine-induced persisting dementia which persists even after the medications are stopped).{{Cite book|title = Diagnostic and statistical manual of mental disorders, fifth edition|last = American Psychiatric Association|publisher = American Psychiatric Association|year = 2013|location = Arlington, VA}} As with alcohol, the effects of benzodiazepines on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for their effects on mood and anxiety.{{cite book |last1 = Collier|first1 = Judith|last2 = Longmore|first2 = Murray|editor1-first = Peter|editor1-last = Scally|title = Oxford Handbook of Clinical Specialties|edition = 6|year = 2003|publisher = Oxford University Press|isbn = 978-0-19-852518-9|page = 366|chapter = 4}}{{cite web |author = Professor Heather Ashton|year = 2002|url = http://www.benzo.org.uk/manual/bzcha03.htm|title = Benzodiazepines: How They Work and How to Withdraw}}{{cite journal | vauthors = Lydiard RB, Laraia MT, Ballenger JC, Howell EF | title = Emergence of depressive symptoms in patients receiving alprazolam for panic disorder | journal = The American Journal of Psychiatry | volume = 144 | issue = 5 | pages = 664–5 | date = May 1987 | pmid = 3578580 | doi = 10.1176/ajp.144.5.664 }}{{cite journal | vauthors = Nathan RG, Robinson D, Cherek DR, Davison S, Sebastian S, Hack M | title = Long-term benzodiazepine use and depression | journal = The American Journal of Psychiatry | volume = 142 | issue = 1 | pages = 144–5 | date = January 1985 | pmid = 2857068 | doi = 10.1176/ajp.142.1.144-b | publisher = American Journal of Psychiatry }}{{cite journal | vauthors = Longo LP, Johnson B | title = Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives | journal = American Family Physician | volume = 61 | issue = 7 | pages = 2121–8 | date = April 2000 | pmid = 10779253 }}{{Cite book|title = Psychiatry, third edition|vauthors= Tasman A, Kay J, Lieberman JA |publisher = John Wiley & Sons|year = 2008|location = Chichester, England|pages = 2603–2615}} Additionally, benzodiazepines can indirectly cause or worsen other psychiatric symptoms (e.g., mood, anxiety, psychosis, irritability) by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Benzodiazepines are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep, they disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood).{{cite journal | vauthors = Ashton H | title = The diagnosis and management of benzodiazepine dependence | journal = Current Opinion in Psychiatry | volume = 18 | issue = 3 | pages = 249–55 | date = May 2005 | pmid = 16639148 | doi = 10.1097/01.yco.0000165594.60434.84 | s2cid = 1709063 }}{{cite journal | vauthors = Morin CM, Bélanger L, Bastien C, Vallières A | title = Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse | journal = Behaviour Research and Therapy | volume = 43 | issue = 1 | pages = 1–14 | date = January 2005 | pmid = 15531349 | doi = 10.1016/j.brat.2003.12.002 }}{{cite journal | vauthors = Poyares D, Guilleminault C, Ohayon MM, Tufik S | title = Chronic benzodiazepine usage and withdrawal in insomnia patients | journal = Journal of Psychiatric Research | volume = 38 | issue = 3 | pages = 327–34 | date = 2004-06-01 | pmid = 15003439 | doi = 10.1016/j.jpsychires.2003.10.003 }}

= Dementia =

Sedatives and hypnotics should be avoided in people with dementia,{{cite journal | vauthors = Lee J | title = Use of sedative-hypnotics and the risk of Alzheimer's dementia: A retrospective cohort study | journal = PLOS ONE | date=September 2018 | volume = 13 | issue = 9 | pages = e0204413 | doi = 10.1371/journal.pone.0204413 | pmid = 30248129 | pmc = 6152975 | bibcode = 2018PLoSO..1304413L | doi-access = free }} according to the medication appropriateness tool for co‐morbid health conditions in dementia criteria.{{cite journal | vauthors = Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C | title = Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel | journal = Internal Medicine Journal | volume = 46 | issue = 10 | pages = 1189–1197 | date = October 2016 | pmid = 27527376 | pmc = 5129475 | doi = 10.1111/imj.13215 }} The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications.{{citation needed|date=March 2023}}

=Amnesia=

Sedatives can sometimes leave the patient with long-term or short-term amnesia.

Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods, typically via IV drip, are more likely to experience such side effects.

Additionally, the prolonged use of tranquilizers increases the risk of obsessive and compulsive disorder, where the person becomes unaware whether he has performed a scheduled activity or not, he may also repetitively perform tasks and still re-performs the same task trying to make-up for continuous doubts. Remembering names that were earlier known becomes an issue such that the memory loss becomes apparent.

=Disinhibition and crime=

Sedatives — most commonly alcohol,{{cite journal | vauthors = Weir E | title = Drug-facilitated date rape | journal = CMAJ | volume = 165 | issue = 1 | pages = 80 | date = July 2001 | pmid = 11468961 | pmc = 81265 | url = http://www.cmaj.ca/cgi/content/full/165/1/80 }} but also GHB, flunitrazepam (Rohypnol), and to a lesser extent, temazepam (Restoril) and midazolam (Versed){{cite journal | vauthors = Negrusz A, Gaensslen RE | title = Analytical developments in toxicological investigation of drug-facilitated sexual assault | journal = Analytical and Bioanalytical Chemistry | volume = 376 | issue = 8 | pages = 1192–7 | date = August 2003 | pmid = 12682705 | doi = 10.1007/s00216-003-1896-z | s2cid = 34401047 }} — have been reported for their use as date rape drugs (also called a Mickey Finn) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses.

Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.{{cite news|first=Tony|last=Thompson|url=http://observer.guardian.co.uk/uk_news/story/0,,1376917,00.html|title='Rape drug' used to rob thousands|publisher=The Observer|date=19 December 2004|access-date=2008-05-08}} Cases of criminals taking Rohypnol themselves before they commit crimes have also been reported, as the loss of inhibitions from the drug may increase their confidence to commit the offense, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught.{{Citation needed|date=January 2025}}

See also

Notes

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References

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Further reading

  • Tone, Andrea. The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers (Basic Books, 2009) 288 pp.; {{ISBN|978-0-465-08658-0}} [https://www.amazon.com/Age-Anxiety-Americas-Turbulent-Tranquilizers/dp/B002ECEUX0/ excerpty and text search]

{{Major drug groups}}

{{Hypnotics and sedatives}}

{{Chemical classes of psychoactive drugs}}

{{Authority control}}