Introduction:

It is relatively common to come across people who are addicted to alcohol or cannabis. Not only that but even behavioral addictions such as gambling or gaming addictions are increasingly recognised. But there is one less commonly discussed addiction that we often come across at our clinic, which is addiction to Zolpidem tablets. 

About Zolpidem:

Zolpidem is a non benzodiazepine positive allosteric modulator of GABAa receptor. It is commonly used as a Z-drug (Hypnotic), often administered as zolpidem tartrate. The tablets are white to off white in colour. It is lipophilic in nature, meaning that it can rapidly cross a person’s blood brain barrier and produce effects in one’s brain within 15- 30 minutes. But if taken with food, the initiation of its effects get delayed. The elimination half life of zolpidem is 2-3 hours, which means that 50% of it gets out of the body system in that span of time. 

Is Zolpidem bad?

No medicine is inherently good or bad. It is good when prescribed for treating the right diseases, in right doses, for the right duration. But problems beging when it is used irrationally, outside therapeutic dose range, without an aim to treat a disease, just to enjoy its calming and rewarding effects, without a doctor’s medical opinion and prescription. 

Why does a person get addicted to Zolpidem?

Vulnerability probably results from an interaction between biological predisposition, previous substance-use vulnerability, psychiatric comorbidity, chronic insomnia, reinforcement from the drug’s subjective effects, dose and duration of exposure. And unfortunately, if such people suffer from anxiety too, these are the set of populations that can get addicted to zolpidem tablets. 

Another vital aspect: If the addicted person does not take proper treatment for addiction and anxiety/ depression, then they will require zolpidem perpetually forever in more and more quantities. This phenomenon of increased need of a drug to get the same effect is called tolerance. 

What does Zolpidem addiction look like?

The person may:

• require progressively larger doses to obtain the same effect;
• repeatedly take more zolpidem than intended or prescribed;
• become preoccupied with whether sufficient tablets are available;
• experience significant anxiety when the supply is running low;
• hide tablets, medicine strips or medication pouches from family members;
• obtain zolpidem from multiple pharmacies or prescribers;
• repeatedly attempt to reduce the dose but return to previous consumption;
• continue using zolpidem despite cognitive, occupational, interpersonal or medical consequences;
• experience withdrawal symptoms when the dose is abruptly reduced or stopped.

How do we help people with Zolpidem addiction?

At Harmony Mind Clinic, we have treated people who take more than 30 tablets of zolpidem per day. We take a detailed medical, genetic, developmental and behavioral history of the individual. Common triggers, patterns of consumption, reinforcements are explored in detail. 

There often isn’t one discoverable “root cause.” Addiction is a dynamic neurobehavioral phenotype generated by interacting vulnerability, reinforcement, exposure, neuroadaptation and environmental availability.

Usually it is a result of self medicating to relieve oneself of anxiety, panic attacks, depression, migraine, insomnia, or to offset the stimulation caused by consumption of black coffee/ energy drinks/ chem sex/ cocaine use. Once the root causes are identified, they are targeted pharmacologically along with necessary lifestyle and dietary modifications. This leads to a reduced dependence on zolpidem, with lesser withdrawal effects on quitting it. 

On the other hand, the person is trained in how to manage craving, along with some coping strategies.

Some FAQs:

1. How much Zolpidem is too much? Any amount that is above and beyond what is prescribed to you by your treating doctor.
2. Will I need admission in a hospital? Not every person with zolpidem addiction need indoor care. However, if the amount of consumption is very large, withdrawal risk is substantial, there is concurrent addiction to other substances and proves to be a threat to an individual’s life, then indoor care is advised. 
3. Is taking zolpidem with alcohol dangerous? Yes, it can be.
4. Should I taper zolpidem myself? No. This unmonitored tapering off can cause withdrawal symptoms which can be physically very distressing, affecting a person’s biological and occupational life significantly.

Take Home Message:

Zolpidem is an effective hypnotic medicine when appropriately prescribed, but its therapeutic status does not make it incapable of producing dependence.

Zolpidem dependence is neither simply a failure of willpower nor adequately explained by the drug alone. It is better understood as a dynamic interaction between drug exposure, biological vulnerability, reinforcement, neuroadaptation, psychiatric or sleep disorders and environmental availability.

Treatment therefore requires more than removing zolpidem. It requires identifying and modifying the processes that made zolpidem repeatedly valuable to that particular brain.

By: 

Dr Sagar Bhalke 

MBBS, MD, DNB, PDF (CAMH)

Co- Founder (Harmony Mind Clinic)

References

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