Ambien (zolpidem) is a mild central nervous system depressant drug used to initiate sleep in individuals with insomnia. The drug is not designed for long-term use, as it has a potential for the development of physical dependence; however, it is commonly prescribed for short-term use to help initiate sleep in people with insomnia.
The DEA classifies Ambien as a Schedule IV controlled substance, designating that it has a moderate potential for abuse. Ambien can only be obtained with a prescription from a physician. Because the drug is quick-acting and has a short half-life, most individuals who abuse the drug use it in combination with other drugs of abuse, such as alcohol, other central nervous system depressants (e.g., narcotic pain medications, benzodiazepines, and other sleep-inducing medications), marijuana, and even some stimulant drugs or medications.
Physical Dependence on Ambien
Physical dependence refers to a syndrome that is primarily physical in nature with psychological overtones that occurs as a result of chronic use of certain types of drugs. According to expert sources, such as the American Psychiatric Association, physical dependence consists of both the syndromes of tolerance (the need to take more of a drug to get the effects that were once produced at lower doses) and withdrawal (the onset of negative physical, emotional, and cognitive symptoms when levels of the drug in the person’s system decrease).
Physical dependence alone does not necessarily indicate that an individual has developed an addiction (substance use disorder). A substance use disorder occurs as a result of an individual using a drug or medication for nonmedicinal purposes and experiencing:
- Compulsive behaviors: The person displays a compulsion to use Ambien.
- Perception of need: The person displays the perception that they must use Ambien to cope with everyday stressors.
- Cravings: The person experiences strong cravings for Ambien.
- Issues with control: The person keeps continuing to use Ambien in spite of a number of negative consequences as a result of using the drug.
Most early sources indicated that by itself Ambien was not an attractive drug of abuse, and it was often abused in conjunction with other drugs, as mentioned above. However, more recent research has determined that the drug does carry the potential for physical dependence, and the abuse of medications such as Ambien often results in the development of physical dependence surprisingly rapidly.
Several factors play an important role in the onset of the development of physical dependence, the severity of the symptoms associated with physical dependence, and the length of the withdrawal process:
- Drug type: The type of drug being used or abused affects the syndrome of physical dependence. For example, opioid drugs, such as heroin, Vicodin, and morphine, have a much higher potential for the development of physical dependence in individuals who use and abuse them than drugs like antidepressant medications and acetaminophen. In addition, individuals who chronically use extended-release forms of drugs will most likely experience more severe and longer withdrawal syndromes. This is because these drugs remain in the system longer and therefore tolerance is higher.
- Length of time and amount used: The amount, length of time, and route of administration used when one takes the drug affects the withdrawal process. Individuals who take higher doses, use the drug over longer periods of time, and use more direct routes of administration, such as injecting, snorting, or smoking, will typically have more severe and prolonged withdrawal syndromes than individuals who take smaller amounts, have used the drug for a shorter period of time, and take it in pill form.
- Polysubstance abuse: The presence of any polysubstance use or abuse will affect the severity and length of the withdrawal syndrome. Individuals who have developed physical dependence on multiple drugs will have more severe, complicated, and lengthier withdrawal syndromes.
- Individual differences: Individual differences in mental health (e.g., the presence of the psychiatric disorder), body size, weight, and physical metabolism will also affect the specifics of the withdrawal syndrome.
Ambien Withdrawal Timeline
Individuals who have been taking Ambien for significant length of time may develop physical dependence on the drug, as mentioned. The withdrawal syndrome associated with Ambien is not as severe and lengthy as the withdrawal syndrome that occurs with drugs like opioids (e.g., morphine, heroin, Vicodin, etc.), benzodiazepines (e.g., Xanax, Valium, Klonopin, etc.), and alcohol. As mentioned above, a number of variables can affect the severity and duration of the withdrawal syndrome.
A general timeline for withdrawal from Ambien is outlined below.
- First 48 hours: Because Ambien has a short half-life (the time it takes the person system to reduce the concentration of Ambien in the body by half its original concentration), individuals who have developed a severe physical dependence on Ambien may begin to experience symptoms within a few hours (e.g., 4-8 hours). The average time that withdrawal symptoms appear is typically around 48 hours. During the first 48 hours, individuals are most likely to experience insomnia (rebound insomnia that occurs as a result of symptoms returning that the drug was designed to control), mood swings, difficulty concentrating, and mild confusion.
- Days 3-5: Symptoms of withdrawal from Ambien will peak between three and five days of discontinuation. Typically, individuals will experience nausea, stomach cramps, shakiness, mood swings, anxiety (panic attacks have been observed), depression, uncontrolled crying, urinary difficulties, flushing, and overall flulike symptoms.
- Weeks 1-2: For most individuals, within a week or two, the symptoms will have subsided. In some cases, psychological symptoms, such as insomnia, depression, and anxiety, may continue, and individuals may experience ongoing cravings for Ambien.
In some cases, it also been noted that individuals going through withdrawal from Ambien develop tremors, hallucinations, and even seizures; however, these are rare.
Withdrawal Management for Ambien
Anyone who has developed a physical dependence on a drug or medication should not discontinue the drug without being under the supervision of a physician. Individuals who are emotionally unstable may be at risk for self-harm due to accidents or even potential suicide during the withdrawal process.
In addition, withdrawal from some drugs, such as benzodiazepines and alcohol, can be potentially fatal due to the development of seizures. While seizures occurring in withdraw from Ambien are rare, it would be a mistake to rule out the potential danger that one could develop seizures during the withdrawal process.
A professional withdrawal program for Ambien would utilize the following steps:
- Assessment: A full assessment should be done to determine the presence of any polysubstance abuse and co-occurring disorders.
- Tapering: A tapering strategy should be used, where the individual is given Ambien in periodic reduced doses in order to slowly wean them off the drug and avoid any negative withdrawal effects. This type of strategy should only be attempted under the supervision of a physician. The withdrawal management process will lengthen the period of withdrawal due to the tapering strategy; however, it will significantly reduce the symptoms of withdrawal.
- Additional medications: Other medications, such as benzodiazepines, anti-nausea medications, etc., may also be used during the withdrawal management process.
- Monitoring: Individuals are observed closely for the first several days of the withdrawal process to ensure that any complications are managed.
Individuals completing the withdrawal management process should enroll in a comprehensive treatment program to deal with the issues that drove their substance abuse and to develop a plan to avoid relapse in the future. Individuals who simply complete a withdrawal management program and do not engage in a complete treatment program that includes therapy, psychoeducation, family support, and participation in social support groups, along with any medical interventions that are needed, are at a higher risk to relapse shortly following their initial recovery. Individuals should remain in long-term aftercare programs for a minimum of five years after completing a withdrawal management program in order to reduce future relapse risk.