A decade ago, in 2010, the Drug Enforcement Agency spearheaded a nationwide initiative to take back unused prescription medications. This move aimed to heighten public awareness about the potentially lethal implications of prescription drug misuse. Despite these efforts, the prevalence of misuse and its consequences remain concerning.

Astonishingly, the Centers for Disease Control and Prevention has documented that accidental prescription drug overdoses claim the lives of more than 20,000 individuals annually. Deaths from drug overdose continue to be a public health burden in the United States (Hedegaard et al. 2018). High-profile cases, such as those of Prince, Heath Ledger, Anna Nicole Smith, Michael Jackson, and Tom Petty are just a few examples of drug overdose deaths. It’s important to note that drug overdose can affect individuals from all walks of life, and countless other cases occur outside the spotlight. 

These cases have underscored the fatal risks of combining different prescription drugs, or what we refer to as “drug cocktails”. These lethal combinations often include drugs for pain management, depression, and anxiety such as oxycodone, hydrocodone, alprazolam, diazepam, temazepam, and doxylamine.

In our current society, many individuals grapple with common disorders like depression, anxiety, and sleep issues. The quest for relief often leads to the use of over-the-counter sleep aids and pills, sometimes coupled with alcohol. This creates a harmful loop, as substances like alcohol found in common antihistamines like Nyquil or Benadryl may induce sleep but hinder the deep restorative stages of sleep, causing frequent wakefulness. Alcohol can further exacerbate apneic events, leaving individuals feeling unrefreshed or groggy upon waking.

In my clinical practice, I have encountered patients relying on a risky mix of hard alcohol, over-the-counter antihistamines, and benzodiazepines like Valium, Ativan, or Xanax. Those who have been using such combinations for a prolonged period often exhibit heightened anxiety about their sleep patterns, particularly if they have demanding responsibilities the next day. It’s a long journey, typically taking 4 to 8 months, to gradually discontinue each medication and replace it with effective Cognitive Behavioral Therapy (CBT) strategies to manage insomnia and anxiety.

The co-occurrence of depression, anxiety, and sleep disorders is not unusual (Alvaro et al 2013). This complex interplay, when tackled with prescription drugs, over-the-counter medications, and alcohol, can lead to severe addiction and even death. It is high time we reconsider our approach to managing these disorders.

Modern psychological and therapeutic interventions offer a wealth of strategies to address these concerns. Cognitive Behavioral Therapy, combined with a holistic approach involving nutritional analysis and physical exercise, has shown promising results in recovery (Garraway 2016). With careful, individualized guidance, it’s possible to disentangle patients from the harmful patterns of prescription drug misuse and steer them toward healthier, sustainable alternatives for managing their mental health.

Charles R. Freeman, Ph.D.  | Sleep, Pain, Behavioral Medicine Psychologist & Addictionologist  |  Available online via teletherapy and in-person in San Diego

References

Alvaro, P.K., Roberts, R.M., & Harris, J.K. (2013). A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. Sleep, 36 7, 1059-1068.

Garraway, H. (2016). ‘Free to be me’: Introducing a holistic approach to cognitive behavior therapy. Clinical Psychology Forum.

Hedegaard, H., Miniño, A.M., & Warner, M. (2018). Drug Overdose Deaths in the United States, 1999-2017. NCHS data brief, 329, 1-8 .

This blog post is authored by Dr. Charles R. Freeman, PhD, a psychologist specializing in sleep disorders and cognitive-behavioral therapy. The information provided here is for educational purposes and should not be considered as medical advice. Please consult a healthcare professional for personalized medical advice.