Comparison of the use of hypnotics and benzodiazepines in patients with alcohol dependence with or without sleep disturbances

Introduction: Hypnotics and benzodiazepines are frequently used to relieve sleep disturbances such as insomnia in alcoholic patients. The study compared hypnotics and benzodiazepines use in alcoholics with or without insomnia. Methods: Male patients with alcohol dependence, diagnosed with Structured clinical interview according to DSM-IV criteria, and a Structured questionnaire for the history of hypnotic and benzodiazepine use, from the Clinics for psychiatry Vrapce, Department for alcoholism and other addictions, were subdivided according to the items 4, 5 and 6 of the Hamilton Depression Rating Scale into 51 with, and 41 patients without early, middle or late insomnia. They received zolpidem, nitrazepam, midazolam, flurazepam, diazepam, oxazepam, alprazolam, lorazepam, or bromazepam. The results were evaluated with one-way ANOVA or Mann Whitney Rank Sum Test. Results: HDRS scores differed significantly (P<0.001) between patients with or without early, middle or late insomnia. The prescription of the first medication differed significantly (P=0.014) since more patients with than without insomnia used medication without prescription, in higher doses than prescribed (P = 0.007), or longer than one month (P<0.001). Insomnia occurred at similar age (38.8±10.2 vs. 38.9±14.3 years) in both groups (P=0.972), who did not differ according to later use of medication without prescription (P = 0.428) or information about the side effects of medication (P = 0.151). Conclusions: These preliminary data confirmed that alcoholics with insomnia frequently self-medicate and use hypnotics and benzodiazepines in higher doses and longer period than prescribed. Closed monitoring is advised to evade self-medication, potential side effects and worsening of addiction.