Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
11.7 Major clinical issues with gambling and benzodiazepine use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence
2. Management of people with comorbidity of mental disorders and substance use- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 11.1 Gambling
- 11.2 Comorbidity with gambling
- 11.3 Major clinical issues with gambling and cannabis/ hallucinogen use
- 11.4 Major clinical issues with gambling and alcohol use
- 11.5 Major clinical issues with gambling and opioid use
- 11.6 Major clinical issues with gambling and stimulant (including methamphetamine) use
- 11.7 Major clinical issues with gambling and benzodiazepine use
- 11.8 Major clinical issues with gambling and inhalant/ solvent use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- Benzodiazepines will interfere with response to psychological treatments in a dose-related manner.
- Benzodiazepine use should be discouraged and reduced. Cessation should be a long-term goal with the introduction of alternative management strategies.
11.7.1 Effects of benzodiazepines on problem gambling
- Comorbid benzodiazepine use and gambling is not commonly reported.
- High doses of benzodiazepines (or low doses combined with alcohol) can increase risk taking, impulsive behaviours(499) and cognitive impairment, all of which are likely to result in adverse consequences in people with problem gambling.
11.7.2 Interactions between benzodiazepines and therapeutic agents for problem gambling
- Benzodiazepines can exacerbate the sedative effects of tricyclic antidepressants, and mood stabilisers (lithium and sodium valproate). This increases the risk of impaired driving and injury as well as overdosex.
- Benzodiazepines and antidepressants are both metabolised by CYP 450 enzymes which may result in the inhibition or induction of either drug group. Therefore, individuals should be monitored closely to ensure they are experiencing the appropriate therapeutic effectx.
- Fluvoxamine will inhibit the metabolism of alprazolam, midazolam, triazolam and diazepam causing increased sedation and potential toxicityx.
- Citalopram and sertraline are the least likely SSRIs to have cytochrome mediated drug interactionsx.
11.7.3 Management approaches to comorbid problem gambling and benzodiazepine use
- Benzodiazepines will interfere with response to psychological treatments in a dose-related manner(196)
- Benzodiazepine use should be discouraged and reduced. Cessation should be a long-term goal with the introduction of alternative management strategies.
- If large quantities of benzodiazepines (e.g. 40mg diazepam daily equivalent or more) are being consumed, then inpatient withdrawal to lower levels should be considered to avoid and manage seizure risk(194).
- If dependence has developed, then graduated withdrawal through slow reduction of dosage should be commenced****(194-196), possibly after transferring the patient onto a long acting benzodiazepine.
- If long-term benzodiazepine use is indicated, then:
- This should be subject to a contract with the patient.
- Authorities should be advised, including registration with the relevant local government health authority.
- The seeking of additional benzodiazepines from other prescribers should be monitored (e.g. using the Authority to release personal PBS claims information to a third party form).
- Daily or weekly dispensing of benzodiazepines should be considered and may assist with controlling use.
