Barbiturate Misuse and Addiction: Signs, Risks, and Treatment

Barbiturates are sedative-hypnotic drugs that work by reducing activity in the brain and central nervous system, inducing drowsiness and regulating many functions throughout the body, including alertness, arousal, and a person’s overall level of excitation or relaxation.¹ Once commonly prescribed for anxiety disorders, sleep problems, and seizures, barbiturates are used much less often today, mostly because the difference between a therapeutic dose and a potentially toxic dose can be small, and safer medications are now available.^1,2

Unfortunately, barbiturates are still misused today, although far less commonly than illicit drugs like cocaine or prescription opioids, stimulants, and benzodiazepines. In 2021, the National Survey on Drug Use and Health conducted by SAMHSA estimated that 756,000 Americans ages 12 and older used prescription barbiturates within the past year, while 51,000 reported misusing them during that time.³

What Are Barbiturates?

Barbiturates are in a class of drugs known as central nervous system depressants—often referred to as "downers"—which reduce certain types of brain activity, producing calming and sedating effects.² They enhance the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter and brain chemical that makes nerve cells less excitable and reduces communication between them.² These actions on the central nervous system help make barbiturates effective at reducing anxiety, promoting sleep, and controlling seizures.^1,2

Doctors once prescribed barbiturates on a more frequent basis, but they are used much less often now.² Because barbiturates carry a higher risk of overdose than many alternatives, safer medicines have largely replaced them, though they are still used in some surgical procedures and to treat seizure disorders.2 Today, barbiturates are classified as controlled substances in the United States, regulated under the Controlled Substances Act.^1,4

Types of Barbiturates

Barbiturates are traditionally grouped by how quickly they act and how long their effects last, ranging from ultra-short-acting to long-acting.¹ The shorter-acting barbiturates have historically been the most frequently misused and most commonly linked to barbiturate addiction.¹

Common types of barbiturates include:¹

• Luminal (phenobarbital), a long-acting barbiturate used to treat seizures and sometimes to manage alcohol withdrawal.
• Amytal (amobarbital), an intermediate-acting barbiturate historically used for sedation.
• Nembutal (pentobarbital) and Seconal (secobarbital), shorter-acting drugs once used for sleep and sedation.
• Pentothal (thiopental) and Brevital (methohexital), ultra-short-acting drugs used in anesthesia.

Barbiturate Misuse vs. Addiction

Dependence and addiction often overlap, but they are not the same thing, and understanding dependence vs. addiction can help you make sense of what you or a loved one is going through.

Barbiturate (or any prescription drug) misuse occurs when:⁵

• They are taken outside the guidelines of how it was prescribed.
• Someone uses another person’s prescription.
• They are used to get high or experience other desired effects.

Barbiturate misuse can quickly become difficult to control as tolerance and dependence develop.² Tolerance occurs when increasingly larger amounts are needed to achieve the same effects, while dependence occurs when the body adapts to the drug and withdrawal symptoms develop if use is suddenly stopped.² Neither tolerance nor physical dependence necessarily means that a person has an addiction, though they can contribute to patterns of escalating or problematic use that increase the risk of addiction for some people.

When barbiturate use does become compulsive and difficult to control despite harmful or negative consequences, it may signal the development of addiction, or a substance use disorder.⁶

Health Effects of Barbiturate Misuse

Barbiturate misuse can cause a wide range of health effects, some of which can be serious or life-threatening. With regular or prolonged misuse, barbiturates can have significant cognitive, behavioral, and physical effects, including:⁷

• Memory problems.
• Reduced attention span.
• Difficulty thinking clearly or understanding and processing information.
• Difficulty controlling the muscles used for speech (dysarthria).
• Slowed or slurred speech.
• Rapid or unpredictable changes in mood.
• Development of tolerance.
• Physical dependence.

Signs and Symptoms of Barbiturate Addiction

An addiction to a prescription medication like a barbiturate can only be diagnosed by a qualified healthcare professional. They will use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine whether a formal substance use disorder (SUD) diagnosis is appropriate.

Clinically, a barbiturate addiction is referred to as a sedative, hypnotic, or anxiolytic use disorder.⁸ A diagnosis requires at least 2 of the following criteria to occur within a 12-month period:⁸

• Taking barbiturates in larger amounts or for longer than intended.
• Wanting to cut down or control use, or trying without success.
• Spending a lot of time getting, using, or recovering from barbiturates.
• Experiencing strong cravings or urges to use.
• Failing to keep up with responsibilities at work, school, or home.
• Continuing to use despite ongoing relationship problems it causes.
• Giving up important activities because of use.
• Using in situations where it is physically dangerous.
• Continuing to use despite knowing it is causing physical or psychological harm.
• Needing more to get the same effect, known as tolerance.
• Experiencing withdrawal when not using.

Reviewing these criteria can help you recognize patterns that may warrant professional evaluation; however only a healthcare provider can make the official diagnosis. If you are concerned that you may be experiencing an addiction to barbiturates, contact your primary care provider or therapist for next steps.

What Causes Barbiturate Addiction?

Repeated barbiturate use can cause the brain to adapt to the drug, which may result in tolerance and physical dependence.¹ Chronic or high-dose use increases these risks, and for some people, tolerance and dependence can contribute to escalating patterns of use that become increasingly difficult to control and may eventually develop into addiction.^2,6

But, no single factor causes barbiturate addiction. Instead, addiction develops through a complex interaction of biological, behavioral, and environmental factors.⁶

Individual and Biological Factors

A variety of individual characteristics and experiences can influence a person’s risk of developing an addiction, including barbiturate addiction. These factors can include:^6,9

• Biological sex.
• Early use of drugs or alcohol.
• Family history of mental health disorders or addiction.
• Having a mental health disorder, such as anxiety or depression.
• Certain characteristics like risk-taking, sensation-seeking, or aggressive behavior.

A person’s environment and life experiences can also influence their risk of developing an addiction. Environmental risk factors that lend themselves to potential addiction development include:^6,9

• Trauma.
• Chronic stress.
• Abuse and/or neglect.
• Lack of parental supervision.
• Being around peers who use drugs/misuse alcohol.
• Living in neighborhoods with high levels of poverty or violence.

Barbiturate Overdose

If you think someone is overdosing on barbiturates or any other substance, call 911 immediately. If you have naloxone (Narcan) available, administer it—even if you are unsure whether opioids are involved. Naloxone does not reverse a barbiturate overdose, but it will not harm someone who does not have opioids in their system. It can be lifesaving if opioids were taken, either knowingly or unknowingly.10Stay with the person and follow the 911 operator’s instructions until emergency medical services arrive.

The most serious risk of barbiturate misuse is overdose, which can happen quickly and without much warning.1 An overdose occurs when someone takes enough of a substance to cause serious or life-threatening effects.

Signs of a barbiturate overdose can include the following:^7,11

• Confusion or decreased consciousness
• Respiratory depression
• Abnormal heart rate and rhythm
• Decreased blood pressure
• Decreased body temperature
• Decreased urine output
• Coma

When barbiturates are used simultaneously with opioids or other CNS depressants, such as alcohol and benzodiazepines, their effects can compound, increasing the risk of severe respiratory depression, overdose, and death.¹²

Barbiturate Withdrawal Symptoms

When significant physical dependence on a barbiturate has developed, reducing or stopping the it can cause drug withdrawal symptoms, which may include:⁷

• Anxiety.
• Insomnia.
• Dizziness.
• Weakness
• Tremor.
• Nausea.
• Vomiting.

Stopping barbiturates suddenly after regular or prolonged use can be dangerous. Barbiturate withdrawal can cause potentially life-threatening complications, including seizures, hallucinations, and delirium, which is why it is highly recommended to obtain medical supervision prior to quitting cold turkey.²

Barbiturate Addiction Treatment

Barbiturate addiction is treatable, and effective treatment options often combine medically supervised detoxification with ongoing therapy and support.¹³ For people who have developed physical dependence, treatment may begin with medically supervised detox and withdrawal management. Because barbiturate withdrawal can be dangerous, the treatment team can monitor symptoms and help reduce the risk of serious complications.^7,13

From there, many people move through one or more treatment programs and levels of care as their needs change and they become more stable in recovery. These levels of care include:¹⁴

• Inpatient treatment: Provides a highly structured treatment environment with 24/7 care and support. Treatment may include behavioral therapy, individual and group counseling, medication management, and support for co-occurring disorders and mental health conditions.
• Partial hospitalization programs (PHP): Provides intensive treatment for several hours a day, multiple days per week, without requiring you to live at the treatment facility.
• Intensive outpatient programs (IOP): Offers structured therapy and support several days per week while allowing you to continue living at home and maintain more of your daily responsibilities.
• Outpatient treatment: Provides the most flexible level of care, with regularly scheduled therapy, counseling, and other recovery services while you live at home and continue with work, school, or family responsibilities.

There is no medication approved specifically to treat barbiturate addiction, but medication can still help manage withdrawal safely and treat any co-occurring conditions.¹³

There Is Hope for Recovery

Addiction is treatable, and a life of freedom is possible. Connect withdrug and alcohol treatment centers that specialize in your specific needs, from holistic care and connecting you to support groups to medication-assisted treatment. Don’t wait another day to get help; find a recovery program that works for you.