GABA and addiction

10What is GABA’s role in the reward system and addiction?

In the brain’s reward circuit there are cells that release GABA whose job is to act as brakes on dopamine cells, stopping them from becoming overactive. A number of addictive substances act on these brakes: suppressing these GABA cells frees the dopamine cells from their restraint, so dopamine rises indirectly.

This mechanism is known, for example, with opioids such as heroin and tramadol, and research suggests a similar role for some sedatives. That is, GABA takes part not only in the “calming” that the person using is looking for, but in reward learning itself.

GABA has a second role that is no less important: many people with anxiety, insomnia or trauma discover that a sedative substance quickly “switches off” their tension, so the brain learns that the fastest route to relief is the substance. This is called self-medication, and it is one of the most common ways into addiction to sedatives and alcohol in Egypt.

11Which addictive substances affect GABA?

What these substances have in common is that they are central nervous system depressants. That is why the most dangerous thing a person can do is combine them, or combine them with opioids: their effect on the breathing centers multiplies, and breathing can stop during sleep.

12Why is pregabalin such a big problem in Egypt?

Pregabalin, best known by its brand name “Lyrica,” is a legitimate medication for nerve pain and epilepsy. But it has spread in Egypt among people who use other substances, especially tramadol, opioids and hashish, in search of calm, or to “boost” their effect, or to ease their withdrawal symptoms.

The lesson from these numbers is that restricting one drug alone does not treat addiction; a person who depended on it may move to another substance if they do not get treatment. Since 2019 the US Food and Drug Administration has also warned of serious breathing problems with pregabalin and gabapentin, especially when combined with opioids or sedatives, or in older adults and people with lung disease.

13How does the GABA system adapt to use and produce tolerance?

When the brain receives an outside sedative every day, it works to regain its balance: the makeup of GABA-A receptors and their subunits changes so they become less sensitive, natural GABA production falls, and at the same time activity of the excitatory glutamate rises to offset the excess inhibition.

Physical dependence can occur even with regular medical use over a long period, without misuse. That is why doctors usually prescribe benzodiazepines for short periods and plan to stop them from the start.

14Why does withdrawal from GABA substances cause seizures?

When a person suddenly stops, the brain is left with less sensitive GABA receptors and more active glutamate, meaning weak brakes and a pressed accelerator. The result is overexcitation that begins with tremor, anxiety, insomnia, sweating and a fast heartbeat, and may progress to hallucinations, seizures and delirium. Medical references describe withdrawal from alcohol, benzodiazepines and barbiturates as among the life-threatening kinds of withdrawal.

The time frames are approximate and vary with the substance, length of use, amount, health status and history of previous withdrawal episodes. Details for each substance are on the pages alcohol withdrawal symptoms, Xanax withdrawal and pregabalin withdrawal.

15Why is safe medical detox needed for GABA substances?

Because seizures and delirium can happen suddenly, and the family at home cannot monitor vital signs or give the right medications at the right time. In medical detox, the team assesses the severity of dependence and the risks, then uses medications chosen by the doctor to prevent seizures and delirium and tapers them gradually according to a plan, while treating nutritional deficiency and dehydration and monitoring continuously.

• Do not suddenly stop alcohol, sedatives or pregabalin after long daily use without consultation.
• Do not make up your own tapering plan from the internet; the plan differs by substance and by case.
• Do not swap one substance for a “milder” one without a doctor; you may move from one dependence to another.
• If you have a history of seizures or delirium in a previous withdrawal, supervision inside a medical facility is essential.
• Tell the doctor everything you use; a mixture changes the withdrawal plan completely.

16How does the GABA system recover after stopping?

The brain is able to regain its balance. After safe detox, GABA receptors gradually begin to regain their sensitivity and glutamate activity settles. Acute symptoms usually fade within days to weeks, while some people, especially after long-term benzodiazepine use, go through a prolonged phase of anxiety and sleep disturbance that improves slowly over weeks or months.

1. The first days
   Acute withdrawal

   The most dangerous phase, managed by the medical team to prevent seizures and delirium.

2. The following weeks
   Gradual easing

   Sleep and anxiety improve gradually, with normal ups and downs.

3. The first months
   Rebalancing

   Mild anxiety and insomnia symptoms may persist in some people, and psychotherapy helps get past them without a substance.

4. In the long term
   Relapse prevention

   Stress-coping skills, treatment of accompanying anxiety or depression, and regular follow-up.

17How does treatment help with addiction to GABA substances?

Medical detox is the beginning, not the whole treatment. Someone who has been calming their anxiety with a substance needs to learn new ways, which cognitive behavioral therapy helps with, along with treatment of accompanying anxiety, insomnia and trauma with non-dependence-forming medications when needed, plus relapse prevention programs. This is called dual diagnosis treatment.

Some people may turn to compulsive behaviors to calm anxiety instead of substances, such as smoking or excessive phone use, and they benefit from the Smoking and Nicotine Addiction guide and other behavioral addictions within a comprehensive recovery plan.

18How should the family act with a person with an addiction to alcohol or sedatives?

• Don’t force them to stop suddenly at home, and don’t suddenly hide their medication; this can cause dangerous withdrawal.
• Learn the emergency signs: seizure, severe confusion, hallucinations, extreme drowsiness and slow breathing, and call 123 immediately.
• Keep sedative medications in the home stored away and tracked, and don’t share your medications with anyone.
• Talk calmly about the anxiety and insomnia underlying the use, not only about “weak willpower.”
• Ask for specialist consultation even if the person refuses at first; family guidance alone changes a great deal.

At Eradah we provide safe medical detox under a specialist team for alcohol, benzodiazepines, pregabalin and mixed substances, followed by psychological and drug treatment of accompanying conditions and a relapse prevention program with family involvement, in complete confidentiality.