Gabapentin Addiction: Signs, Causes, Effects, and Treatment

Gabapentin addiction is a condition shown by the continuous usage of the drug gabapentin despite the effects it has on its users. When individuals misuse the medication, it leads to physical and psychological dependence. 

According to Lennox, R.’s 2019 study, ‘Gabapentin misuse, ’ 15-22% of people with opioid use disorder report gabapentin misuse. Research indicates users consume gabapentin through oral, intranasal, and intravenous routes, with doses ranging from therapeutic levels (<3600 mg/day) to supratherapeutic amounts (12,000 mg/day). Coprescribed gabapentin and opioids increase death risk compared to opioids alone, with moderate-dose (900-1799 mg) and high-dose (>1800 mg) gabapentin associated with approximately 60% increased risk of opioid-related death.

Signs of gabapentin addiction include excessive drowsiness, confusion, and uncoordinated movements. Individuals also exhibit behaviors such as doctor shopping, using higher doses than prescribed, and continuing use despite negative consequences. Psychological signs include anxiety, depression, and cravings for the drug.

Gabapentin addiction is caused by its misuse for recreational purposes or to enhance the effects of other substances. Risk factors include a history of substance abuse, mental health disorders, and chronic pain conditions. The drug’s availability and perceived safety also contribute to its misuse.

The effects of gabapentin addiction include physical health issues such as dizziness, fatigue, and respiratory depression. It also leads to psychological problems like mood swings, depression, and cognitive impairment. 

Treatment for gabapentin addiction involves a combination of medical detoxification, behavioral therapies, and support groups. Cognitive-behavioral therapy (CBT) and motivational interviewing (MI) are effective in addressing the psychological aspects of addiction. Support groups like Narcotics Anonymous (NA) also provide peer support and accountability during recovery.

What is Gabapentin Addiction?

Gabapentin addiction is a type of substance use disorder characterized by the compulsive misuse of gabapentin, a prescription medication primarily used to treat nerve pain and seizures. According to the American Journal of Medicine (2020), 1.1% of the general population has reported misusing gabapentin.

Unlike other substance use disorders that often involve substances like opioids, stimulants, or alcohol, gabapentin addiction frequently begins with the legitimate use of the drug for its FDA-approved purposes, such as treating epilepsy and neuropathic pain. However, its off-label uses—such as for managing anxiety, insomnia, and even opioid withdrawal symptoms—have significantly contributed to its misuse and addiction potential.

Gabapentin’s abuse potential stems from its ability to produce euphoric effects and enhance the impacts of other substances, particularly opioids. This has led to an increasing trend of misuse, with studies indicating that approximately 1.1% of the general population and up to 22% of individuals with opioid addiction misuse gabapentin. The drug’s accessibility and perception as a “safer” alternative to more potent opioids often lead individuals to misuse it in attempts to self-medicate or intensify the effects of their primary drug of abuse.According to “Gabapentin Abuse Potential” by Smith et al., Journal of Clinical Psychiatry (2016), the misuse of gabapentin is particularly prevalent among individuals with a history of substance abuse, highlighting the need for careful monitoring and regulation of its prescription and use.

What are the Symptoms of Gabapentin Addiction?

The symptoms of Gabapentin addiction include physical manifestations like headaches, dizziness, nausea, and tremors, psychological effects such as mood swings, irritability, depression, and anxiety, as well as behavioral changes including secretive behavior about medication use, neglect of responsibilities, and legal or financial difficulties.

Here are the common symptoms of Gabapentin addiction:

Physical Symptoms

The physical symptoms of gabapentin addiction refer to the changes that deviate from an individual’s normal physical function. 

Here are the physical symptoms of Gabapentin addiction:

• Headaches: A common discomfort characterized by pain or pressure in the head, often resulting from withdrawal from alcohol.
• Dizziness: A sensation of lightheadedness or unsteadiness, which occurs as the body adjusts to the absence of alcohol.
• Nausea: A feeling of sickness with an urge to vomit, frequently experienced during the withdrawal process.
• Tremors: Involuntary shaking or trembling of the body, particularly noticeable in the hands, often associated with alcohol withdrawal.

Psychological Symptoms

Psychological symptoms of gabapentin addiction refer to the emotional and cognitive changes that occur in response to chronic gabapentin use.

Here are the psychological symptoms of Gabapentin addiction:

• Mood Swings: Rapid and intense changes in emotional state, which fluctuate between feelings of euphoria and sadness during withdrawal.
• Irritability: A heightened state of agitation or frustration, commonly experienced as the body reacts to the lack of alcohol.
• Depression: A persistent feeling of sadness or loss of interest, which intensifies during withdrawal due to chemical imbalances in the brain.
• Anxiety: A state of excessive worry or fear, often exacerbated by the stress of withdrawal and the challenges of recovery.

Behavioral Changes

Behavioral symptoms of gabapentin addiction refer to the observable actions and habits that indicate a person’s dependence on the substance. 

Here are the behavior symptoms of Gabapentin addiction:

• Increased Secrecy About Drug Use: A tendency to hide or lie about alcohol consumption, reflecting a desire to conceal the extent of the problem from others.
• Neglect of Personal Responsibilities: A decline in the ability or willingness to fulfill daily obligations, often resulting from prioritizing alcohol use over personal or professional duties.
• Legal or Financial Problems Related to Drug Use: Complications arising from alcohol-related behaviors, such as arrests or financial difficulties, which stem from impaired judgment and decision-making.

What Are The Gabapentin Withdrawal Symptoms?

Gabapentin withdrawal symptoms include restlessness, disorientation, confusion, agitation, anxiety, headache, light sensitivity, and nervousness.

According to Hellwig, T. R.’s 2010 case report, ‘Withdrawal symptoms after gabapentin discontinuation’, a 53-year-old woman developed withdrawal symptoms after gabapentin was discontinued during her hospitalization. On day 3, she experienced restlessness, disorientation, confusion, agitation, and anxiety. By days 4-5, she also developed headache, light sensitivity, and increasing nervousness. These symptoms did not respond to benzodiazepines but completely resolved when gabapentin was restarted on day 5, confirming they were likely withdrawal symptoms rather than alcohol withdrawal as initially suspected.

What Causes Gabapentin Addiction?

The causes of gabapentin addiction are a combination of genetic, environmental, and psychological factors. These factors influence the likelihood of misuse and dependency on the drug, contributing to its growing prevalence.

Here are the common causes of gabapentin addiction:

Genetic Factors

Genetic factors refer to inherited traits that influence an individual’s susceptibility to addiction, including gabapentin addiction. Genetic factors determine how a person metabolizes the gabapentin, as well as their predisposition to developing dependency or addictive behaviors.’

The following are genetic factors affecting gabapentin addiction:

• Genetic Predisposition: This refers to an inherited genetic makeup that increases an individual’s likelihood of developing substance use disorders. Some individuals have a genetic predisposition to substance use disorders, including gabapentin addiction. Genetic variations affect how a person metabolizes gabapentin and their susceptibility to its euphoric effects. According to an article titled Genetic Influences on Substance Use Disorders by Nora D. Volkow in the Journal of Clinical Psychiatry, “genetic factors account for 40-60% of the risk for substance use disorders, including those related to gabapentin.”
• Neurobiological Factors: Biological mechanisms influence brain processes related to rewards and pleasure, impacting addiction likelihood. Genetic factors influence the brain’s reward system, affecting neurotransmitter responses, including dopamine and GABA, to drugs. Genetic differences increase the likelihood of certain individuals experiencing intense pleasure or anxiety relief from gabapentin, leading to repeated use and eventual addiction.

Environmental Factors

Environmental factors refer to external conditions or influences, such as social surroundings, stress, and access to substances, that contribute to the likelihood of developing addiction. Individuals in environments with high-stress levels, peer pressure, or easy access to gabapentin are more at risk of misuse and dependency. 

The following are environmental factors affecting the causes of gabapentin addiction:

• Availability and Accessibility: Gabapentin’s widespread prescription for various conditions, including neuropathic pain and anxiety, makes it readily accessible, increasing the risk of misuse. The perception of gabapentin as a safer alternative to opioids led to its overprescription and subsequent abuse. According to Smith, R. V.’s 2016 study, ‘Gabapentin misuse, abuse and diversion: a systematic review.’, gabapentin misuse is surprisingly common among individuals who have legitimate prescriptions, with rates ranging from 40-65%. This represents a significant concern since gabapentin is widely prescribed, often for off-label uses, which account for 83-95% of all gabapentin prescriptions. The study found that individuals take larger doses than prescribed, creating potential risks for adverse effects, dependence, and withdrawal symptoms.
• Peer Influence and Social Environment: Social circles and peer pressure significantly impact drug use behaviors. Individuals in environments where drug use is prevalent are more likely to experiment with and misuse gabapentin. Social acceptance of using medications for non-medical purposes also contributes to addiction. According to an article titled Social Influences on Substance Use by John E. Schulenberg in the Journal of Adolescent Health, “peer pressure and social environments where drug use is normalized increase the likelihood of substance abuse by up to 50%.”
• Stressful Life Events: These are significant life challenges that increase the likelihood of substance use as a coping mechanism. Environmental stressors such as trauma, financial difficulties, and relationship problems drive individuals to misuse gabapentin as a coping mechanism. The drug’s calming and soothing effects provide temporary relief, reinforcing its use during stressful times.

Psychological Factors

Psychological factors refer to mental and emotional conditions that drive a person to misuse the drug. Individuals develop a dependency on gabapentin to manage stress or emotional pain, leading to compulsive use despite harmful consequences.

The following are psychological factors affecting the cause of gabapentin addiction:

• Co-occurring Mental Health Disorders: This refers to the presence of both a mental health disorder and a substance use disorder in an individual. Individuals with mental health disorders such as anxiety, depression, and bipolar disorder are at a higher risk of developing gabapentin addiction. These individuals misuse gabapentin to self-medicate their symptoms, leading to dependency. According to an article titled Comorbidity of Mental Health and Substance Use Disorders by Ronald C. Kessler in the Journal of Clinical Psychiatry, “Individuals with mental health disorders are twice as likely to develop a substance use disorder, including addiction to medications like gabapentin.”
• Personality Traits: These are enduring characteristics that influence an individual’s behavior, including their propensity for risk-taking and substance use. Certain personality traits, such as impulsivity, sensation-seeking, and tenacity for risk-taking, are associated with a higher likelihood of substance abuse. These traits drive individuals to experiment with drugs like gabapentin, increasing the risk of addiction. According to an article titled Personality Traits and Substance Use by Sarah W. Feldstein Ewing in the Journal of Abnormal Psychology, “impulsivity and sensation-seeking behaviors are associated with a 40-60% increased risk of substance abuse.”
• Previous Substance Use: A history of substance use or addiction to other drugs significantly increases the risk of gabapentin misuse. According to Smith, R. V.’s 2016 study, ‘Gabapentin misuse, abuse and diversion: a systematic review.’, gabapentin is frequently misused in combination with other substances, especially opioids, benzodiazepines, and alcohol, which enhance or alter its effects. Among opioid users specifically, gabapentin misuse rates range from 15-22%, suggesting it’s particularly popular in this population. The recreational effects reported included experiences reminiscent of opioids, benzodiazepines, and psychedelics, with users describing a “high” that could include euphoria, improved sociability, relaxation, and sensations comparable to marijuana or MDMA. This recreational use occurred across various doses, including those within clinical recommendations, indicating that even properly prescribed amounts are misused for their psychoactive effects.

What Are The Effects of Gabapentin Addiction?

The effects of Gabapentin addiction include physical symptoms like dizziness, drowsiness, impaired coordination, respiratory depression, and withdrawal symptoms, psychological effects such as mood swings and cognitive impairment, and behavioral changes including isolation and poor decision-making.

Here are the common effects of Gabapentin addiction:

Short-Term Effects of Gabapentin Addiction

Individuals addicted to gabapentin experience a range of physical and psychological symptoms that are both troubling and dangerous.

Physical Health Effects of Gabapentin Addiction

The physical health effects of gabapentin addiction include dizziness, impaired coordination, blurred vision, gastrointestinal issues, tolerance, dependence, and organ damage. Continuous abuse results in serious long-term health complications, including difficulty breathing and reduced motor function.

The following are the most important physical health effects of gabapentin addiction:

• Withdrawal Symptoms: These are physical and psychological symptoms that occur when an individual stops or reduces their intake of a substance they are dependent on. Acute withdrawal symptoms include anxiety, sweating, nausea, and insomnia. These symptoms are severe and drive continued use of the drug to avoid discomfort.
• Drowsiness and Fatigue: This refers to excessive sleepiness and a general lack of energy or motivation. Misuse of gabapentin often results in excessive drowsiness, dizziness, and general fatigue, impairing daily functioning.
• Respiratory Depression: This is a condition where breathing becomes slow and insufficient, often due to the effects of depressant drugs. High doses of gabapentin slow breathing, leading to respiratory depression, especially when combined with other depressants like opioids. According to Shrestha, S.’s 2020 study, ‘Respiratory concerns of gabapentin and pregabalin: What does it mean to the pharmacovigilance systems in developing countries?.’, gabapentin contributed to 15 cases (30.6%) of respiratory depression during a five-year monitoring period, with 24% of affected patients dying as a direct result. Research confirmed 92% of cases involved patients with respiratory risk factors or concurrent CNS depressant use. The FDA issued a safety alert highlighting these serious breathing concerns in December 2019.

Psychological Effects of Gabapentin Addiction

The psychological effects of gabapentin addiction include mood swings and cognitive impairment, memory problems, and academic performance.

The following are the common  psychological effects of gabapentin addiction:

• Mood Swings: These are sudden and intense changes in emotional state. Users experience intense mood swings, ranging from euphoria to severe depression and anxiety.
• Cognitive Impairment: This refers to a reduction in mental functions such as memory, concentration, and problem-solving. Short-term use of gabapentin causes memory problems and difficulty concentrating, which affect academic and work performance. According to Oh, G.’s 2021 study, ‘The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition, ’ Gabapentin users showed 55% higher odds of cognitive decline within the first year. These users experienced nearly double (94% higher) odds of decline in the CDR sum of box scores. By the second year, gabapentin users had 78% higher odds of functional status decline. Falls increased dramatically, with users having 2.5 times higher odds of falling within two years. The data demonstrates clear negative effects on cognition, daily functioning, and motor control following gabapentin use.

Behavioral Effects Of Gabapentin Addiction

The behavioral effects of gabapentin addiction include social isolation and impaired judgment.

The following are the most important behavioral effects of gabapentin addiction:

• Impaired Judgment: This involves the inability to make sound decisions, often leading to risky behaviors. Addiction leads to risky behaviors such as driving under the influence and poor decision-making.
• Isolation: This is the act of withdrawing from social interactions and relationships. Individuals withdraw from social interactions and isolate themselves to hide their drug use.

Long-term Effects of Gabapentin Addiction

The long-term effects of gabapentin addiction are effects that occur after a long period of use of the drug. They occur due to severe physical dependence on the drug and significantly impact the overall quality of life. 

The following are the long-term effects of gabapentin addiction:

• Chronic Fatigue and Weakness: This refers to a persistent state of tiredness and reduced physical strength. Long-term use leads to persistent fatigue and muscle weakness, significantly impairing physical health.
• Gastrointestinal Issues: These are problems related to the digestive system, including nausea, vomiting, and constipation. Prolonged use causes chronic nausea, vomiting, and constipation, leading to severe digestive problems.
• Liver and Kidney Damage: This involves harm to the liver and kidneys, which impair their ability to function properly. Long-term misuse strains the liver and kidneys, leading to potential damage or failure.
• Severe Cognitive Impairment: This refers to significant and lasting reductions in mental abilities. Extended use results in lasting cognitive deficits, including impaired memory, concentration, and executive function.
• Mental Health Disorders: These are psychological conditions that affect mood, thinking, and behavior. Long-term misuse exacerbates existing mental health issues or leads to new conditions such as depression, anxiety, and psychosis.
• Dependence and Tolerance: Dependence is a condition where the body relies on a drug to function normally, while tolerance is the need for increased doses to achieve the same effect. Over time, individuals develop tolerance, requiring higher doses to achieve the same impact, increasing the risk of overdose and dependence.
• Neglect of Responsibilities: This refers to the failure to fulfill personal, professional, or social obligations. Chronic addiction often leads to significant neglect of personal, experienced, and social responsibilities.
• Relationship Strain: This describes the tension and difficulties in personal relationships caused by addiction. Addiction causes severe strain in relationships with family and friends due to erratic behavior, secrecy, and neglect.
• Financial Problems: These involve monetary difficulties that arise from the costs associated with sustaining an addiction. The cost of maintaining an addiction leads to financial problems, debt, and legal issues.
• Social Isolation: This is the withdrawal from social interactions and activities, often to conceal addiction. Prolonged addiction results in social isolation as individuals withdraw from their social circles to hide their addiction.

How Gabapentin Affects the Brain?

Gabapentin affects brain chemistry by binding to voltage-gated calcium channels, specifically the alpha-2-delta subunit, which reduces the release of excitatory neurotransmitters like glutamate and substance P. Despite its structural similarity to GABA, it doesn’t bind directly to GABA receptors but enhances GABAergic activity indirectly, producing anxiolytic and sedative effects. Chronic use influences the brain’s reward system by affecting dopamine levels, contributing to addiction through three key pathways: neuronal plasticity (changes in brain structure making it more sensitive to the drug), disruption of reward circuitry (affecting the nucleus accumbens and prefrontal cortex, crucial for decision-making and pleasure), and the development of tolerance and physical dependence. According to NIDA and the Mayo Clinic, these changes lead to the need for higher doses to achieve the same effects and withdrawal symptoms upon cessation, creating a cycle of addiction where the brain requires gabapentin to function normally despite negative consequences.

How is Gabapentin Addiction Diagnosed?

Gabapentin addiction is diagnosed through a comprehensive approach combining medical history reviews, physical examinations, and laboratory tests. Healthcare professionals conduct detailed patient histories to understand gabapentin use patterns and assess symptoms such as cravings and withdrawal. Physical examinations identify signs like drowsiness, coordination issues, and neurological impairments, while blood and urine tests detect gabapentin presence and assess organ function. Standardized screening tools enhance diagnosis accuracy, including the DSM-5 criteria (which evaluates tolerance, withdrawal symptoms, cravings, and functional impairment) and the CAGE-AID questionnaire (focusing on cutting down use, annoyance by criticism, guilt feelings, and morning eye-openers). Additional tools like DAST, Brief Substance Abuse Survey, and SASSI help identify addiction patterns and severity, allowing clinicians to develop targeted treatment plans according to guidelines from the Mayo Clinic and National Institute on Drug Abuse.

What Are The Treatment Options for Gabapentin Addiction?

The treatment options for Gabapentin addiction include therapy approaches like cognitive behavioral therapy to modify negative thought patterns, medically supervised detoxification programs to manage withdrawal symptoms, motivational interviewing techniques to enhance recovery commitment, and various support systems, including group counseling.

Here are the common treatment options for Gabapentin addiction:

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) serves as a psychotherapeutic approach that helps individuals identify and change negative thought patterns and behaviors. CBT focuses on understanding thoughts and feelings that influence behaviors. This therapy emphasizes changing negative thought patterns and developing healthier coping mechanisms.

According to Alghamdi, A. A.’s 2023 study, ‘Cognitive behavioral therapy treatment for drug addiction, ’ CBT emerged as an effective non-pharmacological intervention since the 1970s. The therapy employs three main techniques: cognitive restructuring to eliminate distorted thinking, relapse prevention to identify high-risk situations, and contingency management using rewards to reinforce positive behaviors.

Medical Detox Program

A medical detox program is designed to safely stabilize individuals by gradually tapering off gabapentin under close medical supervision. This controlled process helps minimize severe withdrawal symptoms, such as anxiety, insomnia, and seizures, which are common in gabapentin dependence. Throughout the medical detox program, healthcare providers continuously monitor vital signs and adjust treatment protocols as needed to ensure patient safety and comfort. This comprehensive approach supports a smoother transition to recovery and reduces the risk of complications during withdrawal.

According to Deng, H.’s 2021 study, ‘Gabapentin dependence and withdrawal requiring an 18-month taper in a patient with alcohol use disorder: a case report.’, gabapentin tapering requires a carefully structured approach. The patient’s initial 1,200 mg daily dose decreased by precisely 100 mg per month until reaching 300 mg. The taper then slowed to 20-30 mg decrements monthly for the middle phase. In the final phase, doses were reduced by 5 mg every one to two weeks until reaching 60 mg before complete discontinuation. The entire taper process took exactly 18 months to complete.

Support Groups and Counseling

Support groups and counseling are structured forms of help that provide emotional support, coping strategies, and guidance for individuals dealing with addiction. Support groups and counseling offer a space for sharing experiences, receiving professional advice, and developing skills to manage withdrawal and recovery effectively. 

Peer-led groups like Narcotics Anonymous (NA) or SMART Recovery provide shared experiences and accountability. Regular attendance strengthens motivation and reduces isolation, which are critical for long-term sobriety. Members learn practical strategies from others facing similar challenges.

Outpatient Addiction Treatment

Outpatient programs allow individuals to attend therapy sessions while maintaining work or family commitments. They focus on skill-building, relapse prevention, and addressing triggers in real-world settings. Regular counseling sessions in outpatient addiction treatment help sustain progress by reinforcing coping strategies.

What Does Long-term Management of Gabapentin Addiction Involve?

Long-term management of gabapentin addiction involves a multifaceted approach, including ongoing counseling, medication management, regular monitoring, and a robust support network. These strategies maintain sobriety and prevent relapse.

Here are the key long-term management strategies of gabapentin addiction:

• Ongoing Counseling and Therapy: Provides continuous psychological support, addressing addiction issues and emotional challenges.
• Support Groups: Offer peer support and accountability, enhancing recovery outcomes.
• Lifestyle Changes: Include modifications in daily habits to improve health and well-being.
• Relapse Prevention Strategies: Involve ongoing counseling, medication management, and regular monitoring.
• Building a Support Network: Surrounds individuals with supportive family, friends, and professionals for encouragement and accountability.

What Should I Do If a Loved One Is Addicted to Gabapentin?

If a loved one is addicted to gabapentin, encourage them to seek professional help and provide non-judgmental support. You help by researching treatment options and offering to accompany them to appointments. It’s important to express your concerns gently and to join a support group for families dealing with addiction, where you share experiences and gain advice on supporting your loved one.

Are There Any Medications to Help With Gabapentin Withdrawal?

There are no specific medications universally recommended for gabapentin withdrawal. Instead, healthcare providers typically employ a gradual tapering process, such as the BRAVO Protocol, to minimize withdrawal symptoms, including agitation, confusion, and anxiety. Reintroducing gabapentin resolves withdrawal symptoms that emerge, which highlights the importance of slow, supervised tapering rather than abrupt discontinuation. Medical supervision during this process is recommended to manage symptoms and adjust the tapering schedule as needed.

According to Deng, H.’s 2021 study, ‘Gabapentin dependence and withdrawal requiring an 18-month taper in a patient with alcohol use disorder: a case report.’, a 32-year-old female with alcohol use disorder developed gabapentin dependence while taking 1,200 mg daily. Her tapering process using the BRAVO Protocol took exactly 18 months. She reduced her daily dose by 100 mg per month until reaching 300 mg, then slowed to 20-30 mg decrements monthly. The final 100 mg required the slowest reduction at 5 mg every one to two weeks until reaching 60 mg, at which point she discontinued the medication completely. The entire taper followed a patient-centered approach originally developed for opioids and adapted to benzodiazepines before being applied to gabapentin in this case.

How Long Does It Take to Recover from Gabapentin Addiction?

Recovery from gabapentin addiction or dependence varies significantly among individuals, depending on factors such as the duration of use, dosage, and individual health conditions. Withdrawal symptoms occur when gabapentin is stopped abruptly and last from a few days to several weeks. Gradual tapering under medical supervision is the most effective approach to managing gabapentin withdrawal, minimizing symptoms, and supporting a smoother recovery process.

How to Find Help and Support for Gabapentin Addiction?

To find help and support for gabapentin addiction, start by consulting your healthcare provider for an assessment and referrals. Treatment facilities specializing in prescription medication dependence offer professional care tailored to your needs. SAMHSA’s National Helpline (1-800-662-HELP) provides free, confidential guidance 24/7, while FindTreatment.gov helps locate local options. Support groups like Narcotics Anonymous offer valuable peer connections during recovery. In Nevada, The Nestled Recovery Center provides specialized services for those struggling with gabapentin addiction. Remember that reaching out for professional help is the crucial first step toward recovery and long-term wellness.