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You’ve likely heard about the dangers of combining alcohol with drugs or medications. Among the most hazardous combinations is alcohol and benzodiazepines (“benzos”). This pairing can lead to severe health risks, including sickness, overdose, and even death. In this article, we’ll explore why mixing alcohol and benzodiazepines is so dangerous and provide actionable steps to help protect your loved ones.
Key Takeaways
- Mixing alcohol and benzodiazepines increases the effects of both, which may lead to poorer decision-making and serious health issues, like respiratory depression, which can cause coma and death.
- Benzodiazepines are generally safe for short-term use and can be used to treat alcohol withdrawal, but also carry a high risk of dependence, intentional misuse and addiction.
- Treating both benzodiazepine and alcohol use disorders requires careful management, often involving medically supervised detox.
What are benzodiazepines and what are they used for?
Benzodiazepines are known as prescription tranquilizers. When used as prescribed, tranquilizers can help relieve acute anxiety, tension, muscle spasms, stress reactions, panic attacks and sleep disorders.1 They are also often prescribed or used in hospitals to treat epilepsy.2 Commonly known examples of medications include:
- Xanax (alprazolam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Ativan (lorazepam)
You may have also heard of barbiturates. Barbiturates are prescription sedatives, or “sleeping pills.” Barbiturates have largely been replaced by benzodiazepines due to their significantly high risk of overdose.3 Today, they’re mostly used for severe insomnia, treatment-resistant anxiety and seizures, as well as general anesthesia in some cases.4
It is important to note that long-term benzodiazepine use is not very common. Most patients stop using them within a few days or weeks and certainly within a year. It is also typically a short-term treatment strategy.5 For example, they may be prescribed for a few days when a person has suffered the loss of a loved one and is having trouble sleeping. They are also used to help people who need some symptom relief while waiting for an antidepressant to work.
Can benzodiazepines treat alcohol withdrawal symptoms?
In many cases, benzos are used to reduce alcohol withdrawal symptoms while someone is going through a medically supervised detox (in inpatient treatment).6 Alcohol withdrawal can not only be very painful, but deadly. Benzos like lorazepam and diazepam can help gradually taper someone off alcohol in order to reduce the risk of these serious health effects.7 They are generally considered safe options, though there is recent research investigating non-benzo medications to treat withdrawal.8
What are the risks of benzodiazepines?
When these medications are intentionally misused, they can have serious side effects. “Misuse” can mean taking a prescribed medication more often and in higher quantities than prescribed; going to multiple doctors to receive multiple prescriptions; or illegally obtaining a medication that has not been prescribed to you.
Because they slow normal brain function, their use can result in slurred speech, shallow breathing, sluggishness, fatigue, disorientation, slowed reflexes and lack of coordination. Heavy use can cause impaired memory, judgment and coordination, irritability, paranoia and thoughts of suicide. While it is rare to overdose on benzos on their own, they can be found in overdoses involving multiple substances.9
Additionally, these medications are not effective long-term solutions to treat conditions like anxiety and insomnia.10 There is evidence to suggest that using them beyond a few weeks can increase one’s risk of developing dependence or a substance use disorder. In general, benzodiazepines have a high potential for intentional misuse, especially because dependence can develop so quickly.11
The DEA has also issued a warning about fake prescription pills, like Xanax, that may contain lethal doses of fentanyl. This can lead to accidental overdose.12
How do you treat benzodiazepine use disorder?
One can become dependent on benzodiazepines and develop painful withdrawal symptoms. This risk is especially high among individuals with a co-occurring mental health or substance use disorder.13 Benzo withdrawal symptoms can include sweating, shivering, anxiety, panic, restlessness, mood swings, insomnia and issues with muscles such as spasms or tremors.14 Severe withdrawal symptoms, like alcohol withdrawal, can result in seizure or death.
Benzodiazepine dependence is usually treated with a gradual tapering off of the medication over a period of a few weeks.15 A person might do this in an outpatient setting, while more severe cases, such as in patients with a co-occurring disorder or who are taking particularly high doses, may be better treated in a hospital.
In an inpatient setting, patients are tapered off both benzos and alcohol using another benzo; often Ativan or Librium. The tapering schedule may be relatively short – like 5 to 7 days. Healthcare staff will also prescribe other medications as needed including antiseizure (e.g., Keppra), anti-anxiety (e.g., Vistaril, BuSpar) and sleep medications (e.g., Trazadone). Patients may note that the non-benzo medications are not as powerful as benzos and that they feel very anxious. A longer tapering schedule may be helpful if possible.
Additionally, a patient may benefit from one of three medications for alcohol use disorder. These are Disulfiram, Acamprosate, and Naltrexone. You can learn more about these medications here.
There are currently no FDA-approved medications to treat benzodiazepine use disorder, though there are studies underway investigating the effectiveness of medications such as flumazenil.16
Why is it so dangerous to mix alcohol and benzodiazepines?
Both alcohol and benzodiazepines are central nervous system depressants. Depressants cause the body to slow down. Using them together can increase the level of effect that each substance has on the body.
There can be serious health consequences when mixing alcohol and benzos. Using prescription sedatives and tranquilizers with other substances — particularly alcohol — can slow breathing, or slow both the heart and respiration, and possibly lead to death.
The most serious risk is respiratory depression. This refers to when someone breaths too slowly, or cannot take deep breaths, which causes carbon dioxide to build up in the blood.17 Respiratory depression can cause people to stop breathing, have a heart attack, or go into a coma.
In addition, an individual using a combination of alcohol and benzos can become even more intoxicated or “drunk.” This can result in risky choices and poor decisions like engaging in fights or accidentally injuring themselves. Additionally, research shows that combined use of benzos and alcohol can cause problems with driving.18
Co-occurring alcohol and benzo use disorder can put patients at a higher risk of illness and death. One report by the Substance Abuse and Mental Health Administration (SAMHSA) found an increased risk of emergency department visits with a more serious outcome for those using a combination of benzodiazepines and alcohol.19 20% of benzo-related deaths studied over the course of a decade also involved alcohol.20
It is very important to note that research indicates people who drink heavily or have a history of problem drinking have a higher risk of intentionally misusing benzodiazepines. A significant number of individuals with alcohol use disorder often also struggle with benzodiazepine use.21 Individuals with a co-occurring mental health and substance use disorder generally are also at higher risk of developing a benzodiazepine use disorder.22
What if my loved one is prescribed benzos?
If your loved one is prescribed benzodiazepines, monitor their use to make sure they are using them safely. Ensure they take their medication as directed, which means taking the correct amount and not using longer than prescribed. Keep them updated on the potential risks associated with benzo use and encourage them not to drink or use other substances,
Safe prescribing practices are very important. If your loved one is prescribed benzodiazepines, make sure that their provider knows about any existing substance use or mental health conditions. Providers should screen for these disorders and determine if your loved one may be at risk of intentionally misusing benzodiazepines.
What if my loved one drinks or has an alcohol use disorder?
Individuals who use alcohol or have an alcohol use disorder should not use benzodiazepines due to the risk of overdose. Speak with their medical provider about alternative medications or treatment options. Also know that if a loved one has a serious drinking problem, they may need to go through a medically supervised detox.
What if my loved one has co-occurring disorders?
It can be tricky to undergo treatment for co-occurring benzodiazepine and alcohol use disorders, especially because benzos are used to treat alcohol withdrawal symptoms. Both substances can also cause similar withdrawal symptoms. An individual struggling with simultaneous alcohol and benzo use will likely have to have a medically supervised detox and start treatment. Read here to learn more about different types of substance use disorder treatment.
Also encourage your loved one to take measures to reduce the risks associated with benzo and alcohol use. These might include never using alone or trying to use in moderation.
If you are concerned about your loved one’s benzodiazepine and alcohol use and aren’t sure where to start, we are here for you. You can contact our support services here.