Effects of Mixing Benzodiazepines & Alcohol

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  1. Effects of Benzodiazepines on the Brain
  2. What Happens When You Combine Sedatives and Alcohol
  3. Treatments for Mixing Alcohol with Sedatives like Xanax and Ativan
  4. Associated Social and Mental Health Problems
  5. Sources

Effects of Alcohol on the Brain

Drinking too much alcohol can lead to abnormally slowed breathing and can impair brain regions responsible for judgment, speech and vision.

It also decreases the excitatory effects of glutamate-- a neurotransmitter that contributes to normal respiratory functions and therefore, can cause respiratory depression.

Effects of Alcohol on the Brain

Effects of Benzodiazepines on the Brain

Benzodiazepines also exert sedative effects by interacting with the GABA receptor to upregulate inhibitory neurotransmission--albeit at a site of action distinct from that of alcohol.

Benzodiazepines effectively increase inhibitory signaling throughout the brain. When abused, they can result in:

  • Intense drowsiness or confusion.
  • Dizziness.
  • Slurred speech.

GABA receptors eventually become desensitized to the presence of persistently elevated serum benzodiazepine levels, as would occur in cases of sedative abuse.

As a result, it becomes increasingly less effective at mediating a normal level of inhibitory signaling.

When left unchecked, excitatory processes in the brain can elicit feelings of anxiety or panic in a tolerant user, unless more and more benzodiazepine is taken to counter it. If you or someone you love is currently suffering from co-abuse of benzodiazepine or alcohol, call 1-888-993-3112Who Answers? to find a treatment program that suits your needs.


What Happens When You Combine Sedatives and Alcohol

Because both sedatives and alcohol are central nervous system depressants, using them together can cause excessive sedation and respiratory depression.

  • Cognitive delays further reduce response time, thus increasing the risk of having accidents (e.g., falling, car accidents).

  • Both acute or chronic alcohol intake in combination with large amounts of sedatives can significantly increase sedation through a synergistic effect at both GABA and glutamate neurotransmitter sites in the brain--which may cause an individual to stop breathing or slip into a coma.

How Common is Combining Benzodiazepines and Alcohol

The Substance Abuse and Mental Health Administration (SAMHSA) estimates that serious medical outcomes resulted from 44% of all emergency medical treatment related to the combination of benzodiazepines and alcohol

  • This risk may be affected by increasing age; only 39% of emergency department visitors suffering from adverse effects of this drug combination in 2014 were in age range of 12 - 34 years.

According to SAMHSA, substance abuse treatment admissions for concurrent sedative and alcohol use has tripled from more than 22,000 in 1998 to 60,200 in 2008, and the numbers are continuing to increase.

  • Furthermore, even when the involved prescription sedatives were being taken as prescribed, drug and alcohol interactions caused an 86% increase in emergency room visits between 2005 and 2010.

  • SAMHSA also found that the rates of treatment admissions for the abuse of benzodiazepines combined with other drugs increased by nearly 570% between 2000 and 2010, whereas the rates for all other forms of drug abuse fell by about 10% in the same time period.

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Alcohol & Sedative Deaths

man taking pills with alcohol
A recent Center for Disease Control (CDC) analysis found that nearly 30% of all drug-related deaths were associated with benzodiazepines.

SAMHSA's Drug Abuse Warning Network (DAWN) found that alcohol use was linked to just over 27% of all emergency department visits necessitated by benzodiazepine abuse, and to 21% of all deaths linked to this form of substance abuse in 2010.

The majority of sedative and alcohol-related deaths were due to suppressed respiration.

Why Do Some Users Combine Sedatives with Alcohol

1. People are often prescribed benzodiazepines to counteract the anxiety that may be associated with conditions such as cancer or chronic pain.

  • Alcohol may be consumed in combination with sedatives to further mask the pain, especially if an individual has started to develop a tolerance to the sedatives.

2. In addition, people struggling with alcohol addiction tend to suffer from insomnia and anxiety, and experiencing these conditions may motivate them to take sedatives as well.

  • Extreme sedation is accompanied by a dramatic reduction in the perception of pain or anxiety, and this is often the goal when sedatives are mixed with alcohol.

3. Some individuals also start taking prescription drugs in order to get high or experience feelings of euphoria, thinking that this would be safer than taking illicit drugs.

4. Often times withdrawal symptoms make it difficult for individuals to discontinue the abuse of either drug, and the development of withdrawal may further motivate a person's continued attempts at self-medication with alcohol or sedatives.

Concurrent drug use is also known to coexist with, contribute to, or develop due to several different psychiatric syndromes such as: Major depression, Bipolar-related psychoses, Personality disorders and Anxiety disorders.

  • If you or someone you love has fallen in the grips of an addiction to alcohol and benzodiazepines, it may be a result of trying to mask pain or anxiety. Treatment can prevent you and your loved one from developing severe mental health problems as a result of abuse. Please call 1-888-993-3112Who Answers? to speak with a treatment support staff member today.

Treatments for Mixing Alcohol with Sedatives like Xanax and Ativan

One of the main impediments to treating concurrent alcohol and benzodiazepine abuse is the evaluation of associated mental health issues, that may have contributed to the development of poly-drug use behaviors.

Adverse outcomes further complicate treatment; when drug abuse and psychiatric disorders co-exist, patients tend struggle to:

    • Maintain abstinence.
    • Use mental health services.
    • Avoid suicide-attempts.
    • Maintain employment and social relationships.


The most critical factor in the treatment of concurrent benzodiazepine and alcohol abuse is detoxification; a process by which the body is physiologically weaned off a drug of abuse.

Due to the combined CNS intoxication, severe sedative effects, behavioral disinhibition and cross-tolerance, detoxification from concomitant abuse of alcohol and benzodiazepines requires medical monitoring. Severe effects can include:

  • Delusions.
  • Convulsions.
  • Suicidal ideation that may end in self-harm.
  • Psychosis.

  • Severe confusion.
  • Mania.
  • Respiratory depression.

Due to these effects, abrupt discontinuation from benzodiazepines and alcohol is not recommended.

Don't wait Hear from others on their journey through addiction and recovery Withdrawal & Detox

The rate of withdrawal and symptom alleviation differ greatly depending on individual case characteristics. A gradual tapering schedule has shown positive results.

  • A long-acting benzodiazepine is administered at decreasing doses and administered based on the progression of symptoms.

Due to the need to monitor symptoms (that fluctuate markedly) and alter treatment accordingly, detoxification cannot be conducted without medical support.

The severity of withdrawal from benzodiazepines has been linked to high neuroticism, lack of social support and lower quality of life--all of which have been associated with an increased severity of alcohol dependence.

Therefore, the importance of a uniform environment-without the possibility of accessing either drug- cannot be emphasized enough.

Further, treating individuals who co-abuse benzodiazepines and alcohol is challenging due to the additive risk and physical dependence.

  • Brief interventions include increasing the frequency of office visits and contingency prescribing, which involves requiring a patient to produce clean test results or a negative urine screening before allowing the individual to receive a new prescription.

    • This has been shown to be effective in some patients with aberrant alcohol and drug use behaviors.

Additional therapy for this type of concurrent abuse entails the use of non-central nervous system depressants such as lower-toxicity antidepressants, atypical antipsychotics, or buspirone instead of benzodiazepines.


  • An approach called cognitive behavioral therapy (CBT) has become the mainstay in psychotherapeutic treatment for concurrent benzodiazepine and alcohol abusers who have underlying anxiety disorder.

    • CBT involves the use of imagery, relaxation, meditation, desensitization, and distraction techniques as a form of non-pharmacotherapeutic substance abuse treatment.

Impulse and emotional control, as well as distress tolerance is also taught through CBT--improving these skills has shown to positively influence drug-seeking behavior and decisions.

One of the most important aspects of CBT is the use of sessions where patients are presented with scenarios that trigger cravings and may lead to relapse.

  • Learning how to combat these situations effectively is extremely beneficial in long-term recovery.


  • An inpatient center offers access to medical professionals who can supervise detoxification; a critically important factor in the management of adverse withdrawal symptoms from concomitant benzodiazepine and alcohol dependence.

Additionally, some patients may find themselves in situations in which they require medical therapy for illnesses sustained as a result of depressant abuse (e.g. respiratory distress) as well as treatment for substance abuse.

These may be found in hospital stay-type care or in a facility which offers both. This is known as inpatient care.

Mixing alcohol and benzodiazepines can cause mental health problems that make it hard for individuals suffering from them to overcome the abuse without receiving closely monitored treatment, or specialized dual diagnosis approaches to effectively target both the substance abuse and mental health issues simultaneously. But specialized treatment programs are available, please call 1-888-993-3112Who Answers? to find treatment today.

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  • Alternatively, patients whose functional status has not been adversely affected may feel more competent to integrate outpatient care into their lives.

    • This involves making regular appointments at clinics or facilities at which they can access regular medical and/or psychological treatments.


  • Some patients may prefer to remain within a center for treatment, regardless of their health or functional status. These decisions may be affected by personal or abuse-specific (e.g. wishing to avoid the temptation to slide back into abuse patterns) reasons. Therefore, they may check into a residential facility to work at their treatment.

    • Residential options may extend beyond initial care for substance abuse problems. These options may include 'sober living' facilities, in which the client lives free of drug-abuse temptations or 'cues'.

Associated Social and Mental Health Problems

People who co-abuse both alcohol and sedatives may develop long-term mental health problems such as:

  • Persistent disorientation and confusion.
  • Learning and memory problems.
  • Speech impairments.
  • Insomnia.
  • Major depression.
  • Persistent anxiety.

A number of social issues may also begin to develop, mostly due to drug-seeking behavior. Such as:

  • Try to borrow or steal sedatives from others.
  • Forge prescriptions.
  • Experience serious financial problems as a result of the expense associated with buying alcohol and sedatives.

As long-term substance abuse changes the way neurotransmitters such as glutamate and GABA respond to stimulation, mental impairments may become chronic problems that make it hard for individuals to display proper social functioning without effective substance abuse treatment.


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