Benzodiazepine (“benzo”) overdoses in Ontario declined 7% from 2013 to 2020. Unfortunately, the trend is reversed for teens and young adults. In this group, overdose rates rose by 67% during the same period. Doctors prescribe benzos to treat anxiety, insomnia, and other mental health conditions. These drugs are safe when used as prescribed. Yet, they can be highly dangerous when used alongside other substances like alcohol. Benzos and alcohol are commonly abused together. They are both depressants and can amplify each other’s effects, including the risk of overdose. It is crucial for people with a Benzodiazepine prescription to steer clear of alcoholic beverages. Why are benzos and alcohol such a dangerous combination? We will answer that question in this in-depth guide. Plus, find out about the use of benzodiazepines for alcohol withdrawal.

What Are Benzos and How Do They Affect the Body?

Benzos are depressants. They affect the body by decreasing activity in the central nervous system (CNS). They do so through interaction with the CNS’s primary inhibitory neurotransmitter, GABA.

All of the different types of benzodiazepines have similar mechanisms of action. They act as positive allosteric modulators for GABA receptors. Positive allosteric modulators increase GABA’s inhibitory effects on the brain.

Doctors commonly prescribe these drugs for anxiety and insomnia. Some benzos can also help with seizures. All of these conditions feature overactivity in the brain.

Additionally, benzos can help treat people with alcohol use disorder (AUD). These drugs can reduce withdrawal symptoms when people stop using alcohol. Alcohol withdrawal symptoms include:

• High blood pressure
• Insomnia
• Shaking
• Overactive bodily reflexes (hyperreflexia)
• Anxiety
• Gastrointestinal issues
• Headaches
• Heart palpitations
• Hallucinations
• Seizures

Delerium tremens is a severe alcohol withdrawal symptom. Around 50% of people who experience moderate alcohol withdrawal symptoms (hallucinations and seizures) also develop delirium tremens.

People who progress to the most severe withdrawal symptoms may experience irregular heart rate, hyperthermia, excessive sweating, and general agitation. Alcohol withdrawal may even result in death.

Benzodiazepines also cause these kinds of withdrawal symptoms. The only way to relieve these symptoms is to drink more alcohol or take a medication with similar effects.

Types of Benzos

Benzodiazepines are a class of drugs. They fall into three categories: long-acting, short-acting, and intermediate-acting benzos.

There are also different brands of benzos, including:

• Alprazolam (brand names Xanax, Kalma, and Alprax): Alprazolam treats anxiety disorders. This drug’s mechanism of action is to reduce activity in the brain to calm someone down.
• Diazepam (brand names Valium and Ducene): Diazepam also treats anxiety, as well as muscle spasms and seizures. This is the type of benzodiazepine doctors prescribe for alcohol withdrawals, too. Drugs containing this ingredient promote calmness and sleep.
• Clonazepam (brand name Klonopin): Clonazepam treats anxiety and panic disorders in addition to seizures. It reduces activity in the brain and communication between the brain and the body.
• Lorazepam (brand name Ativan): Lorazepam helps people with anxiety and insomnia, but it is only a short-term treatment. Doctors can only prescribe this benzodiazepine for up to 4 months. Then, the patient can find a longer-term solution if needed.
• Temazepam (brand names Restoril, Euhypnos, and Normison): Doctors often prescribe temazepam for insomnia. It reduces activity in the brain at night to help people get to sleep faster and sleep better.
• Oxazepam (brand names Alepam, Murelax, and Serepax): Oxazepam is another go-to treatment for alcohol withdrawal symptoms. Doctors may also prescribe it for anxiety disorders and general tension.
• Nitrazepam (brand names Alodorm and Mogadon): Nitrazepam is a short-term treatment for severe insomnia. Doctors may also prescribe it for seizures since it has a calming effect on brain activity.

Brand-name benzos containing oxazepam, temazepam, and alprazolam are short-acting drugs. Nitrazepam-containing benzos are intermediate-acting. Meanwhile, benzos with diazepam are long-acting.

Why Are Benzodiazepines Abused?

Benzodiazepines are abused because they are widely available and provide euphoric effects (i.e., a “high”). These euphoric effects come from benzos’ interaction with the brain’s dopamine reward system.

The brain’s reward system regulates human behaviours and emotions. Increased activity in this system encourages us to keep doing something, such as eating tasty food or participating in a pleasurable activity.

Dopamine is the chemical that regulates this system. Increases in dopamine promote certain behaviours. Meanwhile, constant or decreased dopamine levels may make someone feel neutral about or discouraged from doing something.

For example, stress leads to a decrease in dopamine. The decrease in dopamine encourages people to avoid the situation or individual that caused the stress.

When people take benzos, it leads to a spike in dopamine. Dopamine is the brain’s “feel good” neurotransmitter. So, substances like benzos that increase dopamine are highly addictive and can even be deadly.

Taking benzos as directed by a physician should only cause mild side effects. However, heavy use of these drugs can lead to more severe symptoms. Signs that someone may be misusing benzos include:

• Extreme drowsiness
• Confusion
• Dizziness
• Blurred vision
• Muscle weakness
• Slurring speech
• Poor coordination
• Difficulty breathing
• Coma (rare)

Chronic abuse of benzodiazepines can also lead to headaches and anorexia. It can also reverse the benefits of this drug, increasing anxiety levels and insomnia.

Interestingly, researchers have found that people who abuse benzos do not use these drugs alone. Instead, it is more common to misuse them along with other substances, such as alcohol.

Alcohol Use and Abuse

Alcohol is a widely available and used substance in Canada. In moderation, this substance can have positive effects on sociability. However, alcohol can be hazardous when consumed in excess.

Unfortunately, it is the most commonly abused substance among Canadians. This is due, in part, to the fact that alcohol is legal to buy and consume. Canadians do not need a prescription as long as they are 19 or older.

Despite its legality, alcohol can be just as dangerous as benzos and other prescription drugs. In Canada, alcohol causes around 18,000 deaths per year. Annually, over 4,000 people die from alcohol-related deaths in Ontario alone.

Alcohol Use Disorders

An alcohol use disorder (AUD) is a condition that results from problematic alcohol use. It may occur due to frequent sessions of binge drinking. Or someone may develop an AUD from long-term, regular alcohol use.

Signs that someone may have an alcohol problem include tolerance (needing more and more alcohol to get drunk) and cravings for alcohol. The presence of withdrawal symptoms after quitting drinking may also indicate an AUD.

Alcohol withdrawal symptoms depend on how long someone has been drinking and how much they drink per session. These symptoms begin appearing as soon as six hours after someone’s last drink and may last three or more days.

Some people use alcohol without developing an addiction. Alcohol can even benefit social settings because it reduces anxiety and lowers inhibitions. Other people overuse alcohol to take advantage of these effects.

Benzos and Alcohol

Like benzodiazepines, alcohol is a CNS depressant. However, it has stimulating properties when used in small amounts. When taken in large quantities, alcohol reduces brain activity, providing the following effects:

• Slowed reactions, including slurred speech and decreased alertness
• Lowered inhibitions, which may lead someone to talk louder, use inappropriate language, and be overly friendly toward others
• Physical alterations, such as red eyes, excessive sweating, and a flushed face
• Coordination issues like swaying, stumbling, and falling
• Poor judgement, which may lead someone to become argumentative, irrational, or careless

Another similarity benzos and alcohol share is that both substances activate the brain’s reward system. Though alcohol is commonly used, it can be as dangerous and deadly as benzodiazepine misuse.

Alcohol and Benzodiazepine Misuse

80% of people who misuse benzos also use another substance. Heroin and methadone are commonly abused alongside these drugs. Additionally, up to 41% of alcoholics also use benzos.

Doctors prescribe benzos when their benefits outweigh their potential side effects. They believe benzos are safe for people to use. However, doctors recommend against mixing benzos with other depressants like alcohol.

Alcohol and benzodiazepine use can increase the negative side effects of each substance alone. Using these substances simultaneously can also increase the potential risk of addiction.

So, why would someone want to use benzos and alcohol together? There are many reasons. For example, someone with a pre-existing alcohol use disorder (AUD) may receive a benzodiazepine prescription.

The person’s doctor will advise against using alcohol and prescription benzos together. However, the person may be unable to stop using alcohol while taking their prescription.

In other cases, people believe taking alcohol and benzodiazepines together is safe because they have a prescription. This is not the case, though, as no amount of alcohol is safe to use with prescription pills like benzodiazepines.

Signs that someone may be abusing alcohol and benzodiazepines include:

• Significant sedation
• Reduced cognitive (i.e., thinking)
• Delayed physical reactions
• More severe side effects
• Increased risk of cardiovascular disorders and suicidal tendencies
• Increased risk of liver damage, gastrointestinal issues, and kidney damage
• Increased risk of mental health conditions like depression, PTSD, anxiety, and bipolar disorder

Many addicts also struggle to maintain their personal relationships and meet financial obligations. They may even continue to use these substances despite legal ramifications and the threat of fines or jail time.

Benzodiazepines for Alcohol Withdrawal

It may not be safe to use benzodiazepines with alcohol. However, it is safe to take benzos while in recovery from alcohol use disorder. Benzos can mitigate the painful withdrawal symptoms that come with quitting alcohol.

Why? A substance’s withdrawal symptoms are the exact opposite of its effects. For example, alcohol suppresses the CNS, while its withdrawal symptoms stimulate the CNS.

One of the only ways to stop withdrawals is to take more of the substance that caused them. Another strategy is to give someone a medication that has similar effects.

As we’ve mentioned, benzos and alcohol have similar effects. Giving someone benzodiazepines while they are withdrawing from alcohol will mitigate some of their worst symptoms, making the recovery process a little bit easier.

Of course, benzos come with their own risk of dependence and withdrawal symptoms. They are only a temporary solution, though. Taking the medication as prescribed briefly can prevent people from becoming dependent.

What Are the Most Common Benzos Prescribed for Alcohol Withdrawals?

Diazepam, oxazepam, clonazepam, lorazepam, and chlordiazepoxide are the most common benzos prescribed for alcohol withdrawals. Of these, diazepam, chlordiazepoxide, and lorazepam have the most research to support their effects.

The exact prescription someone receives depends on the severity of their symptoms. It also depends on factors such as age and pre-existing health conditions.

Short-acting benzos are often best for older patients. This is especially true for older patients with liver and lung diseases. Short-acting benzos like oxazepam are ideal for these populations.

Longer-acting benzos like diazepam are best for people who experience rebound symptoms. The rebound effect happens after someone undergoes detox and then experiences new symptoms.

For example, sleep disruptions are a common rebound effect after detoxing from alcohol. People who experience these effects will benefit from longer-acting benzos that keep blood levels uniform throughout the treatment.

Benzo Treatment Regimens for Alcohol Detox

There are three benzo treatment regimens used to treat alcohol withdrawals. They are fixed tapering dose regimens, symptom-triggered regimens, and loading dose regimens.

Fixed tapering dose regimens

Fixed tapering dose regimens (FTDRs) are used to treat mild alcohol withdrawal symptoms. Patients can receive them in an inpatient or outpatient setting. FTDR is the only regimen approved for outpatient programme use.

In FTDR, patients receive a fixed dose of benzodiazepines throughout their treatment. The dose remains the same regardless of symptom severity.

Symptom-triggered regimens

Symptom-triggered regimens (STRs) are suitable for all kinds of symptoms. However, patients can only access this treatment at an inpatient centre under the supervision of a medical professional.

STR differs from FTDR in that the dose may change depending on someone’s symptoms. Medical professionals will determine the proper dose based on a withdrawal symptom rating scale.

Loading dose regimens

Loading dose regimens (LDRs) are ideal for patients with severe withdrawal symptoms. This treatment works particularly well for seizures. Like STRs, patients can only receive LDRs under direct medical supervision.

During an LDR, patients receive long-acting benzos every 2 hours or so. In addition to helping prevent deadly seizures, this regimen can also reduce delirium tremens symptoms, which can also be fatal.

Alcohol Withdrawal and Diazepam

Diazepam can treat moderate to severe alcohol withdrawal symptoms. Research shows that this type of benzodiazepine can help with:

• Anxiety and fear
• Agitation
• Aggression
• Hallucinations
• Seizures
• Delerium

It may also decrease the fatality risk in people withdrawing from alcohol.

Many medical professionals prefer this type of benzo for alcohol withdrawals because it is fast-acting. It is also much easier to work out the proper dose since patients do not have to wait long for the drug to take effect.

Additionally, diazepam has the longest half-life of the various types of benzos. It stays in patients’ systems longer, allowing for a smoother withdrawal process.

Another reason diazepam is the benzo of choice for alcohol withdrawals is its safety profile. It is safe for elderly patients as well as people with liver damage.

What Happens When You Take Diazepam and Alcohol?

When you take diazepam and alcohol, they can interact negatively. One thing that can happen is that people are at greater risk of falls and injuries. Both substances lead to less control over the body.

Alcohol and diazepam use will also increase other symptoms these substances share. In the worst-case scenario, taking alcohol and diazepam together can increase the risk of overdose and death.

For these reasons, recovering alcoholics can only take benzos under a medical professional’s supervision. It is also crucial to avoid drinking alcohol while using benzodiazepines for recovery.

What Happens When You Take Clonazepam and Alcohol?

When you take clonazepam and drink alcohol, you may experience increased depressant effects. People who use these substances together often report extreme drowsiness, trouble concentrating, and dizziness.

Like all benzos, taking clonazepam with alcohol can increase the risk of overdose. When used together, these two substances can also make it easier and faster to develop a substance use disorder.

Clonazepam is not commonly prescribed for alcohol withdrawals. However, some medical professionals do rely on it for certain severe symptoms. These symptoms include seizures, anxiety, and panic.

Can Mixing Benzos and Alcohol Lead to Overdose?

Yes, mixing benzos and alcohol can lead to overdose since both drugs are CNS depressants. An overdose can occur when someone takes a lethal dose of a substance. There are a few ways to achieve a lethal dose.

First, someone can take an excessive amount of a single substance. That could look like taking too many benzodiazepines. Or an overdose could occur from drinking too much alcohol in one sitting.

Another way overdose can occur is when someone combines two substances with similar effects. They may take a reasonable number of benzos and only have a few drinks. On their own, these amounts may not be harmful.

However, when taken together, these moderate doses can become deadly. The depressant quality of these drugs combines and increases, leading to the following symptoms of depressant overdose:

• Severe drowsiness
• Shallow breathing
• Impaired movement and thinking
• Coma

Over-inhibiting the CNS can make transferring messages from the brain to the body difficult. When messages can’t travel from the brain to vital organs, death can result.

Treatment for Benzos and Alcohol Abuse

The good news is that benzo and alcohol abuse are treatable. Treatment centres like Simcoe Addiction and Mental Health offer programmes for polysubstance abuse (i.e., abusing multiple substances at once).

The first step is to undergo medical detox. At Simcoe, we offer supervised withdrawal management services. Our medical professionals are available around the clock to help ease withdrawal symptoms.

Patients who do not have benzodiazepine substance use disorders can also receive benzos to ease their withdrawals. Medications are also available after detox to reduce alcohol cravings and reduce the risk of relapse.

The best rehab programme for people with benzo and alcohol abuse problems is inpatient treatment. Inpatient programmes allow patients to live at the facility where they receive care.

At Simcoe, we recommend our residential treatment programme for patients with severe addictions. We offer treatments for patients who have detoxed from alcohol and benzos.

Patients can choose between 30, 45, 60, and 90-day stays. People with more severe addictions should consider a longer stay for the best results.

We customize treatment plans to the individual. Patients will receive therapy consisting of individual, group, or both sessions. We also offer alternative therapies and self-care activities to all our patients.

After treatment, we set patients up for success with aftercare and transitioning programmes. Our goal is to give you tools for optimal recovery. That way, patients can find the courage to kick their addiction and stay sober for life.

There Is Hope for Benzo and Alcohol Addiction in Ontario

Benzodiazepines and alcohol can be beneficial in moderation. Benzos are prescription drugs that can help ease symptoms of anxiety, insomnia, and more. Meanwhile, alcohol can have positive benefits in social settings.

At the same time, it is critical to know that benzos and alcohol can be deadly when combined. Abusing these substances together can increase the risk of addiction and overdose.

Do you or your loved one need help for benzos and alcohol addiction in Ontario? Simcoe offers withdrawal management, inpatient treatment, and even interventions for alcohol and prescription drug use disorders.

Contact Simcoe today to learn more about our facility and finally get the help you need to recover for good.