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The Dangers of Mixing Benzodiazepines with Alcohol

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 11, 2019

Benzodiazepines and alcohol are some of the most commonly abused drugs in the country. When benzodiazepines such as Xanax, Ativan, and Valium are mixed with alcohol, the combination has the potential to lead to serious liver damage and even overdose.

Understanding Benzodiazepine And Alcohol Abuse

A lot of people drink alcohol, because of the calming feeling it produces. Drinking becomes alcohol abuse when it starts causing health problems, relationship problems, or inability to work, or when they’re drinking more than a moderate amount. According to the United States Department of Agriculture, “moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men.

This definition is referring to the amount consumed on any single day and is not intended as an average over several days. However, the Dietary Guidelines do not recommend that individuals who do not drink alcohol start drinking for any reason.”

Prescription benzodiazepines can be abused just as easily as alcohol, and abuse is using them any other way than for their medical or intended purpose. This information from the Drug Enforcement Administration (DEA) might help to better understand this kind of abuse, “benzodiazepines, particularly those having a rapid onset, are abused to produce a euphoric effect. Abuse of benzodiazepines is often associated with multiple-substance abuse.”

The article goes on, “the doses of benzodiazepines taken by abusers are usually in excess of the recommended therapeutic dose.” So using prescription drugs to intensify the effects of alcohol is also considered abuse. Unfortunately it can be an unhealthy, and sometimes fatal combination.

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Similarities Of Benzodiazepines And Alcohol

Alcohol and benzodiazepines are both considered central nervous system depressants, meaning that they slow down activity in the brain and body. This can be a surprising concept, because alcohol often causes a person to be less reserved—louder, animated, and do things they wouldn’t normally do. But the fact is, after a couple of drinks the alcohol actually starts to slow down the motor functions and brain activity. Benzodiazepines serve the same purpose—to slow down brain activity for those with anxiety, and insomnia.

Are Benzodiazepines Addictive?

Even when used properly, benzodiazepines run a high risk for dependence and addiction. According to the DEA, benzodiazepines are Schedule IV substances because of their “low potential for abuse relative to substances in Schedule III.” Schedule III substances includes drugs such as Suboxone, Tylenol with Codeine, and Anabolic Steroids. Once again from the DEA, “There is the potential for dependence on and abuse of benzodiazepines particularly by individuals with a history of multi-substance abuse.”

What Are The Most Commonly Abused Benzodiazepines?

There are a lot of different types of benzodiazepines; some are primarily used to treat anxiety, insomnia, muscle spasms, and alcohol withdrawals, but a more potent form of the drug will be used to treat insomnia.

From NIAAA, some of the most commonly used benzodiazepines that interact with alcohol are:

  • Ativan (lorazepam)
  • Klonopin (clonazepam)
  • Librium (chlordiazepoxide)
  • Valium (diazepam)
  • Xanax (alprazolam)

Interaction Of Benzodiazepines And Alcohol

When a person mixes alcohol with benzodiazepines, these two central nervous system depressants go into overhaul and can cause serious complications. Some of these symptoms caused by benzodiazepines and alcohol are:

  • Drowsiness
  • Dizziness
  • Increased Risk for Overdose
  • Slowed or Difficulty Breathing
  • Impaired Motor Control
  • Unusual Behavior
  • Memory Problems
  • Liver damage
  • Drowsiness

Benzodiazepine Tolerance, Dependence, And Withdrawal Symptoms

The DEA goes even further to shed light on benzodiazepine dependence, “tolerance often develops after long term use requiring larger doses to achieve the desired effect. Physical and psychological dependence may develop, whether taken under a doctor’s orders or used illicitly. Withdrawal symptoms, the severity of which is dependent on the dose, duration of use, and drug used, include anxiety, insomnia, dysphoria, tremors, and seizures.”

Benzodiazepines For Treatment Of Alcohol Withdrawals

Even though benzodiazepines can be used to treat alcohol withdrawals, the two aren’t meant to be taken at the same time. Benzodiazepines can be useful in medicine, and they help a lot of people deal with serious psychological issues—from helping sexual assault victims deal with traumatic events, to treatment of anxiety and other central nervous system problems, and as mentioned treatment of alcohol withdrawal. The point here is not to marginalize benzodiazepines as a medicine, but to inform what can happen when they are abused and mixed with other substances like alcohol.

Benzodiazepine And Alcohol Liver Damage

Alcohol abuse can take a serious toll on the body and lead to numerous health complications with the liver like alcoholic hepatitis, cirrhosis of the liver, liver disease, and kidney failure. Certain benzodiazepines like, “alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, flurazepam and triazolam have been linked to rare instances of cholestatic liver injury but the other benzodiazepines have not.  The absence of reports of this rare adverse event, however, may be due to the fact that these other benzodiazepines are not as commonly or continuously used” (U.S. National Library of Medicine).

Adverse Effects Of Benzodiazepine And Alcohol Overdose

Alcohol mixed with any other depressant can be dangerous. Adverse effects include increased reaction time, motor uncoordination, anterograde amnesia, slurred speech, restlessness, delirium, aggression, depression, hallucinations, and paranoia. Unlike barbiturates, large doses of benzodiazepines are rarely fatal unless combined with other CNS depressant drugs, such as alcohol or opioids” (DEA).      

What Factors Can Contribute To Alcohol Use Disorders?

Not everyone who uses alcohol will react the same way, and there are a lot of different factors that can play a role in whether a person will develop an alcohol use disorder or alcoholism. Those factors, from the Center of Disease Control and Prevention, are:

  • Age.
  • Gender.
  • Race or ethnicity.
  • Physical condition (weight, fitness level, etc).
  • Amount of food consumed before drinking.
  • How quickly the alcohol was consumed.
  • Use of drugs or prescription medicines.
  • Family history of alcohol problems.       

How To Find Treatment For A Substance Use Disorder

Sometimes addiction can get the best of us, and after all it’s a natural occurrence of brain chemistry and dopamine—so it can be easier than expected. After detoxifying your body, getting away to a behavioral rehab treatment can help you clear your mind and give you the recovery skills to get your life back on track. If you or someone you love is struggling with a substance use disorder or addiction, we might be able to find you help. Contact the caring people at to learn more about rehab treatment for substance use disorders.

Center for Disease Control and Prevention - Alcohol and Public Health

Drug Enforcement Administration - Controlled Substance Schedules

National Institute on Alcohol Abuse and Alcoholism - Harmful Interactions: Mixing Alcohol with Medicines

U.S. National Library of Medicine - Benzodiazepines and Alcohol

U.S. National Library of Medicine - LiverTox: Benzodiazepines

United States Department of Agriculture - Dietary Guidelines for Americans 2005

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