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Benzodiazepines: The Risks of Mixing with Alcohol and Long-Term Use

Benzodiazepines, or benzos, are a class of drugs commonly prescribed for anxiety and insomnia. They have a sedative effect that helps calm people down and make them feel more relaxed.

However, benzodiazepines also have a dangerous side, especially when combined with alcohol. Here, we will explore the history of benzodiazepines, their current use and prescriptions, and the risks of mixing them with alcohol.

We will also take a closer look at how benzodiazepines work in the brain, their mechanism of action, and the potential for addiction and dependence.

History of Benzodiazepines

The discovery of benzodiazepines happened by accident in the early 1960s, thanks to the work of Leo Sternbach, a chemist at Hoffman-LaRoche. In 1960, Sternbach synthesized a compound that he called chlordiazepoxide, or Librium, which turned out to have tranquilizing effects.

A year later, he developed diazepam, or Valium, which became the most widely prescribed drug in the world in the 1970s.

Current Use and Prescriptions

Today, benzodiazepines are still used to treat anxiety and insomnia, with drugs like lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax) being some of the most commonly prescribed. While effective in the short-term, the long-term use of benzodiazepines can lead to dependence and addiction.

They are often prescribed in high doses, leading to an increased likelihood of overdose, respiratory depression, and cognitive impairment.

Dangers of Combining with Alcohol

The dangers of combining benzodiazepines with alcohol are well documented, with the interaction between the two drugs potentially fatal. Combining the two can depress the central nervous system, causing respiratory failure, coma, or death.

Even small amounts of alcohol combined with benzodiazepines can lead to dangerous outcomes. It is best to avoid alcohol completely when taking benzodiazepines, or at least to wait a few hours between consuming alcohol and taking the medication.

How Benzodiazepines Work

Benzodiazepines work by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. GABA is an amino acid that acts as a natural tranquilizer, calming the brain and reducing anxiety.

Benzodiazepines bind to the GABA receptor and increase the brain’s response to GABA, producing a sedative effect.

Mechanism of Action of Benzodiazepines

Benzodiazepines bind to specific sites on the GABA receptor, activating the receptor and increasing the amount of GABA that can bind to it. This amplifies the calming effect of GABA, leading to sedation and muscle relaxation.

The drugs can also block nerve activity and reduce seizures, making them useful for treating epilepsy.

Addictiveness and Dependence

Despite their therapeutic benefits, benzodiazepines can be addictive and lead to dependence. Prolonged use of the drugs can lead to a tolerance for their effects, requiring larger and larger doses to achieve the same effect.

This can eventually lead to physical dependence, where the body experiences withdrawal symptoms, such as tremors, anxiety, and hallucination, when the drugs are discontinued. It is important to follow a doctor’s instructions carefully when taking benzodiazepines, to avoid addiction, dependence, and withdrawal symptoms.

In conclusion, benzodiazepines are a class of drugs commonly prescribed for anxiety and insomnia. While they can be effective in calming the brain and reducing anxiety, they also carry risks, especially when combined with alcohol.

Understanding how benzodiazepines work in the brain, their mechanism of action, and the potential for addiction and dependence can help patients make informed decisions when it comes to their treatment. It is important to discuss any concerns about benzodiazepine use with a healthcare provider.

Lack of Research and FDA Warning

Despite the widespread use of benzodiazepines, there is still insufficient research and knowledge about the long-term effects of these drugs. Inadequate physician knowledge concerning the risks and benefits of benzodiazepine use has also led to a potential danger for patients.

The medical community needs to recognize the full scope of the problem to better protect patient health.

FDA Warning and New Labeling Information

In 2020, the US Food and Drug Administration (FDA) issued a warning about the potential for abuse, misuse, addiction, and dependence associated with benzodiazepines. The administration has required new labeling information to include warnings about potential risks, especially when consumed with opioids and other central nervous system depressants.

The FDA has also issued recommendations for clinicians on how to safely and effectively prescribe these drugs.

Long-term Effects and Withdrawal Symptoms

Benzodiazepines can be addictive, and long-term use can cause severe addiction, leading to physical dependence and withdrawal symptoms. Withdrawal symptoms, such as tremors, anxiety, and hallucination, can be severe, intense, and long-lasting.

Individuals who have used benzodiazepines long-term and want to quit should seek medical help and gradually wean themselves from the medication under their healthcare provider’s supervision.

Special Cautions for Older Adults

Older adults are at risk for harmful side effects of benzodiazepines. These effects may include longer-lasting effects than in younger people, increased risk for falls, and cognitive decline.

There is also an association between benzodiazepine use and an increased risk of Alzheimer’s disease, although more research is needed to determine the extent of this connection.

Recommendation for Alternative Treatments

For older adults struggling with anxiety or insomnia, nonpharmacological approaches such as sleep restriction and cognitive-behavioral therapy may be viable alternatives to benzodiazepines. They work to identify and change maladaptive patterns of thinking that may contribute to sleep disturbances while promoting healthy sleep hygiene.

Exercise, mindfulness meditation, and relaxation techniques may also alleviate symptoms.


Benzodiazepines are an effective treatment option for short-term anxiety and insomnia. However, their long-term use can lead to addiction, dependence, and withdrawal symptoms.

Older adults, in particular, are at greater risk of serious side effects and should consider alternative treatments such as nonpharmacological approaches. The medical community and regulatory agencies must continue to work together to ensure that physicians and patients have full and accurate information on the risks and benefits of benzodiazepine use, aiding in the safe prescribing and use of these important medications.

Benzodiazepines and COVID-19

In light of the COVID-19 pandemic, taking benzodiazepines must come with extra precautions for patients with respiratory illnesses. It is essential to exercise caution in prescribing benzodiazepines for patients with respiratory distress or depression, as these drugs can lead to respiratory failure.

Healthcare providers are urged to monitor patients closely and limit benzodiazepine use when appropriate.

Anxiety and Lung Function

COVID-19 is known to impact respiratory health, and anxiety may also impact lung function. Anxiety can lead to hyperventilation, which may result in acute respiratory decompensation.

Patients with anxiety and respiratory illnesses should receive a thorough assessment before starting benzodiazepines.

Conclusion and Recommendations for Consumers

Benzodiazepines are a powerful treatment option for anxiety and sleep disorders, but they are not without risks. Long-term studies show the potential for addiction, dependence, and withdrawal symptoms.

As such, it is essential to consult a medical professional when considering benzodiazepines. Patients must take benzodiazepines as directed and avoid alcohol consumption, which can dangerously interact with benzodiazepines.

Reducing alcohol intake can be effective in preventing complications with benzodiazepine use.

Treatment of Benzodiazepine Dependence

Benzodiazepine dependence is a significant concern, and there are currently no accepted medications for treating benzodiazepine dependence. As such, psychotherapeutic approaches are often used to help patients taper off benzodiazepines and manage withdrawal symptoms.

Psychotherapy works to identify the underlying causes of anxiety and promote healthy coping strategies.

In conclusion, while benzodiazepines can be highly effective in the short-term treatment of anxiety and sleep disorders, they come with significant risks.

It is essential to consult a healthcare provider when considering benzodiazepines and follow their instructions carefully. Patients must avoid alcohol while taking benzodiazepines and be cautious about taking these drugs if they have respiratory illnesses.

Finally, due to the lack of accepted medications for treating benzodiazepine dependence, individuals who wish to quit should seek psychotherapeutic approaches to avoid the risks of developing dependence and withdrawal symptoms.

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