Mixing Benzodiazepines and Alcohol: Risks, Effects, and Dangers

What are Benzodiazepines?

Benzodiazepines (aka downers and benzos) are prescription medications that work on the inhibitory neurotransmitter GABA to reduce neuronal excitability in the CNS. In other words, benzos help slow down (depress) an otherwise overly excited nervous system and create a calming effect.¹ Benzos are widely prescribed for anxiety, insomnia, and alcohol withdrawal management, as well as for seizure and movement disorders.² In fact, based on data from the 2022 National Survey on Drug Use and Health (NSDUH), roughly 25 million people aged 12 and older used prescription benzos in the last year.³

Some of the more common benzodiazepines (and their recognizable brand names) include:⁴

• Clonazepam (e.g., Klonopin).
• Alprazolam (e.g., Xanax).
• Lorazepam (e.g., Ativan).
• Diazepam (e.g., Valium).
• Triazolam (e.g., Halcion).

While benzodiazepines rarely result in overdose-related death when used independently of other substances, they can be addictive due to their calming and euphoric effects, even when taken as prescribed.² According to the aforementioned NSDUH data, roughly 3.7 million people aged 12 and older misused prescription benzos in the last year, with the highest percentage of use occurring among those aged 18 to 25.⁵

Additionally, benzodiazepines are rarely misused alone, as approximately 80% of those who misuse benzos do so in combination with other substances.² A recent review of the literature also revealed that among those with a substance use disorder, rates of benzo misuse are 3.5 to 24 times higher than that of the general population.⁶

Effects and Dangers of Mixing Benzos and Alcohol

Polysubstance use is the intentional or unintentional use of more than one substance within a short period of time. The practice is never safe, and it can produce effects that are unpredictable, stronger than the effects of either drug alone, and even deadly.⁷

Those who intentionally partake in polydrug use—aka polysubstance use—often do for reasons such as to:^2,8

• Enhance the euphoric effects of other substances such as opioids.
• Diminish cocaine highs.
• Heighten alcohol effects.
• Manage withdrawal symptoms between substance use.
• Replace their primary drug of choice when it’s unavailable.

While any type of polysubstance use is risky, it’s particularly dangerous to mix benzodiazepines with other depressants such as alcohol, which also works on the GABA neurotransmitter. Since both substances suppress respiratory activity and increase sedation, the combined impact can have severe respiratory effects.⁹

These effects are partly due to the fact that concurrent use of benzodiazepines and alcohol may produce synergistic as opposed to additive effects on brain circuits that are involved in vital body functions.^7,9 To simplify the concept, imagine that substance A has 4 effects and substance B has 6; the additive effect is the sum of the two, which is 10. With a synergistic relationship, the drugs work together to produce more effects—and more unpredictable outcomes—than the sum of substance A and substance B. In this case, 4 plus 6 might equal effects of 15.

Effects of combining alcohol and benzos can also include:^7,9-11

• Drowsiness.
• Dizziness.
• Impaired motor control.
• Unusual behavior.
• Memory problems.
• Enhanced risk of injury, falls, driving accidents, violence, and risky sexual behavior.
• Increased risk of alcohol or substance use disorders.
• Slow or difficult breathing and central nervous system depression.
• Increased risk of overdose, damage to the brain and other organs, chronic disease, and death.

Research also shows that compared to those with a single substance use disorder, those who misuse multiple substances may have higher rates of:⁸

• Suicide attempts.
• Arrests and incarceration.
• Financial and legal problems.
• Severe medical and psychiatric comorbidities.

Treatment for Benzos and Alcohol Misuse

While most forms of substance use disorder treatment share some commonalities, treatment for polysubstance use has a few unique requirements according to the Substance Abuse and Mental Health Services Administration. It indicates that this treatment should address:⁸

• Simultaneous intoxication and withdrawal from two or more substances.
• Withdrawal from multiple substances with symptoms potentially appearing at different times.
• Potential interactions between substances and medications used to treat substance use and/or mental health disorders.

SAMHSA recommends that FDA-approved medication and counseling should be used to address polysubstance use. The administration also supports the use of contingency management and/or 12-step programs in conjunction with counseling and medication.⁸

Given the potential perils of alcohol withdrawal, medically monitored detox may be the first step of treatment. But detoxing from alcohol is simply one of several steps in an effective treatment program, which typically includes a unique combination of the following levels of care:¹²

• Detox: Medically assisted detox (which is available in both inpatient and outpatient settings) supports patients as they withdraw from substances, keeping them safe and as comfortable as possible.
• Inpatient treatment: With inpatient care, patients live in a rehab facility where they receive 24/7 care, therapy, counseling, and supervision.
• Outpatient treatment: As the name suggests, outpatient care allows patients to live at home while also attending treatment. Outpatient options vary in intensity, as they include traditional outpatient care, intensive outpatient programs (IOPs), and partial hospitalization programs (PHPs), the latter of which are also known as day treatment. Additionally, some programs offer telehealth services as part of outpatient care.
• Aftercare and sober living. Many professionals recommend some form of aftercare—such as sober living facilities, ongoing therapy, 12-Step programs, etc.—following inpatient and/or outpatient care.

Within these levels of care, various therapies and practices are employed based on the unique needs of each individual. Options include:¹²

• Psychoeducation. The purpose of psychoeducation is to expand patients’ awareness of substance use consequences and the recovery process, instill self-awareness, suggest options for growth and change, identify community resources, etc.
• Individual, group, and peer-supported counseling. Counseling can help patients build ways to combat urges and cravings to use alcohol and drugs such as forming healthy habits, improving problem-solving and coping skills, and more.
• Behavioral therapies. A host of behavioral therapies are available to help patients recognize and change behaviors. Options include contingency management (CT), cognitive behavioral therapy (CBT), motivational interviewing (MI), and dialectical behavior therapy (DBT).
• Medication-assisted treatment (MAT). Often combined with behavioral therapies, MAT is employed to treat a variety substance use disorders.
• 12-Step programs. Popular programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) add a layer of community support to help patients maintain long-term sobriety.

If you or a loved one is struggling with polysubstance use involving alcohol and benzodiazepines, American Addiction Centers can help. With facilities scattered across the United States, AAC offers all levels of care and is equipped to treat a host of disorders including those involving polysubstance use.

To learn more about treatment options, verify your insurance benefits, and/or discuss payment options, contact our admissions navigators at . They’re available 24/7 for free and confidential conversations to support you as you take your first steps toward recovery today.