Are you worried that you or a loved one is struggling with alcohol addiction? Alcohol use disorder, commonly referred to as AUD, isn’t a choice; it’s an indiscriminate, chronic relapsing brain disease. Those diagnosed with AUD compulsively drink and, despite the negative impact it has on their life, find it impossible to control the quantity consumed. Diagnosis classifications range from mild, moderate, to severe, often resulting in a number of symptoms, including but not limited to:

  • The need to drink regularly
  • Incapacity to limit alcohol intake
  • A seemingly higher tolerance to alcohol
  • Participation in risky behaviors
  • Mental and physical withdrawals when alcohol isn’t available
  • Susceptibility to certain cancers and chronic diseases
  • Trouble learning and remembering
  • Irreparable damage to the liver and brain
  • Depression and, or anxiety

AUD is an extremely dangerous condition, resulting in significant detriment to and loss of life. According to the National Institute of Alcohol Abuse and Alcoholism, the inappropriate use of alcohol is a leading cause of preventable death in the United States, claiming an estimated 88,000 lives yearly. AUD is also widespread, with approximately 16 million individuals suffering from the disease nationwide.

Regardless of the severely of the addiction, however, those who seek and receive professional treatment can overcome AUD. While treatment plans vary significantly from patient to patient, they generally consist of a combination of therapy, medical prescriptions, and participation in support groups.

Currently, there are three types of medications prescribed to treat AUD: naltrexone, acamprosate, and disulfiram. These medications can help curb the urge to drink and limit the amount consumed. Benzodiazepines, sometimes referred to as ‘benzos,’ have also been found effective in treating withdrawal-related symptoms.

What are benzodiazepines?

Benzodiazepines are a controlled, schedule IV substance available only with a prescription from a healthcare professional. As minor tranquillizers, benzodiazepines are sedatives that induce sleep, relieve anxiety, ease muscle spasms, and prevent seizures. They are most commonly prescribed for anxiety and insomnia, but are also helpful in alleviating AUD withdrawal symptoms.

There are several variations of this drug, the most familiar being Valium, Klonopin, Librium, Xanax, and Serax. Generic versions of benzodiazepines can often be identified by the presence of “aze” or “azo” in the name. It’s most commonly used in tablet or capsule form, but some variances are available as syrups or injections.

While benzodiazepines are widely prescribed by doctors, dependency can develop in as few as four weeks. For this reason, healthcare practitioners often prescribe them sparingly, for short periods of time, and under close supervision.

How are benzodiazepines used in treating alcoholism?

For some, AUD symptoms develop quickly and aggressively, but it may be years before signs become noticeable in others. Addiction occurs because the brain learns to rely upon alcohol to produce certain chemicals, eventually resulting in withdrawals when alcohol is withheld. Common alcohol withdrawal symptoms include:

  • Irritability
  • Agitation
  • Anxiety
  • Dysphoria
  • Trouble sleeping
  • Hallucinations
  • Delirium
  • Rapid heartbeat
  • Elevated blood pressure
  • Excessive sweating
  • Shaking
  • Seizures

While many people diagnosed with AUD never experience severe withdrawal symptoms or complications, benzodiazepines are often prescribed during the first phase of detoxification. This is when alcohol withdrawal symptoms present most strongly and it’s impossible to determine the exact effects on any given person. Prescribing some form of benzodiazepine often provides symptom relief and ultimately increases the likelihood of completing detoxification.

Benzodiazepines are most commonly used to manage withdrawal symptoms during the first week or two of treatment. As the symptoms subside, benzodiazepine doses are tapered off and eventually halted completely.

In most cases, detoxification and any necessary medicating take place under the supervision of highly-trained and experienced alcohol treatment specialists. This is recommended, as the process is unpredictable and benzodiazepines can be a habit-forming drug. Proper care and intentional surveillance of benzodiazepine use is often essential.

The most commonly prescribed regimens of benzodiazepines for alcohol rehabilitation are symptom-triggered, loading dose, and fixed tapering dose.

Symptom-triggered regimen

Symptom-triggered administration of benzodiazepines generally takes place in an inpatient treatment facility. Medical staffs closely monitor the development of withdrawal symptoms and then prescribe an appropriate dosage. The worse the symptoms become, the higher the dose administered.

Loading dose regimen

Loading dose regimens are also utilized during inpatient treatments. This method utilizes long-acting benzodiazepines that remain active in the body for several days. The goal of this is to reduce the risk of extreme withdrawal symptoms like seizures and delirium.

Fixed tapering dose regimen

This is the only benzodiazepine regimen that doesn’t coincide with inpatient treatment. Fixed tapering doses do not require adjustment as withdrawal symptoms appear, making it an ideal method for individuals participating in outpatient rehabilitation.

How do benzodiazepines work?

Benzodiazepines work to slow down the body’s central nervous system by enhancing the effects of gamma-amino butyric acid (GABA), a major inhibitory neurotransmitter in the brain. The ultimate result is decreased brain activity or, in simpler terms, sedation.

This process can produce very positive results during AUD rehabilitation, as it helps to alleviate the uncomfortable, and sometimes painful, withdrawal symptoms experienced during the detoxification period. Prescribed benzodiazepines help to keep patients calm and relaxed, despite potentially mentally and physically unpleasant circumstances.

While benzodiazepines effectively assist with the management of withdrawal symptoms, it’s important to realize that they do not help patients reduce their actual use of alcohol. Nor do they help to prevent relapse. These drugs are best used during the detoxification treatment period to combat mild to severe symptoms associated with alcohol withdrawal.

Side effects of benzodiazepines

The effects of benzodiazepines vary greatly from person to person. This is another reason why supervision is often encouraged for recovering alcoholics. How benzodiazepines will impact a particular person often depends on the following:

  • Dosage prescribed
  • Height and weight
  • General health
  • Past experiences with similar drugs
  • Use of other medications
  • Setting
  • Type of administration (pill, syrup, or injection)

While prescribed benzodiazepines are safe for use, it’s not uncommon to experience minor side effects. These often include, but are not limited to:

  • Drowsiness
  • Dizziness
  • Diarrhea
  • Appetite changes
  • Dry mouth
  • Weakness

In rare cases, more serious effects can present themselves. Seek assistance from a healthcare professional if you notice any of the following:

  • Frequent or difficult urination
  • Blurred or double vision
  • Paranoia
  • Aggressive behavior
  • Difficulty breathing
  • Slurred speech
  • Poor motor function and coordination
  • Yellowing of the skin or eyes
  • Depression
  • Delirium or hallucinations
  • Anterograde amnesia
  • Skin rash

It’s important to note that taking benzodiazepines during pregnancy is discouraged. Doing so can negatively impact fetal growth and development, as well as cause illness after birth and the development of symptoms associated with drug withdrawal. If you are pregnant, make sure to mention this to your healthcare professional when discussing potential AUD treatment plans.

You should also speak with a medical practitioner about the risk of benzodiazepine dependency. While benzodiazepines will often help manage withdrawal symptoms associated with AUD, it’s possible to experience withdrawal from the prescribed drug as well. Speak with your doctor right away if you begin to notice increased anxiety, insomnia, dysphoria, tremors, or seizures as you decrease your use of benzodiazepines.

Do not take benzodiazepines, prescribed or otherwise, in conjunction with other CDS depressant drugs (alcohol or opioids), as the result can be fatal.

Types of benzodiazepines

There are several different types of benzodiazepines, but not all of them are suitable for AUD treatment. While there are generic versions available, here are several of the most easily recognizable branded varieties:

  • Valium
  • Xanax
  • Halcion
  • Klonopin
  • Ativan
  • ProSom
  • Dalmane
  • Restoril
  • Versed
  • Librium
  • Tranxene
  • Paxipam
  • Serax
  • Centrax
  • Doral

The most common benzodiazepines utilized by AUD treatment specialists are diazepam, chlordiazepoxide, oxazepam, and lorazepam.

Diazepam

Diazepam, recognized as Valium, is a long-acting benzodiazepine used to reduce withdrawal symptoms like anxiety, muscle spasms, insomnia, and seizures. It’s generally given in tablet form or via an injection, a single dose lasting up to three days. Effects should be noticeable anywhere from five minutes (injectable) to 60 minutes (pill) after administration.

Chlordiazepoxide

Similarly, chlordiazepoxide, or Librium, also alleviates anxiety and muscle spasms as a result of alcohol withdrawal. Patients usually receive this long-acting benzodiazepine in pill form daily and notice results in as little as 30 minutes. It’s primary purpose is to make the detoxification period more comfortable.

Oxazepam

Commonly prescribed as Serax, oxazepam is a short-to-intermediate-acting benzodiazepine that combats anxiety during AUD treatment. It’s generally administered daily under medical supervision, allowing for constant monitoring of patient vitals in case of emergency. This benzodiazepine takes longer to activate and the effects last approximately 24 hours.

Lorazepam

Lorazepam, often seen as Ativan, is an intermediate-acting benzodiazepine used to limit anxiety, as well as prevent seizures, associated with alcohol detoxification. It’s generally administered in rehabilitation centers in pill form or via an injection and the effects will last anywhere from 11 to 20 hours. This benzodiazepine is particularly effective for older patients and those suffering from liver failure.

Getting Treatment for AUD

While AUD is a very difficult disease to live with, there are numerous treatment options available. Because everyone responds to rehabilitation differently, it’s best when you or your loved one can work closely with a certified health professional to develop an individualized recovery plan. Treatment plans produce the best results when they include a well-balanced combination of therapy, mutual-support group participation, and medicine.

If you or a loved one is struggling with AUD, take steps to get the help you need right away. Remember to discuss the potential benefits of prescribed benzodiazepines with your alcohol treatment specialist during consultation.