Alcohol Use and Abuse
Alcohol is among the most used and abused drugs in the United States. Alcohol generally has central nervous system depressant actions; however, at very small doses, individuals who consume it may experience mild stimulant-like effects.
Drinking alcohol is associated with numerous physiological reactions, including significant effects on the central nervous system. Basically, alcohol increases activity of the inhibitory neurotransmitters gamma-aminobutyric acid (GABA) and glycine as well as decreases the activity of excitatory neurotransmitters such as NMDA (N-methyl-D-aspirate).
Social use of alcohol in restricted amounts may have some beneficial effects; however, regular and moderate to heavy use of alcohol is associated with numerous adverse effects to physical and emotional wellbeing. In addition, deaths associated with the misuse or abuse of alcohol run into the millions when one begins to look at the long-term effects of alcohol use and the probability of developing conditions, such as cancer, heart disease, gastrointestinal diseases, etc.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) annual National Survey on Drug Use and Health in 2015 found the following to be true:
- Among individuals age 12 and over, 138.3 million Americans reported being current users of alcohol.
- Among individuals age 12 and over, 66.7 million Americans met the criteria for binge drinking within the month prior to the survey; binge drinking is defined as four or more alcoholic drinks on the same occasion for females, and five or more alcoholic drinks on the same occasion in males.
- Among individuals 12 and over, 17.3 million Americans met the criteria for heavy drinking within the month prior to the survey; heavy drinking was defined as meeting the criteria for binge drinking five or more days out of the month.
- Based on the above information, 48.2 percent of all individuals drinking alcohol met the criteria for binge drinking at least once, and 26 percent of binge drinkers met the criteria for heavy alcohol use.
- In the US, it is estimated that 15.7 million individuals met the criteria for an alcohol use disorder in 2015.
BenzodiazepinesBenzodiazepines make up a large category of medications that were originally developed to treat anxiety disorders or issues with anxiety, seizures, and issues with sleeping. They have also found medicinal uses in other areas. These drugs have largely assumed the role of the barbiturates and represent one of the most often prescribed classes of drugs in the US. Their development was spurred by the need to develop a sedative/tranquilizer that was not as addictive as the barbiturates but still efficacious; however, benzodiazepines are significant drugs of abuse and carry the potential for the development of physical dependence.
The Drug Enforcement Administration classifies all benzodiazepines as controlled substances. Some of the more familiar benzodiazepines include:
- Xanax (alprazolam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Ativan (lorazepam)
- Restoril (temazepam)
Benzodiazepines are central nervous system depressants like alcohol, and they have their major mechanism of action on the inhibitory neurotransmitter GABA. Except in a very few cases, such as the control of seizures in disorders like epilepsy, benzodiazepines are not designed to be long-term solutions to the issues they treat, such as anxiety, issues with sleep, etc. Nonetheless, these drugs are still widely prescribed. Even though the majority of individuals with a prescription for these medications do not abuse them, drugs that are prescribed frequently are also more available to potential abusers. According to SAMHSA, in 2015, nearly 2 million Americans misused tranquilizers.
Alcohol and Benzodiazepines Together
Professional sources, such as SAMHSA and the National Institute on Drug Abuse (NIDA), report that when benzodiazepines are misused or abused, they are not typically the primary drug of abuse. Benzodiazepines are most often abused in conjunction with other drugs.
The most common drugs abused or misused along with benzodiazepines are other benzodiazepines, prescription pain medications (particularly opiates), and alcohol. Previous data collected by SAMHSA indicates a steady rise in hospital emergency department admissions associated with the misuse of benzodiazepines and alcohol from 2007 through 2011. There are several reasons given by individuals who take these drugs for abusing them in combination.
- According to data from SAMHSA, individuals abuse the two drugs together because this practice enhances the effects of at least one of the drugs.
- Individuals who misuse benzodiazepines are often under the impression that using prescription medications with other drugs is a safer practice than using illicit drugs in combination with alcohol or other drugs.
- Alcohol can be legally procured by most adults, and it is readily available at parties or in social situations. This makes it an ideal companion drug for any individual who misuses or abuses drugs.
- Numerous sources, such as the Drug Abuse Handbook, report that there is a significant body of research that suggests that individuals with alcohol use disorders experience enhanced psychoactive effects from benzodiazepines compared to individuals without alcohol use disorder, most likely due to neurobiological mechanisms associated with alcohol use disorder.
Risks of Mixing Alcohol and Benzodiazepines
There are numerous dangers associated with mixing benzodiazepines and alcohol. Every warning label on the container for a benzodiazepine cautions against this practice, and physicians often explicitly instruct their patients to avoid alcohol when they are prescribed benzodiazepines. The risks for abusing these drugs in combination are significantly more severe than the risks of abusing them singularly.The major risks of combining these drugs include:
- Enhanced effects: Mixing two drugs that have the same mechanism of action results in the enhancement of the effects of both drugs. This means that the effects of both drugs are increased significantly compared to the use of either drug alone.
- Increased risk of overdose: When an individual mixes two central nervous system depressants, they are at an extreme risk for overdose on one or both of them. An overdose on either drug can have serious and even fatal ramifications, including significant organ damage or brain damage due to a lack of oxygen as both drugs suppress breathing.The amount of alcohol that can lead to an overdose is significantly reduced when one drinks alcohol with benzodiazepines, and the dose of benzodiazepine that can result in overdose is significantly reduced as a result of taking the drug with alcohol. Whenever an individual drinks alcohol, the person’s system metabolizes the alcohol before metabolizing any other substances. This means that drugs like benzodiazepines remain in the individual’s system longer if they consume these drugs with alcohol. A person who drinks alcohol and continues to take benzodiazepines may develop extremely dangerous levels of benzodiazepines in their system.
- Increased reduction of cognition: Due to the enhanced effects of both drugs, individuals mixing them will experience a significant reduction in their cognitive abilities. This can result in several different potentially serious situations, such as a loss of inhibitions that can lead to accidents, impaired judgment that can lead to poor or risky decisions, significantly reduced reasoning abilities, and an inability to control one’s emotions that can result in becoming hostile or aggressive. In addition, the potential for suffering a blackout is increased when these drugs are used in combination.
- Decreased physical reactions: Due to the enhanced effects of both drugs, individuals will experience significant reductions in their response times, motor coordination, and ability to perform routine or complex actions. These effects can result in a number of potentially dangerous situations.
- Increased side effect potential: Combining two central nervous system depressants also enhances their potential side effects. Individuals may experience numerous negative effects, such as nausea, vomiting, lethargy, allergic reactions, etc., as a result of mixing these drugs.
- Increased potential for unpredictable effects: Mixing drugs leads to an increased probability that an individual will experience unusual reactions that may be difficult to diagnose even by experienced clinicians.
- Increased potential to develop acute conditions: Combining drugs increases the potential to develop serious acute reactions, such as heart attack, stroke, psychosis, suicidal tendencies, or seizures.
- Increased risk of long-term physical conditions: Continuing to use benzodiazepines and alcohol together increases the long-term risks that are associated with these drugs when they are used singularly. These risks include the development of cardiovascular issues, gastrointestinal issues, potential liver damage, potential kidney damage, and potential neurological issues that can include the development of dementia.
- Increased risk of a mental health disorder: Long-term abuse or misuse of alcohol and benzodiazepines in combination is associated with an increased probability to be diagnosed with a serious psychological condition. Conditions like depression, trauma and stressor-related disorders, anxiety disorders, psychotic disorders, bipolar disorder, etc., are more prevalent in people who suffer from polydrug abuse.
- Increased risk to develop physical dependence on one or both drugs: Prolonged use of either alcohol or benzodiazepines is associated with a risk to develop physical dependence. Continued abuse of one or both drugs increases the risk that an individual will develop physical dependence on one or both. The withdrawal process from either drug can be potentially fatal due to the development of seizures in some individuals.
- Increased risk to develop a substance use disorder: Continuing to abuse these drugs in combination increases the risk that one will develop a formal substance use disorder to one or both substances. Individuals with polysubstance use disorders can present with complicated presentations that can be very difficult to treat.
- Increased risk of issues with relationships, professional goals, educational goals, finances, etc.: Continued abuse of one or both drugs increases the potential that an individual will suffer significant impairment in one or more areas of life, such as with work, personal relationships, obligations and responsibilities, family life, etc.
Any level of abuse of one or both of these drugs is an extremely serious condition. Individuals who abuse these drugs often require intensive and long-term treatment programs to help them recover from their drug abuse.
There are important reasons that the warnings on the instruction labels of benzodiazepines strongly advise against drinking alcohol with these drugs. Combining alcohol with benzodiazepines can be dangerous practice even if it is engaged in only occasionally.
Chronic abuse of these two drugs together can result in a number of serious short-term and long-term effects. These ramifications are not limited to potentially serious health issues but extend to issues with an individual’s overall life satisfaction and everyday functioning. Because abuse of either of these drugs can result in the development of physical dependence that can have serious ramifications, individuals should not attempt to stop using these drugs without first consulting with a licensed medical professional.