What Are the Risks Associated with Mixing Xanax and Alcohol?

According to the book Benzodiazepines, Xanax (alprazolam) was developed as an alternative medication to Valium (diazepam) for the treatment of anxiety, particularly panic attacks.
 
Both Xanax and Valium are benzodiazepines, which are tranquilizer drugs or central nervous system depressant drugs that are primarily designed to deal with anxiety disorders, control of seizures, and, in some cases, as preanesthetic agents. Many of these drugs also have several other medicinal uses, such as assisting individuals in withdrawing from alcohol or other drugs.

Benzodiazepines are generally classified as Schedule IV controlled substances by the United States Drug Enforcement Administration (DEA), indicating that they have a moderate potential for abuse and the development of physical dependence. Xanax has become one of the most prescribed benzodiazepines. Despite the intent to develop a safer drug that was less prone to abuse than Valium, Xanax is also a significant potential drug of abuse.

Benzodiazepines are typically not primary drugs of abuse but most often abused with other drugs. One of the most common combinations is the use of Xanax with another benzodiazepine or with alcohol.

The Mechanism of Action of Xanax and Alcohol

According to the two-volume set The Oxford Handbook of Substance Abuse and Substance Use Disorders, Xanax facilitates the release of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in an indirect manner and increases the concentration of dopamine in the central nervous system. This combination results in both the sedative/tranquilizing effects of Xanax as well as the mild euphoria that is associated with its use.

Alcohol is a substance that produces varied different effects depending on the dosage. At low doses, many individuals feel stimulated and invigorated, whereas at more moderate to higher doses, individuals find themselves becoming more sedated or relaxed. The primary effects of alcohol are to affect the concentration of the inhibitory neurotransmitter GABA, increasing the effects of the inhibitory neurotransmitter glycine (which is prevalent in the spinal cord and brain stem and decreasing actions of neural transmitters that are excitatory. Alcohol use also affects dopamine levels in the brain mostly through its influence on a particular serotonin receptor. Thus, the mechanism of action for both Xanax and other benzodiazepines and alcohol share numerous similarities.
Even though most sources report that abuse of benzodiazepines like Xanax more commonly occurs in conjunction with abuse of other drugs, polysubstance abuse figures can be unreliable.  According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the yearly rate of emergency room visits for co-occurring benzodiazepine and alcohol use remained stable at around 20,000 cases per year until 2008 when it jumped to around 27,000 cases nationally and remained at that level until SAMHSA stopped collecting information for the Drug Abuse Warning Network (DAWN) surveys.

Effects Associated with Mixing Alcohol and Xanax

counselorWhen taken within its therapeutic dosage range, Xanax is generally considered to be safe. When individuals take small doses of both Xanax and alcohol, the potential for severe interactions is minimized compared to the potential effects that could occur with higher doses. At lower doses, both substances are easily metabolized, but when individuals begin using higher doses of one or both substances, this puts significant strain on the system. Having one beer and one Xanax is obviously not as problematic as drinking a 12-pack of beer and taking six or seven Xanax. Obviously, larger amounts of either or both substances during same time period lead to greater potential effects and interactions between the two drugs.

Individuals who use Xanax and alcohol together will experience the effects of both substances, but technically, the specific effects and reactions that occur as a result of using these drugs together will depend on whether one consumes more alcohol relative to Xanax or more Xanax relative to alcohol. Using larger quantities of alcohol compared to Xanax will result in significantly more lethargy and sedation; however, because mixing the drugs will result in synergistic effects, using significantly more Xanax and alcohol will also produce levels of sedation and lethargy, but individuals may also experience more euphoria as opposed to overt depression or irritability. Thus, individuals using both drugs will experience heightened effects of anxiety reduction, sedation, lethargy, decreased motor reflexes, etc. However, individuals who consume significantly more alcohol relative to Xanax are far more likely to become unconscious or pass out quickly, although certainly use of both drugs in any amount can lead to unconsciousness and even comatose states.

Moreover, because the liver makes metabolizing alcohol a priority over almost all other substances, individuals who drink significant amounts of alcohol while taking Xanax will eliminate Xanax from their system at a slower pace than if they just take Xanax alone. This can result in a dangerous buildup of Xanax in the system.

Numerous sources have documented the dangers of potentially mixing benzodiazepines like Xanax and alcohol. According to the book series Neuropathology of Drug Addiction and Substance Abuse, these dangers include:

  • Relaxation and euphoria: The use of both drugs will immediately result in increased feelings of relaxation, a marked reduction in anxiety or perceived stress, and mild feelings of euphoria. These effects most often occur at smaller doses. As individuals take larger doses of one or both drugs, sedation typically takes over.
  • Fatigue, lethargy, and lightheadedness: Individuals taking both Xanax and alcohol will most likely experience some level of lightheadedness. This may be a result of decreased blood pressure (see below). Lightheadedness can be particularly dangerous when an individual is rising from a sitting or lying position, and the more Xanax and/or alcohol one consumes, the more significant the situation is likely to be. In addition, lightheadedness may continue after one has recovered from their substance use.

    Fatigue and lethargy are very common symptoms following the use of Xanax and alcohol together. Fatigue and lethargy can be expressed both physically and mentally with individuals moving more slowly, feeling more tired, lacking energy, and experiencing problems with concentration, thinking, and even memory.

  • Aggression and irritability: Several early studies have found that individuals who use alcohol and benzodiazepines like Xanax together are far more prone to become aggressive, irritable, and angry than individuals who use either substance alone. Even though these drugs produce increased feelings of relaxation and less vulnerability to stress, they also inhibit an individual’s ability to self-monitor their feelings and behaviors, and interfere with their ability to inhibit impulsive actions. As individuals take these drugs in greater quantities, these effects become even more salient. Individuals who have a history of issues with impulse control, anger, outbursts of anger, etc., will often demonstrate this effect rather quickly. Even individuals who do not have a history of violence or anger management issues may become more irritable and aggressive, and demonstrate outbursts of anger under the influence of these drugs.
  • Cognitive issues: Individuals taking alcohol and Xanax in combination will inevitably suffer some cognitive issues. These are dose-dependent; typically, at lower doses, an individual will feel rather “fuzzy” or “spaced out”, and they may move or think more slowly than normal. At higher doses, these effects can become far more significant.
Due to the synergistic properties of both drugs resulting in decreased flow of blood to the brain and increases in inhibitory neurotransmitters, individuals will often begin to experience significant issues with critical thinking, problem-solving, reasoning, self-control, planning, and judgment. In addition, as individuals begin to use more of one or both substances, they may become confused and will not be able to make sense of their environment.

Because of the increased action of inhibitory neurotransmitters, individuals will often experience difficulty forming new memories while under the influence of these drugs. Taking these drugs in sufficient quantities increases the risk that one will suffer a blackout, where one is still responding to the environment (albeit in an impaired way) but later has no memory of the events that occurred. Again, this is the result of the synergistic effects of these drugs inhibiting the functioning of neurotransmitters that are excitatory and that function in many different types of cognitive abilities, including the ability to form new memories. Chronic use of these drugs may produce lasting changes in the brain that inhibit these functions.

  • Cardiovascular and respiratory effects: The general action of these drugs taken singularly is to suppress the functioning of the autonomic nervous system. When used in combination, their synergistic effects can enhance these actions. Obviously, one of the major dangers in using any central nervous system depressant is the drug’s ability to shut down functioning in areas of the brain stem that control automatic life-sustaining functions, such as heart rate, respiration, etc. Even individuals who do not use these drugs at dangerous levels but continue to use them in combination may suffer numerous respiratory and cardiac issues due to chronically slowing these functions and making one system more vulnerable to infections and other disorders. Taking too much of one or both of these drugs can shut down these areas in the brain, and an individual can stop breathing, which can be fatal. Even chronically decreased oxygen flow (hypoxia) to areas of the brain and other organs as a result of chronic use of central nervous system depressant drugs can result in significant brain or other organ damage.
  • Increased potential for unconsciousness or comatose states: Continuing to engage in the use of these drugs in combination increases an individual’s potential to become unconscious or even comatose.
  • Increased potential for liver and kidney damage: Chronically mixing these drugs burdens the liver to metabolize them and rid them from the system. Similar burdens are placed on the kidneys as the system attempts to eliminate the substances. Individuals who chronically abuse multiple drugs are at increased risk to develop liver and kidney damage and disorders compared individuals who use these drugs singularly.
  • Increased risk for overdose: Using central nervous system depressants in combination with one another increases the potential to overdose on either or both drugs. Individuals may lose track of how many Xanax they take, how much alcohol they drink, or be unable to judge how much more of either drug they can handle. In addition, because the drugs are metabolized at different rates and alcohol is typically metabolized before any other substance, individuals may still have dangerously high levels of Xanax in their system even after several hours. This can lead to a potentially dangerous situation if the person starts taking drugs again.
  • Increased potential for peculiar effects: When individuals mix drugs, they become more prone to developing unusual side effects or even allergic reactions to one or both drugs.
  • Increased potential for psychosis or neurological effects: Mixing Xanax and alcohol increases the potential that one will experience hallucinations and/or delusions or even seizures compared to when using either drug alone.
  • Increased potential for the development of physical dependence: Both Xanax and alcohol can produce physical dependence in individuals who use them for a significant length of time. Using both drugs chronically can increase this potential and the potential for very complicated polysubstance abuse issues.
  • The development of a substance use disorder: There is a direct relationship between using more substances together chronically and the development of a substance use disorder. Individuals who chronically misuse Xanax and alcohol are increasing their risk to develop a formal substance use disorder to one or both drugs.
  • Conclusions

    Individuals who abuse benzodiazepines often abuse them with other drugs, such as alcohol. Due to the mechanism of action of both drugs and the synergistic effects that both drugs produce when taken together, this can be a particularly dangerous combination and may result in serious short-term and long-term effects.

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