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 treat anxiety and panic disorders.Benzodiazepines are generally classified as Schedule IV controlled substances by the United States Drug Enforcement Administration (DEA), indicating that they have some 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 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.
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.
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:
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.