What Happens When You Mix Anxiety Meds With Alcohol

By Geoffrey A. Booth, M.D., Medical Director, Rehabs Malibu

Anxiety medications, such as benzodiazepines or barbiturates, are prescription sedatives that help manage the symptoms related to an anxiety disorder. These drugs work by increasing the GABA levels in the brain, which in turn cause the desired sedating effect.

All anxiety medications carry a warning not to consume alcohol while taking the drug. Alcohol has a depressant effect on the central nervous system as well, slowing brain and body functions, so the two substances together could possibly lead to respiratory failure and death.

There are various reasons why an individual might drink alcohol while taking an anxiety drug like Xanax, for example. They may desire to amplify the effects of the benzo; they may take the benzo in order to increase the effects of the alcohol; or they may inadvertently consume alcohol and simply forget that they are on a prescription sedative. To learn more about what can happen when you mix anxiety meds with alcohol, continue reading.

What Are Anxiety Meds?

In recent years, benzodiazepines have mostly replaced highly addictive barbiturates for patients being treated for an anxiety disorder, as benzos are considered to be less dangerous. Although some anxiety patients do respond better to barbiturates like Luminal or Mysoline, for the most part our discussion will focus on benzodiazepines as the primary drug class for the treatment of anxiety disorders.

The most common benzodiazepines prescribed for treatment of anxiety include:

• Xanax (alprazolam)
• Valium (diazepam)
• Ativan (lorazepam)
• Klonopin (clonazepam)
• Librium (chlordiazepoxide)

Anxiety medications work by slowing down brain activity, which helps the person enjoy a sense of relaxation and calm. These fast-acting drugs are highly effective, however, due to their potential for causing dependence and addiction they are not intended for long-term use.

Dependence can develop quickly. This occurs when the desired effects become more elusive the longer the benzo is used, which prompts the individual to take higher or more frequent doses. Over time, brain pathways become modified and physical and psychological dependence can develop.

Benzos also have a high propensity for abuse, therefore carry a Schedule IV controlled substance classification by the Drug Enforcement Administration. As a drug of abuse, benzos are often combined with other prescription drugs or alcohol for the purpose of experiencing enhanced effects.

Signs of a Polysubstance Use Disorder

Although the signs of substance use disorder may appear gradually, eventually the warning signs will be impossible to ignore. This is even more the case when there are two or more substances involved.

Signs that you or a loved one has a benzo/alcohol use disorder may include:

• Increased risky behavior
• Aggressive or violent behavior
• Acute intoxication
• Severe hangovers
• High incidence of accidents and injuries
• Signs of mental health problems
• Increased tolerance that results in increased consumption of both substances
• Secretive behaviors; lying about the substance abuse
• Attempts to cut back or quit the substances fail
• Continued use of both substances despite the negative consequences
• Emergence of withdrawal symptoms

How Does Alcohol Interact with Anxiety Meds?

When someone combines the use of alcohol with a benzodiazepine, serious complications can ensue. This is because both substances reduce respiratory rate, heart rate, and blood pressure. Some of the effects caused by the interaction of alcohol and anxiety meds may include:

• Drowsiness
• Impaired motor control
• Dizziness
• Impulsive or risky behaviors
• Memory problems
• Cognitive impairment
• Slowed or difficult breathing
• Blackout
• Overdose

Continued abuse of alcohol with benzodiazepines can result in serious long-term physical and mental health conditions. These include:

• Cardiovascular issues
• Liver damage
• Kidney damage
• Neurological conditions such as dementia
• Gastrointestinal conditions
• Depression
• Psychotic disorders
• Bipolar disorder
• Poly-substance addiction

What Are the Signs of Overdose?

Experiencing an overdose is the most pressing danger for someone who combines anxiety meds with alcohol. Because the alcohol is metabolized first in the liver, the benzo stays longer in the bloodstream. The combination of both depressants in the body can overwhelm the central nervous system and lead to respiratory distress and possibly death.

Overdose symptoms might include:

• Lightheadedness
• Confusion
• Severe drowsiness
• Difficulty breathing; shallow breathing
• Loss of balance
• Becoming unresponsive
• Floppy limbs
• Fainting
• Coma

If an overdose occurs, immediate medical intervention is necessary.

Seeking Polysubstance Use Disorder Treatment

When you or a loved one develops a problem with both alcohol and benzos you are at a heightened risk of serious health events or even a fatal overdose. It is critical that you seek out a comprehensive treatment program that will guide you to sustained sobriety and wellness.

Detox and Withdrawal

Recovery begins with a medically monitored detox and withdrawal. Withdrawal management must be overseen by a trained detox team working under the guidance of a physician. The detox process will entail a two-week gradual tapering process of the anxiety drug, whichever benzo that is. By slowly reducing the dosage, the body is able to adjust, which greatly reduces withdrawal symptoms. Symptoms might include:

Early stage of benzo withdrawal:

• Anxiety
• Insomnia

Acute stage of benzo withdrawal:

• Nausea and vomiting
• Muscle spasms
• Diarrhea
• Twitching
• Blurred vision
• Difficulty concentrating
• Insomnia
• Foggy thinking
• Mood swings
• Panic
• Anxiety
• Hallucinations
• Seizures
• Suicidal thoughts and actions

Protracted stage of benzo withdrawal:

• Tingling in arms and legs
• Muscle twitches
• Cognitive problems
• Mood swings
• Depression
• Insomnia
• Prolonged anxiety

If the individual is also dependent on alcohol, the detox and withdrawal may be more complicated. There is a risk of the person developing delirium tremens on days 3-4 of alcohol withdrawal, and the risk of seizure exists for both benzo withdrawal and alcohol withdrawal.

Therapy

Rehabilitation begins immediately following the completion of detox. Psychotherapy using behavioral therapies is the centerpiece of addiction treatment, as this is how the individual in recovery learns how to make lasting changes. Evidence-based therapies used in treatment include cognitive behavioral therapy, dialectical behavior therapy, and contingency management.

12-Step

The Alcoholics Anonymous12-step program provides a meaningful roadmap of benchmarks that help the individual progress through the process of recovery and rehabilitation. In addition, the meetings offer a source of social support.

Holistic.

Holistic activities provide methods for reducing anxiety and stress while in treatment, and these same activities can be used in recovery as well. They include yoga, meditation techniques, massage, acupuncture, mindfulness training, and art therapy.

About the Author

Geoffrey A. Booth, M.D. is the Medical Director of LifeSync Luxury Rehab Malibu, an exclusive rehabilitation program located in the heart of Malibu. Dr. Booth has treated thousands of addicts over the years and now has dedicated most of his clinical time to providing medical care and detoxification to clients who suffer from substance abuse. He is committed to helping them establish the foundations for long-term sobriety. While not working, Dr. Booth has a rich personal life filled with activities surrounded by friends and family.