Benzodiazepines as Treatment for Alcoholism

Benzodiazepines are a safe form of sedative medication used to treat symptoms of alcohol withdrawal and other conditions.

They work by slowing down brain functions and inducing a calming effect. [1]

You may be offered Benzodiazepines during a detox period while in treatment. You can expect to see the likes of Diazepam, Chlordiazepoxide Hydrochloride (Librium), Lorazepam and Oxazepam.

Your body produces a natural chemical called gamma-aminobutyric acid (GABA), which controls areas in your brain responsible for reasoning, emotions, memory and essential functions like breathing. [2]

However, if you or your loved one has experienced severe alcoholism, you have begun to replace GABA with alcohol, meaning your body produces less. Benzodiazepines work during detoxifying by substituting the GABA chemical, reducing withdrawal severity.

Benzodiazepines act on your brain and body for varying amounts of time. An excellent way to understand how long a drug’s effects may last is to look at its half-life. The half-life is how long it takes for your body to break down the chemical and metabolise it.

Short-Acting Benzodiazepines

Short-acting benzodiazepines have a shorter half-life. This means the drugs are processed and leave your body quicker.

However, it has been said that these drugs have a higher risk of withdrawal symptoms as your body has less time to adapt to working on its own before it wears off.

Short-acting agents like Lorazepam are offered to those with severe liver dysfunction and those who may experience severe medical consequences following sedation, such as those with lung disease or elderly patients.

Long-Acting Benzodiazepines

Long-acting Benzodiazepines have a longer half-life, meaning as they metabolise, they continue to have an effect.

You or your loved one may experience hangover consequences after taking these drugs. However, you are less likely to experience withdrawal symptoms.

Long-acting agents like Diazepam and Librium can provide a smooth course of treatment with a decreased risk of rebound symptoms like seizures.

Benzodiazepines to Treat Alcohol Withdrawals

When you or your loved one decide to go into treatment for alcoholism, you will go through a detox process, usually facilitated by a medical professional.

Benzodiazepines may be used during this initial detox process and be continued over a short period to treat anxiety or insomnia. They tend only to be prescribed for two to four weeks.

Alcohol addiction withdrawals can include:

• Anxiety
• Nausea
• High heart rate
• Sweating
• Tremors
• Headaches
• Loss of appetite
• Depression
• Irritability
• Insomnia

Studies have shown that anxiety symptoms are persistent during alcohol withdrawal, with panic attacks and agoraphobia common among alcoholics compared to the rest of the population.

Alcoholic Withdrawal Syndrome & Benzodiazepines

Alcohol dependence is one of the most common psychiatric disorders in modern society, second only to major depression. Studies have concluded that nearly 14% of the general population struggle with alcohol dependency. [2]

Alcohol withdrawal syndrome (AWS) is seen as a cluster of symptoms that present themselves in those who are alcohol-dependent after a reduction in alcohol use.

AWS can present from mild to severe, with the most common symptoms occurring as:

• Insomnia
• Tremors
• Nightmares
• Fever
• Nausea
• Vomiting
• Seizures
• Hallucinations

Only a minor proportion of alcoholics develop severe AWS as they involve disturbances in a wide array of neurotransmitter circuits that are implicated and reflect a fundamental disorder of the central nervous system.

AWS is usually diagnosed after a proper examination by a medical professional. You or your loved one will be treated for your AWS through the use of Benzodiazepines to relax the brain and alleviate your hallucinations, delirium, and tremors, as non-treatment or under-treatment can lead to fatality.

Goals of Benzodiazepine Treatment

Through detox, your body will heal and adapt to no longer having alcohol in your system. Severe alcohol addictions will change your or your loved ones’ brain chemistry, so it will take time to replenish the chemicals it is missing.

Through the use of medication, the goals of detoxification include:

• To provide a safe withdrawal from the drugs of dependence and enable you or your loved one to become drug-free.
• For the withdrawal process to be humane and protective of your or your loved ones’ dignity
• To prepare you or your loved one for ongoing treatment.

Effects of Benzodiazepines

As previously mentioned, Benzodiazepines work by substituting the body with the chemical GABA, slowing down the brain and body. This tranquillising effect induces calmness in you or your loved one.

Used more in patients with a severe addiction to alcohol; those with less severe alcoholism may be given lower doses or lower potency benzodiazepines. However, side effects come with taking the drug, even for a short period.

Memory impairment may inhibit the effects of rehabilitation during the initial detoxification process. Lorazepam produces a prolonged period of memory loss in comparison to other Benzodiazepines.

Due to their substitution for the GABA chemical, there can be a chance of slight cardiovascular and respiratory depression, also known as a slower heartbeat and breathing. However, this is uncommon if Benzodiazepines are administered alone.

It is typically required that you or your loved one have a blood alcohol level of near zero due to the additive effects of alcohol and Benzodiazepines.

It is recommended that a medical professional administer and monitor you or your loved one as there is a chance of Benzodiazepine dependency among alcoholics. It is estimated one-in-five alcoholic patients presented a lifetime diagnosis of Benzodiazepine dependency.

Two-in-five alcoholics admitted to non-medical use of Benzodiazepines five or more times in their life. Studies show that women and the unemployed are at a higher risk of Benzodiazepine dependency. [3]

Types of Benzodiazepines Used to Treat Alcohol Withdrawals

The kind of Benzodiazepine you or your loved one may be prescribed depends on the severity of your alcoholism and if you are experiencing any other medical issues like liver problems or respiratory issues.

They all act the same way but metabolise in your body differently. Treatment with Benzodiazepines will be prescribed for a short period, and you or your loved one will be monitored throughout. You will then have a tapered dose to limit withdrawals from the Benzodiazepines.

Diazepam

Diazepam is a type of Benzodiazepine used to relieve withdrawal symptoms of anxiety and insomnia. It can also be used alongside other medications to control muscle spasms caused by medical conditions.

Diazepam is also an effective way to control the chance of seizures during detox. Diazepam has a long half-life of around 48 hours. It takes approximately five half-lives to eliminate the drug, equating to about ten days altogether. [4]

Diazepam can come in the form of tablets, a solution, and as a concentrated liquid to be taken orally.

Side effects can include:

• Drowsiness
• Muscle weakness
• Dry mouth
• Constipation
• Difficulty urinating

Chlordiazepoxide Hydrochloride (Librium)

Also known by its marketed name Librium, Chlordiazepoxide Hydrochloride is used to treat alcohol addiction withdrawals to relieve anxiety and control irritability and agitation.

It works by decreasing activity in the brain. Librium has a long half-life with a maximum of around 30 hours. [5]

Librium can have some side effects, so it is best used in a medical setting where you or your loved one can be monitored.

Side effects can include:

• Drowsiness
• Dizziness
• Tiredness
• Diarrhoea
• Weakness

Lorazepam

Lorazepam is primarily prescribed to treat symptoms of anxiety in alcohol withdrawal, which can be prevalent among alcoholics. It works by promoting relaxation in the brain, slowing chaotic brain activity.

Lorazepam is a fast-acting drug with a short half-life of around 12 hours. [6]

The short half-life may mean you experience alcohol addiction withdrawal symptoms more often. This means a medical professional should be on hand to monitor and administer drugs if your withdrawals become severe.

There are also side effects from Lorazepam:

• Drowsiness
• Nausea
• Changes in appetite
• Blurred vision
• Dry mouth

Oxazepam

Oxazepam is used to relieve anxiety caused by alcohol withdrawals that may develop in those with severe alcohol addiction. It works by slowing the brain’s functions, allowing the body and brain to relax and promote relaxation.

Oxazepam is a fast-acting drug with a half-life of around 20 hours. [7]

Also known by its trade name Seram, this drug is best administered by a medical professional as its fast-acting nature means withdrawals can return before your body has adapted.

Oxazepam has side effects, including:

• Weakness
• Restlessness
• Upset stomach
• Constipation
• Tiredness

It is essential to understand that while Benzodiazepines are a controlled substance, they are entirely safe and reliable to use. There are disagreements in the medical field as to whether those suffering from alcoholism are at a higher risk of developing a dependence on Benzodiazepines.

This overestimation of the risk of dependency means it can be withheld from people who might benefit from them. If you or your loved one decides to go through treatment and is administered Benzodiazepines, it is not a cause for concern.

These medications are used in safe circumstances to help secure a smooth transition into recovery.

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References

[1] https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/about-benzodiazepines/

[2] Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research

[3] MICHEL LEJOYEUX, JACQUELYN SOLOMON, JEAN ADÈS, BENZODIAZEPINE TREATMENT FOR ALCOHOL-DEPENDENT PATIENTS, Alcohol and Alcoholism, Volume 33, Issue 6, November 1998, Pages 563–575,

[4] https://medlineplus.gov/druginfo/meds/a682047.html#why

[5] https://medlineplus.gov/druginfo/meds/a682078.html

[6] https://medlineplus.gov/druginfo/meds/a682053.html

[7] https://medlineplus.gov/druginfo/meds/a682050.html