Central nervous system (CNS) depressants are among the most abused and intoxicating drugs. Many illicit, prescription, and even legal drugs cause the user to feel relaxed, calm, happy, and sleepy; these drugs include alcohol, marijuana, hydrocodone, and benzodiazepines. While many of these drugs affect slightly different areas of the brain, they all work on the balance of neurotransmitters like dopamine, serotonin, and norepinephrine, which in turn affects the reward system, and can lead to intoxication and eventual addiction.
Some CNS depressants work on similar brain systems. Two of these drugs, alcohol and benzodiazepines, like Valium, act on the gamma-aminobutyric acid (GABA) receptors in the brain, leading to very similar effects. Valium has often been used as a medication-assisted therapy (MAT) to treat alcohol withdrawal symptoms because these drugs affect the same area of the brain. However, this also means that combining the two substances can be very dangerous and lead to overdose.
Why Valium and Alcohol Are Used
Valium is the brand name for a benzodiazepine drug, diazepam. Typically, this medication is prescribed to be taken as needed to treat generalized anxiety, panic disorder, and obsessive-compulsive disorder (OCD). It is sometimes prescribed off-label to treat alcohol withdrawal symptoms, particularly delirium tremens, which can involve hallucinations, paranoia, and convulsions.
Most benzodiazepines, including Valium, are no longer prescribed for regular use for longer than two weeks. Medications like Valium can rapidly lead to physical dependence, so taking the drug daily for more than two weeks is not recommended except for very specific conditions like some seizure disorders.
Taking Valium in larger amounts than prescribed, or without a prescription, is abuse of this drug. Because the substance acts on the GABA receptors, it can cause intoxication, euphoria, and relaxation, which may lead to addiction.
- Drowsiness or sleepiness
- Physical weakness
- Nausea, diarrhea, and changes in appetite
- Restlessness or excitement
- Blurry vision
Alcohol is a legal drug that also works on the GABA receptors, leading to intoxication. In the United States, people who are 21 and older can legally consume this substance, with a few restrictions on blood alcohol content (BAC) and driving. Alcohol’s side effects are very similar to those associated with Valium intoxication. Side effects of alcohol consumption include:
- Loss of physical coordination, leading to stumbling and slurred speech
- Relaxation and euphoria
- Lowered inhibitions
- Raised blood pressure
- Memory lapses or blackouts
- Blurry or double vision
These effects are induced by the substance binding to the GABA receptors.
Dangers of Mixing Alcohol with Other Benzodiazepines
How Valium and Alcohol Work on the GABA Receptors
Gamma-aminobutyric acid (GABA) is a very important neurotransmitter, which is involved in how rapidly neurons fire. People who have seizure disorders, anxiety, or insomnia often have less GABA available to moderate the communication speed between neurons, so their neurons fire faster; this leads to a feeling of tension, alertness, and even fear. However, both alcohol and benzodiazepines, along with other sedatives like barbiturates or sleep aids, bind to GABA receptor sites, allowing the neurotransmitter to remain available in the brain for longer. This allows the neurons to fire more slowly. For people with epilepsy or other seizure disorders, this reduces the risk of convulsions; for those with insomnia, the relaxation allows them to fall asleep, although it does not cause them to pass out; and for those with anxiety, a low dose of a drug like Valium reduces tension and fright.
Because both alcohol and Valium work on GABA receptors in the brain, they induce similar effects, especially at high doses. Taking them together can also be very dangerous. Both alcohol and benzodiazepines like Valium increase the bioavailability of intoxicating drugs, and when these two substances are taken together, they increase the other’s bioavailability, which increases the risk of an overdose or poisoning.
Overdose from Mixing Depressant Drugs
Many people may accidentally mix benzodiazepines like Valium with alcohol because they have received a prescription for Valium and are taking it as prescribed, but then have a social drink or two. Standard prescription doses of Valium along with small amounts of alcohol are not likely to cause an overdose, but they can still increase the risk of dangerous side effects, like losing physical coordination or experiencing a blackout. Risks include:
- Increased drowsiness
- Slowed or difficult breathing
- Impaired motor control more quickly than expected
- Unusual behaviors
- Memory problems
Many overdoses involve a combination of benzodiazepines and alcohol. According to the Centers for Disease Control and Prevention (CDC), opioids and benzodiazepines are the two drugs most commonly involved in emergency room admissions due to overdose. The CDC found that, currently in the United States, about 91 people die every day from opioid overdoses, including overdoses on prescription opioids, heroin, and fentanyl. While opioid addiction is touted as a highly publicized epidemic, the issue of benzodiazepine abuse is sometimes referred to as a “shadow epidemic.” It is not often in news headlines, but the drugs are widely abused for nonmedical reasons. These drugs, including Valium, were involved in 30% of overdose deaths in 2013; opioids were involved in 70%. There were also many instances in which opioids and benzodiazepines were both found.
Alcohol is also widely abused, with more than 15 million adults struggling with alcohol use disorder (AUD), and 88,000 people dying every year from some form of alcohol abuse. Because consuming alcohol is legal for many, the overlap of recreational alcohol consumption and other forms of substance abuse is huge.
A CDC analysis of ER data in 2010 found that alcohol was involved in 27.2% of benzodiazepine-related emergency room admissions and 21.4% of benzodiazepine-related deaths. Of 1,512 deaths involving benzodiazepine drugs, 324 of those also involved alcohol.
Treatment to End Abuse of Valium and Alcohol
When Valium or other benzodiazepines are mixed with alcohol, according to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), aggression and hostile behavior are more likely. People who take Valium to manage anxiety or related mood disorders put themselves at risk for worsening their symptoms when they combine the drug with alcohol. Valium in particular is a long-acting benzodiazepine, so it is easier to take this drug as prescribed and then accidentally drink alcohol on top of the medication, putting the person at risk of serious side effects or overdose. The risks of this increase in people who abuse alcohol and begin to abuse other substances like benzodiazepines for nonmedical reasons. Increasing GABA in the brain puts a person at greater risk for sedation, which can reduce oxygen intake and change blood flow, leading to amnesia or blackouts, which can harm memory long-term.
If a person suddenly stops drinking and/or consuming Valium, they are at much greater risk for life-threatening side effects, especially seizures. People who want to stop abusing these drugs, especially in combination, must seek medical oversight to safely detox. Since Valium acts on the body for a long time, which is one of the reasons it is an appealing MAT for alcohol withdrawal, a clinician may develop a taper of the benzodiazepine, to ease the body off physical dependence without increasing the risk of dangerous side effects. During detox, the person will stop drinking completely.
Once the person’s body is no longer dependent on Valium and alcohol to regulate GABA and other neurotransmitters, a rehabilitation program can help the person change behaviors around intoxicating drugs. Evidence-based therapy helps to reduce the risk of relapse back to substance abuse, and helps the person learn to manage stress and triggers without taking drugs.