After three years of fairly heavy drinking (either a bottle of wine or a 6 pack of beer, and occasionally a bit more, nearly every night). I decided to join an AA group. I've also talked to my doctor, who had previously prescribed me alprazolam (Xanax), when I was trying to pass my alcoholism off as an anxiety disorder. Anyway, my doctor told me that I could continue to take the alprazolam, to aid in the alcohol withdrawal, and to help me sleep. This seems like merely substituting one addiction for another, but on the other hand, if I make sure to take the alprazolam in accordance with my doctor's orders it shouldn't be a problem. I have found recent studies claiming that alcohol is the worst possible drug, and I really want to get off of it without taking any other drugs, but the anxiety I have been feeling unless a take 1mg of Xanax at night is horrible. Does anyone know of a good way to manage this medication during alcohol withdrawal?
Can alprazolam aid in alcohol withdrawal?
Question posted by Cheadlemeister on 16 Feb 2011
Last updated on 11 January 2020 by chasef21
6 Answers
Alright, even though this question was posted long ago, I see a lot of half-answers, so I figured I'd give an explanation that has actual science backing it.
Xanax (alprazolam) is a "short-acting" drug that belongs to a class of drugs called benzodiazepines. Included in this same class of drugs include the "ultra-short acting" Versed (midazolam), the "intermediate-acting" Ativan (lorazepam), the "intermediate/long-acting" Klonopin (clonazepam), and the "long-acting" Valium (diazepam) and Librium (chlordiazepoxide). Note: more on why I specify how long they "act" later.
Both benzodiazepines and alcohol exhibit their primary effects on our nervous systems by being what are called GABA-A allosteric modulators. GABA is our brain's primary inhibitory neurotransmitter--it slows down the electrical signals between neurons and counters the effect of it's main competitor, the brain's main excitatory neurotransmitrer glutamate--and enhancing GABA function is why benzodiazepines work so well for conditions like seizures, muscle spasms, anxiety, and insomnia.
Benzodiazepines are also very effective in the treatment of the symptoms of alcohol withdrawal because as they both exert their effect on GABA-A receptors, so very generally speaking, if you experience withdrawal symptoms from one, taking the other will abate those withdrawal symptoms. This is also why acute withdrawal symptoms from either benzodiazepines and alcohol are nearly identical--for example, insomnia, anxiety, tremor, GI issues, and in severe cases seizures and DTs (delerium tremens).
Ok, so I can say without a doubt that Xanax, being a benzodiazepine, will help with alcohol withdrawal symptoms. The problem is, Xanax is an "short-acting" benzodiazepine as mentioned earlier. This means its elimination half-life--the time it takes your body to eliminate half of the drug/metabolites--is pretty fast at 6-20 hours, which leads to a short duration of action: 6 hours at most. This means the constant dosing required, and the levels of the drug in your blood going up and down over and over, make the process unnecessarily more difficult and uncomfortable by initiating a repeating cycle of withdrawal and relief (and this type of withdrawal cycle with alcohol/benzodiazepines is known as "kindling" which makes each successive withdrawal more severe and more dangerous, eventually leading to full-blown DTs/seizures).
The emerging gold standard in treating alcohol withdrawal symptoms (in patients that do not require in-patient detoxification) is to immediately begin the patient on "long-acting" benzodiazepines such as Valium or Librium (although Valium is preferred because it is available in 10mg, 5mg, and 2mg tablet strengths). Great care is taken to establish the lowest possible dose while still controlling symptoms. Along with the multiple dosing options, Valium tends to be the preferred drug of choice because its very long elimination half-life: 20-50 hours for diazepam itself, and between 3-100 hours for the active compounds your body metabolizes diazepam into. These very long half-lifes make Valium ideal to withdraw from--would a 10% dosage decrease be easier if your body had 10 hours to acclimate, or would a slow decline over 200 hours be better?
Interestingly, Doctors are using a similar treatment plan to wean patients off of benzodiazepines. Known as the Ashton Method, it involves converting a patient's current benzodiazepine to an equivalent dose of diazepam. Once the patient is stabilized on diazepam, the Doctor and patient agree on a taper schedule (avg. 10+ months). This is in contrast with the technique for alcohol withdrawal, which commonly employs a fast 10-20 day taper, because due to the similarities in mechanism of action, Doctors are hesitant to prescribe benzodiazepines to patients with co-morbid alcohol use disorder.
I do not see it as trading one addiction for another. If you planned on using the Xanax to become intoxicated in lieu of drinking, then yeah I guess it is. But this is just a case of trying to reduce the symptoms associated with alcohol withdrawal. And I'm guessing not having withdrawal symptoms will probably greatly reduce your urge to drink alcohol. And if you ask any Doctor which substance causes significantly more damage to your body, they're going to say alcohol over benzodiazepines every time.
You can also look at it this way: are patients with opioid use disorder who begin taking buprenorphine (Suboxone) trading one addiction for another? Absolutely not. They're taking a medication that allows them to lead a productive life instead of being consumed with their addiction. No different using benzos for alcohol.
I went through withdrawal from a half of a 1.75 litre a day and they loaded me with 3 milligrams to start when the withdrawals kicked in and then the second day i took 1 milligram 3 times a day, and then the third 2 mg that day 1 mg 2 times and then the following 3 days .5 milligrams 2 times a day and then none, unless i started feeling withdrawals still. The initial first day is when they load you up so as the days go by the xanax actually tapers with the withdrawal.
Hi chead: I am more aware of librium for a one week withdrawal off alcohol, physically. It is in the benzo family, like alprazolam, but more benign and easier to come off of, short term. Also, at night, ask your doctor for a very common and effective drug for withdrawal of alcohol, heroin, etc…It is called Clonidine . It lowers you blood pressure therefor relaxing your nerves and anxiety. Alprazolam or xanax work well, bu, yes may be harded to get off of, and you may think a drink makes sense to get of xanax, So, ask him /her about librium and clonidine, both very benign and safe short term, meanwhile hit some AA meetings, its a powerful group all in the same boat. Listen to other stories and share yours, it feels good to share, and helps kill your addiction, you need a dead addiction to alcohol, bury it in the backyard and get on with your life, you deserve it., good luck, Rc4
From personal experience I can only speak. If you are having extreme anxiety and have taken one at night then I would not take anymore after the 4th day because you should be thru the worst of it. I have found that I will substitute 'anything' for whatever feeling I thought alcohol gave me and I got addicted to anything I took and I have been sober many years but they are marred by periods of ten years sober 6 months screwed up on some pill-either pain meds for a hip replacement or headache meds etc. I realize some of it was necessary medication but it is hard to get off of it unless you realize how it works on your brain. Doctors know next to nothing about addiction . This is a very good reference for any questions you have. I think it is good for everyone to go thru the misery to remember what you will face again if y ou should pick up that drink again and I say this respectfully as I hve done it twice and it is not worth it.
The mind is what is addicted so be careful. AA was my way and I went every day for 3 years and once a week for 10 years and then had a relapse on listerine so it is just a matter of being committed and accepting the fact of your addiction. We are here to help and if you like AA it is the best way and I still go after 30 years.
Hi Cheadlemeister, Hi, Laurie Shay, I wanted to put my response on here because I am what they always would like to say a (recovering alcoholic) but I truly do not think certain people who drink so much, even most of their life are ever really cured... my experience back in 2004 I was literally pushed to the limits and all family members alike saying I had to stop my drinking or I was going to be dead, for 2 months, I put myself through complete and total withdrawal/abstinence and it had to be like that of a heroin addict on the floor of some bathroom... not quite that intense, but the sweating, the shaking, chills, vomiting, loss of weight and so on. At the end of that 2 months, I just could not take it anymore went to see a psychiatrist and he put me on Zoloft/100mg/If my recol is correct and saw how bad I was shaking so put me on .5mg of klonopin...
It is like a whole new world had opened up for me but took some time for my body to adjust and at least 3 months of it being in my system... as for xanax, that is for the md to decide, and keep those mg low, but like klonopin they both are very addictive and are hard to control dosage amounts unless you are willing to get better... The sad story is that same year is when the 3 hurricanes hit Florida back to back, my hubby and I had one of the worst dissagreements in our now 17 year marriage, i left, fell off the wagon, ended up in a gainesville er and had to undergo treatment to just put me to sleep and stop me from shaking... morphine... I awoke 7 hours later and the remainder of that year was the fight of my life... just be careful, take it one day at a time, keep close contact with your physician, and hopefully above all you have a supportive family... and pray... blaze22
Hey Cheadlemeister,
I suppose there are different opinions about whether you are substituting one addiction for another by taking the xanax. My opinions is, like you said, as long as you only take as prescribed, then you should be fine. Just remember that xanax can be addictive too and if you are tempted to take more than your one at night, maybe you better reconsider. Only you can really say how you are feeling. The xanax will help with the anxiety and shakiness from the alcohol withdrawls.
Keep up the meetings, we use to say, 90 meetings in 90 days to start with then you can go less but get in as many as you can in the beginning.
Congratulations and I wish you the best. Keep in touch, we are here to be supportive,
Laurie
Xanax is a good medication and I cannot be the one to tell you that it is not, I can tell you to take it EXACTLY as prescribed, it can help you when taken in the recommended doses but I have seen it abused and it is like watching a horror movie, I have taken it and it has helped but I would not want you to have more problems added to what you have, I wish you the very best, you are in my prayers.
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depression, alcohol withdrawal, anxiety, panic disorder, alprazolam, withdrawal, alcohol, wine
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