Benzodiazepines are medications used acutely for alcohol withdrawal, either in the hospital or at certain inpatient detox facilities. Currently, benzodiazepines are considered the “gold standard” medication for acute alcohol withdrawal, able to relieve symptoms, prevent complications like delirium tremens and keep someone safe during detox. [1]
Benzodiazepines like diazepam, lorazepam and chlordiazepoxide are the best and safest medications for managing acute alcohol withdrawal symptoms. Alcohol and benzodiazepines are cross-tolerant and have similar mechanisms of action, which is why benzodiazepines are so effective at mitigating alcohol withdrawal symptoms.
Benzodiazepines or benzos are a class of depressant medications prescribed to manage insomnia, anxiety, panic disorders, seizures and muscle spasms.
They are also used to manage and treat acute alcohol withdrawal—this is because they can relieve symptoms, reduce the risk of complications like seizures and delirium tremens and decrease cravings. [1]
Benzodiazepines have a similar mechanism of action as alcohol, which means they are highly effective at relieving alcohol withdrawal symptoms, such as:[2]
Benzodiazepines are especially effective at reducing the risk of severe alcohol withdrawal, known as delirium tremens, as well as grand mal seizures.[1]
Many benzodiazepines are suitable choices for alcohol withdrawal treatment, with the goal generally being an option that works quickly and is long-lasting. Common choices include the following:[1]
These benzodiazepines are the best-studied medications for alcohol withdrawal, although other drugs in this class may be used as well.[1] Generally, long-acting benzos with larger half-lives are better because they need to be administered less frequently, which is why Xanax, a short-acting medication, is usually not the first choice. Also, short-acting benzos have a greater chance of rebound symptoms of withdrawal.[1]
Lorazepam is often given to patients who have liver issues, elderly patients, or those with lung conditions that may be affected by severe sedation.[1]
Benzodiazepines may not be necessary for mild alcohol withdrawal symptoms. They are more commonly used when a patient has a history of complicated or severe withdrawal or they have severe alcohol use disorder. Benzos are usually administered in an inpatient setting, such as in the hospital, for patients undergoing acute alcohol withdrawal. Benzodiazepines are usually given orally but can also be administered intravenously for severe and rapid symptom relief.
Benzodiazepines can typically be given in one of three ways when treating withdrawal.
The first is through what is called a symptom-triggered regimen (STR) where a person’s withdrawal symptoms are rated via a scale, and drug doses are administered based on withdrawal severity.[1],[3] This is typically the preferred treatment method as it involves the least use of medication and doctors don’t run the risk of over-sedation.
Another option is a fixed tapering dose regimen (FTDR), where a patient receives fixed doses of benzodiazepine on a predetermined schedule, tapering off them over time. This method is helpful when a patient can’t be monitored as closely by a trained professional or when they may be unable or unwilling to rate their withdrawal symptoms on a scale.[1]
Generally, the benzodiazepine dose for a fixed tapering dose regimen depends on the person’s average daily alcohol intake.[4]
BenzoDoseFrequencyLorazepam2mgEvery 6 hours for 4 doses then1mgEvery 6 hours for 8 dosesOxazepam30mgEvery 6 hours for 4 doses then15mgEvery 6 hours for 8 dosesDiazepam10mgEvery 6 hours for 4 doses then5mgEvery 6 hours for 8 dosesChlordiazepoxide50mgEvery 6 hours for 4 doses then25mgEvery 6 hours for 8 doses
The last option is what is called a loading dose regimen (LDR), where long-acting benzodiazepines are given in high doses immediately, usually in the case of someone with a history of severe alcohol withdrawal in anticipation of another complicated withdrawal. This method requires very close monitoring and may require admission to the intensive care unit (ICU). [1]
There are many advantages of using benzodiazepines to manage alcohol withdrawal, including: [1]
If you have an alcohol use disorder and need help quitting drinking, a medical detox setting is considered the safest environment. Medical detox can occur in a number of settings, including:
What matters most is that there is a team of doctors and nurses available to provide you with 24/7 supervision and monitoring to ensure your safety and comfort.
Aside from administering benzodiazepines to manage alcohol withdrawal and reduce your risk, the medical team will also provide:
Many people who struggle with alcohol misuse may have attempted to quit in the past. Alcohol withdrawal can be an intensely uncomfortable and even potentially dangerous experience. However, with proper medical supervision, alcohol withdrawal is safe and doable. Alcohol withdrawal usually lasts for no longer than one week. After that, your symptoms should greatly improve—especially with the use of benzos. [2]
Getting through alcohol withdrawal on your own can be very difficult and even dangerous in the case of severe withdrawal.
If you are attempting to discontinue alcohol use and you have a history of complicated alcohol withdrawal, severe AUD, medical or mental health problems, poor liver functioning, brain lesions or older age, make sure you talk to your doctor about medical detox and benzodiazepine use—this can help save your life. Whatever you do, never attempt to quit drinking cold turkey. This can have life-threatening consequences. It may be appropriate and safer for you to be admitted to the hospital or to another medical facility so you can undergo detox under medical supervision.
You should never take someone else’s prescription medication or purchase benzodiazepines illicitly in order to self-treat alcohol withdrawal. Instead, you should always talk to your doctor about the safest way to go through withdrawal. Medications can be prescribed for support.
Benzodiazepines are controlled substances that have risks of their own. They can cause respiratory depression and therefore must be given carefully, particularly in patients with other medical conditions such as COPD, cardiovascular problems, or dementia.
In particular, these risks increase if given concurrently with other sedating medications, such as opioids. For example, In 2021, 14% of overdose deaths related to opioids also involved benzodiazepines.[6]
Benzodiazepines also have addiction potential. The rate of benzodiazepine misuse among people using the drugs is fairly low compared to other substances such as opioids, however, the risk is still there: Of about 30.5 million American users, an estimated 17.1% engaged in what could be considered misuse of their benzodiazepine prescription. Fewer than 2% developed what would be considered a benzodiazepine use disorder. [7]
Some side effects of benzos to be aware of include: [2],[8]
However, because benzodiazepines and alcohol are cross-tolerant, someone with AUD or severe alcohol dependence and tolerance may not experience such intense side effects of the medication.
When you enter the hospital or a detox center, the medical team will conduct a thorough evaluation in order to determine the best course of treatment for you—this includes which benzodiazepine will be best for your needs as well as any other medications or treatment modalities necessary. And they will monitor you around the clock so they can make any adjustments as needed.
Are Benzodiazepines Considered MAT for Alcohol Use Disorder? No, benzodiazepines are not considered medication for addiction treatment (MAT) for alcohol use disorder (AUD), but rather, they are used short-term for alcohol withdrawal and detox. There are, however, several FDA-approved medications for alcohol use disorder to help prevent cravings and relapse. These medications include naltrexone (Vivitrol), disulfiram (Antabuse) and acamprosate (Campral).
What Do Doctors Give for Alcohol Withdrawal? Doctors usually administer benzodiazepines like lorazepam, diazepam, oxazepam and chlordiazepoxide for the management of acute alcohol withdrawal.
Why Are Benzodiazepines Used for Alcohol Withdrawal? Benzodiazepines are used to treat alcohol withdrawal because they have a similar mechanism of action as alcohol, meaning they are cross-tolerant. They have been proven to be effective and safe for the management of this condition and can help prevent life-threatening symptoms like seizures and delirium tremens.[5]
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
