Mixing Chlordiazepoxide and Alcohol

What is Chlordiazepoxide?

Chlordiazepoxide (Librium) is an FDA-approved medication used to treat mild to severe anxiety, peri-operative apprehension and anxiety, as well as manage acute alcohol withdrawal symptoms such as seizures and agitation.^1,2 It belongs to a class of drugs called benzodiazepines and works as a sedative and anti-anxiety medication by decreasing central nervous system excitation.²

Adverse side effects of chlordiazepoxide include weakness, confusion, sedation, depression, nervousness, fatigue, dizziness, and slurred speech.²⁰ Rarer side effects may include menstrual irregularity, dry mouth, hallucination, weight gain, hypotension, and hyper-salivation.²⁰

Especially in situations where non-medical misuse of the drugs is a factor, chlordiazepoxide and other benzodiazepines may lead to the development of physical dependence and addiction. Long-term, regular use may lead to the development of significant tolerance, where higher doses of the drug are required to achieve the desired effect. This may lead someone to take more than the prescribed dose or take the drug more frequently than prescribed, which may additionally hasten the onset of dependence and addiction.^1,4,5 

Those who misuse Librium and other benzodiazepines may be doing so to achieve the euphoric high associated with higher doses of the medication. Combining the drug with opioids, alcohol, or any other CNS depressant may also intensify its sedative effects. Taken alone, at doses higher than prescribed, overdoses on Librium or other benzodiazepines are not usually fatal, though they may still be dangerous.  However, the risk of experiencing severe side effects and/or a potentially fatal overdose becomes significantly increased when there is concurrent use of other benzodiazepines, opioids, or alcohol.⁴

U.S. Stats on Librium Abuse

Although specific information regarding Librium abuse isn’t readily available, we do know that benzodiazepine misuse and abuse are a growing problem in the U.S.

Across the U.S.:

• In 2016, the average age of first use among Americans aged 12 to 49 is approximately 23 years old.⁶
• There were an estimated 425,000 benzodiazepine-related emergency department visits in the U.S.in 2011.⁷
• In approximately 95% of those seeking treatment for benzodiazepine addiction, polydrug (i.e., using more than one type of drug) abuse is present.⁸
• More than 30% of overdoses involving benzodiazepines also involve opioids.⁹

Dangers of Mixing Chlordiazepoxide (Librium) With Alcohol?

According to the American Society of Addiction Medicine (ASAM), it’s common for those with an alcohol use disorder (AUD) to also use benzodiazepines, with different prevalence estimates ranging from 29% to 76%.¹⁰ Chlordiazepoxide and alcohol are both CNS depressants; drinking while taking Librium may lead to a cumulative increase in the sedative effects of each drug, which can add up to life-threatening side effects, including excessive drowsiness and loss of consciousness, respiratory depression, coma, or even death.^1,4

When areas of the brain controlling basic life-support functions such as heart rate, breathing, and temperature control become overwhelmed due to great amounts of alcohol in the bloodstream, they eventually begin to shut down.¹³ This is how an overdose occurs. Mixing in chlordiazepoxide or other benzodiazepines could further increase the risk of such an overdose.¹³

Problems with memory, such as difficulty remembering certain circumstances or events and their specific time sequences after an episode of heavy drinking may be even more likely in those who also use benzodiazepines.¹¹

With benzodiazepines, there is an increased risk of depressive symptoms (especially when used in high doses) and in some cases, suicidal thoughts.¹¹ In patients with AUDs, there is also a link to several mental illnesses such as major depression and anxiety disorders.¹² People already experiencing the symptoms of AUD-related depression may be even more likely to should benzodiazepines be added to the mix.¹⁰

Signs of Benzodiazepine or Alcohol Addiction

About 1.9 million people (or about 0.7%) aged 12 or older reported using benzodiazepines in the past month in 2016.⁶ Beyond the immediately dangerous effects of mixing the two substances, people who find it difficult to quit using the combination of alcohol and chlordiazepoxide may have developed significant physical dependence to one or both substances; and, though such dependence isn’t the only criteria used to make a diagnosis of an alcohol or sedative use disorder, it could strongly suggest that one is present.

Physical dependence develops after certain substances are taken for an extended period of time, leading your body to become reliant on it to avoid withdrawal symptoms when substance use is slowed or stopped.¹⁴

Addiction develops as a person begins to compulsively use substance(s) despite the negative consequences of such use.¹⁵ According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person with a substance use disorder must meet at least 2 of the following criteria within a 12-month period to receive this diagnosis: ¹⁴

• Strong urges or cravings to use.
• Taking the substance in higher amounts or more frequent doses than originally intended.
• Being unable to quit.
• Tolerance (i.e., needing higher amounts or more frequent doses to achieve prior effects).
• Withdrawal symptoms when you try to stop using or needing to continue using a substance to prevent the onset of withdrawal.
• Spending a lot of time obtaining, using, and recovering from the effect of the substance.
• Continuing use despite having recurring or persistent interpersonal or social problems because of use.
• Continuing use despite knowing that you have a physical or psychological problem that is likely the result of substance use.
• Failing to fulfill major obligations at work, home, or school due to substance use.
• Giving up important recreational, social, or work activities because of use.
• Using in situations where it is physically dangerous to do so (e.g., driving).

The Risks of a Combined Withdrawal Syndrome

When a person consistently drinks heavily and/or misuses Librium, they may become physically dependent on one or both substances.¹⁴

Quitting or cutting back on alcohol or Librium intake can lead to symptoms of withdrawal that may arise hours to days after the last use. In the case of alcohol, withdrawal commonly occurs within 6 hours to 2 days after the last drink.¹⁶

Not everyone will experience severe withdrawal when substance use stops. Different risk factors influence the likelihood of withdrawal as well as the severity of symptoms, should they be experienced.^16,14 Genetics, how long a person has been consistently drinking, a family or personal history of previous withdrawal, advancing age, and having other health issues can all play a role in whether a person experiences a significant withdrawal syndrome.^16,14

There’s significant overlap in withdrawal symptoms between alcohol and chlordiazepoxide, and a person who mixes both substances regularly may experience some or all of the symptoms below, at varying levels of severity. ^{16,14,18,4,14}

• Headache.
• Insomnia.
• Feeling anxious.
• Irritability.
• Nausea or vomiting.
• Rapid heartbeat.
• Restlessness or fidgeting.
• Hallucinations.
• Seizures.

Delirium tremens (DT), a potentially deadly cluster of symptoms involving agitation, disorientation, fever, sweating, and high blood pressure, is sometimes experienced as part of withdrawal in heavy alcohol drinkers. Benzodiazepines are typically given to patients at high risk of DT as it usually is protective against it.

Similar to withdrawal from alcohol, severe benzodiazepine withdrawal can cause a person to experience delirium or seizures.^4,14,19 Given the complexity of withdrawal management from polydrug use, 24-hour medical monitoring can reduce the risk of life-threatening complications. The level of intensity or type of detox program need for effective alcohol and Librium withdrawal management will depend on the magnitude of dependence and the risk of experiencing a complicated withdrawal.

A doctor or other treatment professional may evaluate for the above factors prior to making a recommendation. Following successful completion of detox, a rehabilitation program may be recommended to continue working toward recovery and sobriety.

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