Benzodiazepines and alcohol.

The frequency and quantity of alcohol consumption is a major consideration in patients who need treatment with benzodiazepines. Alcohol affects the GABA-benzodiazepine-chloride ionophore complex and has an agonist-like action. Thus, additive interactions should be expected from combining alcohol with benzodiazepines. Furthermore, alcohol has clinically meaningful anxiolytic efficacy, and many anxious patients may take advantage of that fact. Therefore, co-administration of alcohol and benzodiazepines is to be expected in an anxious patient receiving benzodiazepines who does not totally abstain from alcohol. This article reviews three clinically relevant issues concerning benzodiazepines and alcohol: (1) interactions of benzodiazepines with social drinking in patients taking benzodiazepines for indications unrelated to alcoholism; (2) use of benzodiazepines in treatment of alcohol withdrawal; and (3) use of benzodiazepines in patients with alcohol dependence.