Are benzodiazepaines really "alcohol in a pill"?

I know that benzos like alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin) act on the GABA receptors which alcohol and GHB act on as well.

Having taking both however, I can say they are vastly different. I first developed dependence on them due to having violent thoughts and constant pains in my stomach (anxiety perhaps) and didn’t even knew the existed or how addictive they could be. I found that they enabled me to “power through the day” and bad thoughts, emotions wouldn’t at all inhibit me like they did when I was not on them.

Even then, the effects were very mild. No euphoria like alcohol and no immediate effects. The plus side with them is that they could bring the relaxation of alcohol without the nausea.

I wonder what in the structure of alcohol enables it to cause euphoria but nausea and even violence in some people that benzos don’t.

The sense in which they are “alcohol in a pill” is in that they both affect the GABA receptors. But, as you say, alcohol has other effects. The whole point of benzos was to be a “cleaner” way of affecting the anti-anxiety aspects. Though they do also reduce reaction time like alcohol, they don’t have the same “high” effect.

And I’m really sorry you got addicted to benzos. I know how bad that can be. They are extremely hard to get off of, and, if you do it wrong, you can fuck up the rest of your life. Be careful. Look up the Ashton method for how to get off.

Do note, BTW, that this is not a drug-related forum. “The straight dope” is an older expression meaning “the
unadulterated truth.” I’m just responding because I know what this sort of thing can be like, and did some research when I was prescribed them.

As we have actual doctors here, possibly others know the actual pharmacology of alcohol and benzos. I just know a bit.

Benzos also were thought to be a safer alternative for barbiturates. I have heard barbiturates compared to alcohol before.

I just looked up the Ashton method. God damn, a six month taper for 6mg a day of Xanax? That’s insane.

Way back in 1973, the book Licit and Illicit Drugs; The Consumers Union Report pretty much said that alcohol was largely the liquid form of barbiturates, in its physical effects. So this is nothing new.

I knew a dentist who was barbiturate-dependent. His taper took over 18 months. A few times he was tapered too fast and started seizing.

Benzo withdrawal is not as bad or as life-threatening as barbiturate (or alcohol) withdrawal, but it’s pretty bad, and can be quite prolonged.

And if one is a recovering alcoholic, then benzos are pretty close to ‘alcohol in a pill’ in that the same receptor sites are activated, and behavior quickly reverts towards that of an active drinker. So the sober alcoholic really needs to avoid benzos wherever possible.

Any reason benzos and barbituates take so long to withdraw from? I thought most drugs (including alcohol) could be withdrawn from in a few days to a few weeks with a taper.

I feel like people can develop benzo dependence with shocking swiftness, and doctors are incredibly willing to prescribe them to anyone, including teens, without any warnings or support. It blows my mind.

Prolonged use of those substances causes profound changes in brain chemistry and architecture. Those reverse only slowly (when they can reverse at all). Some experts say it can take at least two years or more to have the brain remodel as much as it’s going to once the substances are withdrawn.

The pendulum is swinging the other way regarding benzo prescribing. And about time, too.

I find myself prescribing them mainly for end of life care in hospice, for folks with spinal cord injuries whose muscle spasms don’t respond to baclofen, and for one time doses for folks who are anxious in MRI scanners. Their use for treatment of anxiety is actually forbidden in our (prison) system.

Is there any talk within the medical community of raising the controlled substance scheduling of the drugs at all? I know benzos are now schedule IV controlled substances, and that is the lowest level of regulation.

That decision would lie with the DEA, not the medical community.

What is your opinion?

Ugh! This frustrates me so much! I have a nerve disorder and the only thing that fixes it is Xanax. And not a single f’n doctor will prescribe me Xanax. Even though a single prescription would probably last me over a year.

My quality of life has been diminished because of this stupid BS.

I vaguely remember the DEA throwing that particular ball in the direction of the FDA.

How does the DEA make that decision? The first required condition for scheduling a drug in Schedule I is high potential for abuse. One of the Schedule III conditions is having a lesser potential for abuse than the drugs in schedule I & II. How is that assessed? I have a difficult time seeing how they could come to the conclusion that pot, magic mushrooms and DMT have as a high a potential for abuse as heroin, amphetamine and cocaine.

Since Ambien or benzos like Xanax are in Schedule IV, that means they’re thought to have low potential for abuse relative to Schedule III (and even more so, schedule I drugs like pot, DMT and mushrooms). I’m really scratching my head on how they came to that conclusion. Aren’t there a lot more people who lose their wits on Ambien than mushrooms?

Keep in mind marijuana is schedule 1 but meth is schedule 2. It’s an imperfect system.

Supposedly there are several gaba sub receptors, and some newer drugs being researched will bind to receptors that cause anxiolytic effects but not receptors associated with physical addiction or fatigue. Instead of just increasing gaba across the board, they’d bind to particular sub receptors instead.

So hopefully, we may eventually have a newer class of benzos like drugs that combat anxiety but do not cause as much fatigue or addiction.

But I’m not sure how far along that research is or how many drugs are being looked into.

I understand the thought, but I disagree with it. If you don’t prescribe benzos, then your patients will go buy cases of whiskey without your permission.

I’m not clear why your patients should have to suffer with anxiety when there is medication there that can treat them. When the treatment is over, responsibly wean them off of it. People should not have to needlessly suffer with a legitimate medical condition because of some neo-prohibitionist idea that drugs are bad.

ETA: Not YOUR patients. I doubt they get passes to go to the liquor store. :slight_smile:

The problem with this line of thought is that benzos don’t cure anxiety. And the dependence is awful. So the MD has compounded the problem. You now have a patient with anxiety AND a benzo dependency. When these drugs were new, the addictive qualities were thought to be much lower and so they were freely prescribed. Much like steroids, they are almost a miracle drug for short term use. But as the evidence against them built up, prescribing has gone down. I guarantee that this isn’t because of some “neo-prohibitionist idea that drugs are bad.” These are doctors we are talking about, drugs are what they do.

Additionally, speaking of cases of whiskey, alcohol and benzos are one of the most dangerous combos known. Thousands of inadvertent overdose deaths a year.

Yeah but my understanding is that as long as you take 3-4 days between benzo doses and only use them 1-2x a week max, then tolerance isn’t a huge risk. If I’m wrong I’m open to being corrected, but that was my understanding.

Benzos aren’t good for daily use, but for panic attacks or overly stressful situations they can be pretty helpful.

But then again, beta blockers or antihistamines can work for those short periods of panic too. But they aren’t as good as benzos.

I imagine the process to assign a prescription drug to a schedule involves a process, which requires data. The drug trials will yield some data, but once the drug is approved, the amount of consumers will increase exponentially yielding like data.

A drug trial will also probably have a lot of controls in place, a lot of questions asked to the participants, to yield said data. Out in the real-world, things are much less controlled and a lot of factors which possibly couldn’t have been thought of can and will come into play. All that will be taken into account and update the drug classification as need be I imagine. Empirical data, versus sound-bites from ad-driven sources is the way to go.

In regards to marijuana being as high as it is, clearly is due to some politics. Or, possibly bad data/slighted data that was presented at the time. I also imagine changing a drug classification will probably yield a reaction from the manufacturer and political parties. If marijuana was to be removed, manufacturers would be happy and politicians and other agencies might be rather vocal.