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Benzodiazepines for Alcohol Withdrawal

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Key Takeaways

  • Benzodiazepines are depressants that treat alcohol withdrawal syndrome (AWS).
  • They are the most commonly prescribed medications in the country.
  • Benzos work by affecting the brain’s neurotransmitters.
  • Serious side effects can occur with benzodiazepines.
  • Other treatment options are available for patients with AWS.

Can You Treat Alcohol Withdrawal With Benzodiazepines?

When managed by a medical or addiction specialist, benzodiazepines can treat alcohol withdrawal in many cases.9 But they’re only one of the various ways to treat and manage alcohol withdrawal syndrome (AWS) symptoms.

Never try to treat your own alcohol withdrawal symptoms through self-medication with benzodiazepines.

As with all medications, there are pros and cons to taking benzodiazepines. Here’s what you should know about benzodiazepines in general, how they help treat AWS, and the risks of taking them.

What are Benzodiazepines? 

Benzodiazepines (benzos) alter neurotransmitters in the brain. One of these neurotransmitters is gamma-aminobutyric acid (GABA), which suppresses nerve activity. 

Due to this effect, benzos are commonly prescribed to treat mental health disorders (e.g., anxiety), insomnia, muscle aches and pain, and alcohol withdrawal symptoms. 

They are also used as hypnotics and anticonvulsants to treat seizures.2

Common types of benzos include:5

  • Xanax
  • Valium
  • Ativan
  • Librium

What is Alcohol Withdrawal Syndrome (AWS)?

AWS refers to the physical and psychological symptoms that can occur when someone tries to quit or cut back on prolonged and heavy alcohol use

Once the body adapts to alcohol, it might not react well when consumption stops.1

AWS typically starts about 6 to 24 hours after the last alcoholic drink.7

Symptoms of AWS range from minor to moderate or severe. They include:4

  • Headaches
  • Insomnia
  • Nausea
  • Vomiting
  • Delirium tremens (tremors)
  • Seizures
  • Hallucinations
  • Illusions

AWS can happen to anyone who abuses alcohol. It’s important to take alcohol withdrawal symptoms seriously, as they can worsen and even be fatal if ignored.

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How Do Benzos Help With Alcohol Withdrawal?

Benzos can help with the management of alcohol withdrawal by reducing certain symptoms like delirium tremens (DTs).

Benzos are considered effective and safe when prescribed by physicians who are trained in their use and monitor patients closely. They should never be used to treat AWS without medical direction and supervision.3

These drugs help treat alcohol withdrawal symptoms by imitating alcohol’s effects on the brain. After all, both alcohol and benzodiazepines share an anti-anxiety effect.3

Treatment for alcohol withdrawal syndrome with benzos follows 1 of 3 different scheduling options. Which one is best depends on your symptoms and how you respond to the medication:

  1. A fixed regimen with a tapering dose
  2. A regimen triggered by symptoms
  3. A loading dose

In some cases, doctors prescribe additional doses of the medication for ‘break-through’ symptoms. 

Doctors may also choose to move alcohol-dependent patients from a symptom-triggered regimen to a more regular regimen. This can include a fixed tapering dose regimen for severe withdrawal symptoms.4

4 Types of Benzodiazepines for Alcohol Withdrawal

Four types of benzodiazepines are commonly used to help treat alcohol withdrawal. While they share many similarities, there are some key differences.

1. Valium and Tranxene

Diazepam (Valium) and clorazepate (Tranxene) have fast onsets and typically start working within a half-hour to an hour.

Diazepam is most commonly used to treat anxiety disorders and promote muscle relaxation. Its long duration of action makes it less useful to help titrate effects in alcohol withdrawal.

2. Librium

Chlordiazepoxide (Librium) is a long-acting medication with a duration of about 1 to 3 days. 

Librium used to be the most common benzodiazepine for AWS symptoms, but has been replaced by Ativan. 

3. Ativan

Lorazepam (Ativan) is an intermediate-acting agent. Its duration of action lasts about 11 to 20 hours.

Ativan is very commonly used to treat AWS. It’s also used for general anxiety and sometimes seizure disorders.

4. Serax

Oxazepam (Serax) has a slow onset. It can treat anxiety disorders and AWS symptoms. 

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Side Effects of Benzodiazepines

As with all medications, benzodiazepines come with side effects like:5

  • Dizziness
  • Lightheadedness
  • Weakness
  • Unsteadiness
  • Sedation
  • Drowsiness
  • Sleep disturbances
  • Irritability
  • Aggression
  • Excitement
  • Loss of orientation
  • Memory impairment

Some patients who start taking benzodiazepines may abuse them. Substance abuse can lead to addiction. This is especially true for people who already struggle with alcohol dependence or another drug addiction.

Some drug users combine benzodiazepines with other drugs like opioids to boost euphoric effects. In 2019 alone, 16 percent of opioid overdose deaths also involved benzodiazepines.8

People with a benzodiazepine addiction are at a higher risk of developing other health issues like dementia. Dementia affects the brain and leads to memory loss and complications with motor and language skills.

Benzodiazepine addiction can lead to death. Serious signs to look out for include:6

  • Shallow breathing
  • Clammy skin
  • Weak pulse
  • Rapid pulse
  • Dilated pupils
  • Coma

If you suspect you or someone you know is experiencing serious benzodiazepine side effects, call 911 immediately.

Meanwhile, common and less severe symptoms of withdrawal from a benzodiazepine addiction include:2

  • Anxiety
  • Restlessness
  • Sleeping difficulties
  • Irritability
  • Nausea
  • Sweating
  • Blurred vision
  • Nightmares
  • Depression
  • Muscle problems
  • Tremors
  • Hallucinations
  • Delusions
  • Seizures

If you or someone you know is struggling with drug use, talk to your doctor. There are other treatment options available to treat AWS.

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Programs That Offer Medication-Assisted Treatment (MAT)

Inpatient rehabilitation and other long-term rehabs may incorporate benzodiazepines to treat AWS. 


Other treatment centers provide cognitive behavioral therapy (CBT) or holistic therapy. These options can coincide with MAT.

Depending on the treatment center, you might work with a doctor to start symptom-triggered therapy or another regimen.

Alternative Treatment Options

Medication-assisted treatment is not right for everyone. Other treatment options include:

Left untreated, alcohol abuse and alcohol withdrawal symptoms can be fatal.

If you or someone you know is struggling with alcohol abuse or withdrawal, help is available. Talk to your doctor today to discuss professional treatment advice and find the best options for you.

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Updated on March 31, 2022
9 sources cited
  1. Alcohol Withdrawal: Medlineplus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine.
  2. Annette (Gbemudu) Ogbru, PharmD. “Benzodiazepines Drug Class: List, Uses, Side Effects, Types & Addition.” RxList, RxList, 1 Apr. 2021.
  3. Are Benzodiazepines Effective in Treating Alcohol Withdrawal?GoodRx, GoodRx.
  4. Bayard, Max, et al. “Alcohol Withdrawal Syndrome.” American Family Physician, 15 Mar. 2004.
  5. Benzodiazepines.” Benzodiazepines - Alcohol and Drug Foundation.
  6. Benzodiazepines.” DEA.
  7. Herbert L. Muncie, Jr., et al. “Outpatient Management of Alcohol Withdrawal Syndrome.” American Family Physician, 1 Nov. 2013.
  8. National Institute on Drug Abuse. “Benzodiazepines and Opioids.” National Institute on Drug Abuse, 3 Feb. 2021.
  9. Sachdeva, Ankur, et al. “Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.” Journal of Clinical and Diagnostic Research : JCDR, JCDR Research and Publications (P) Limited, Sept. 2015. 

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