Objective Determination of Benzodiazepine Use and Abuse in Alcoholics

Abstract

SummaryThe extent of concurrent use and abuse of benzodiazepines and alcohol in chronic alcoholics is not known. Prospective data collected on 216 consecutive outpatient referrals between 1 June and 31 July 1981 (age range, 16 to 70 years, 75 per cent men) showed that benzodiazepines were detected in the urine of 33 per cent of patients undergoing medical assessment. Other drugs identified in urine were ethanol (5.0 %), codeine (1.99 %) and barbiturates (1.5 %). According to patient histories, the predictive value of benzodiazepine allegation was high for positive and negative allegation (0.87 and 0.83, respectively), indicating that patients reliably report benzodiazepine use if questioned. However, only one patient considered himself to be a benzodiazepine abuser. The proportion of women with a positive test for benzodiazepines (48%) was significantly higher than that of men (28%: X – 7.7; p <0.005). Among patients alleging use of benzodiazepines (n = 61), 54 per cent obtained the drug directly by prescription while 46 per cent obtained it indirectly (e.g. a relative, illicit source). Benzodiazepines were taken most frequently for anxiety (53%) and occasionally for alcohol withdrawal (10%). Forty‐seven (54%) of the patients could be considered abusers of benzodiazepines (i.e. indirect source and/or cumulative drug exposure of >2700 mg of diazepam or equivalent and a positive urine test). These results · indicate that benzodiazepines are very commonly used and abused by alcoholics. Treatment programmes for alcoholics should identify such patients, consider directing treatment toward control of benzodiazepine use, and monitor changes in benzodiazepine use during and after treatment.

Benzodiazepine self-administration in humans and laboratory animals - implications for problems of long-term use and abuse

“…Rates of benzodiazepine use exceeding 30% are not uncommon among alcoholics (Busto et al 1983;Wiseman and Spencer-Peet 1985;Crane et al 1988;Wolf et al 1990;Ross 1993) and studies have repeatedly documented use without a prescription (Busto et al 1983;Bailly et al 1990;Wolf et al 1990;Ross 1993). As discussed in more detail in a later section of this review, experimental studies indicate that people with histories of moderate alcohol consumption (deWit et al 1989;deWit and Doty 1994) and alcoholics (Ciraulo et al 1988a) show increased sensitivity to the reinforcing effects (deWit and Doty 1994) and positive mood effects (Ciraulo et al 1988a;deWit et al 1989) of benzodiazepines.…”

Abuse of Benzodiazepines: The Problems and the Solutions

“…This rate compared to 5% positive for alcohol, and less than 2% positive for codeine and barbiturates, the next most commonly identified drugs [45]. One important study recently found that "benzodiazepines are very commonly used and abused by alcoholics," noting that 33% of 216 consecutive outpatient referrals for alcohol problems had urine tests which were positive for benzodiazepines.…”

Tolerance to Hexobarbital Induced by Short‐Term Treatments with Diazepam and Tested with an EEG‐Threshold Test in Male Rats

“…Some reports deal with cross-tolerance between different benzodiazepines (Busto et al 1983 and between benzodiazepines and barbiturates (Woods et al 1987;Yanagita 198 I). Cross-tolerance between barbiturates and ethanol (Busto et al 1983;Sokolow et al 1981;Schukit & Morrisey 1979) and between benzodiazepines and ethanol (Sokolow et al 1981;Schukit & Morrisey 1979;Ciraulo et al 1988b;Chan et al 1982) are two well documented phenomena. Since both ethanol (Mehta & Ticku 1989;Bergman et al 1980;Ticku 1990) and barbiturates (Ho & Harris 1981) could interact with the GABA/benzodiazepine ionophore, a primary site of action to explain the cross-tolerance could be searched for in this area.…”

“…The use of benzodiazepines has recently been affected by increasing concern about their potential to induce tolerance, dependence and abuse. Clinical experience and epidemiological data suggest that alcoholics may be at higher risk to abuse benzodiazepines (Busto et al 1983;Ciraulo et al 1988b;Thomas et al 1989;Senay 1989). The common determinant behind such abuse could be a cross-dependence between ethanol and benzodiazepines.…”