The Concurrent Use of Alcohol, Cigarettes and Caffeine in British Benzodiazepine Users as Measured by a General Population Survey

Abstract

A 1985 general population survey was conducted by Gallup in Great Britain. Subjects (4,148) were questioned about their use of benzodiazepines of whom 1,284 were also questioned about their alcohol, cigarette and caffeine consumption. Data were examined to find possible multiple substance misuse. No strong evidence could be found. People taking benzodiazepines at the time of the survey consumed significantly less alcohol than nonusers or past users. Cigarette consumption was found to be increased in current and past benzodiazepine users. Subgroups of bemodiazepine users, defined as 'high users', 'dosage escalators' or 'chronic users' were also examined. Again no strong evidence of multiple substance misuse could be found. However, high users and dosage escalators did smoke more than others. Concurrent misuse of benzodiazepines and other legally available psychoactive substances is not common in the general population.

Alcohol consumption among Canadians taking benzodiazepines and related drugs

“…20,21 In an overview of psychotropic drug use using the same data source as the present study, Beck et al 22 reported that 3.1% of the Canadian population had used either a benzodiazepine or the non-benzodiazepine hypnotic zopiclone over a 2-day period. Studies examining use over longer periods of time 23 have generally reported higher levels of use, which presumably reflects the fact that BZDs are frequently used on an as-needed (prn) basis. A recent review of BZD prescribing found this pattern of use to be present in more than half of all BZD users.…”

Acute Nicotine Exposure Alters Ventral Tegmental Area Inhibitory Transmission and Promotes Diazepam Consumption

“…Recent epidemiological studies report a steep rise in benzodiazepine misuse and overdose mortality, occurring most commonly in poly drug users (Dunbar et al, 1988;Woods et al, 1992;Griffiths and Weerts, 1997;Lekka et al, 1997;Neutel, 2005;Licata and Rowlett, 2008;Bachhuber et al, 2016;Lembke et al, 2018;Maust et al, 2019). We showed that nicotine pretreatment increases diazepam intake for several days.…”

“…Unfortunately, these drugs also retain a liability for abuse and dependence, especially in polydrug users and individuals with comorbid anxiety and depression (Woods et al, 1992;Griffiths and Weerts, 1997;Licata and Rowlett, 2008). Interestingly, benzodiazepine abuse is more likely to occur in smokers (Dunbar et al, 1988;Lekka et al, 1997;Neutel, 2005), and evidence from rodents shows that exposure to nicotine increases the reinforcing properties of benzodiazepines (White, 1989;Irvine et al, 2001;James-Walke et al, 2007). Like nicotine, benzodiazepine reinforcement involves midbrain GABAergic signaling, as genetic manipulation of GABA A Rs in the VTA was shown to decrease benzodiazepine consumption (Tan et al, 2010;Tolu et al, 2013).…”

Assessing the Risks and Benefits of Benzodiazepines for Anxiety Disorders in Patients with a History of Substance Abuse or Dependence

“…However, five large‐scale epidemiological studies comprising over 16,000 long‐term BZD users and controls in the community have yielded no clinical evidence to substantiate these theories 143,184–187 . Similarly, in a 6‐month prospective study following 367 long‐term BZD users and matched controls, no evidence was found to suggest that BZD use led to alcohol or drug abuse 137 .…”

“…This finding is especially surprising since BZD users have been found to be sicker than the general population, both physically and psychologically, 137,143,186,187,192 and such co‐morbidity conveys a worse prognosis for recovery from substance abuse 193 . Although some have speculated that BZD users are older and perhaps drink less as a function of their age, 184 this has not been borne out in aged‐matched controlled surveys 143,186–187 . One could also argue that clinicians might avoid prescribing BZDs to patients who are abusing alcohol, and that this could account for the lower rate of alcohol consumption among BZD users.…”