Benzodiazepines like Ativan for Alcohol Withdrawal: Are They Safe?

Of the few pivotal crossroads and turning points you might encounter in life, deciding to stop drinking after a prolonged period is one of them.  

It’s a deeply personal and challenging choice, a decision to reclaim your life, to not identify with the stark numbers that paint a picture of alcohol use disorder in the U.S., affecting nearly 29 million people, according to the 2023 National Survey on Drug Use and Health.   

Once you’ve made the decision to enter rehab, one of the first hurdles is detoxing and managing alcohol withdrawal symptoms. Medications like Ativan for alcohol withdrawal can help lessen the side effects or complications that can sometimes arise from more serious alcohol addiction. 

Is using Ativan for alcohol withdrawal a safe path to take? Being a powerful benzodiazepine with addictive potential, can it help with alcoholism or raise the risk of developing an additional dependency?  

What Is Ativan?  

Ativan is a well-known brand name of the medication lorazepam and belongs to a class of drugs called benzodiazepines, colloquially referred to as “benzos.”  

Benzos work for alcohol addiction and alcohol withdrawal because they imitate and replace the effects of alcohol on the brain when you stop drinking, making withdrawal easier to bear. In detail, they enhance the production of a neurotransmitter called gamma-aminobutyric acid, or GABA. GABA works to make certain nerves in the brain less prone to stimulation, calming and somewhat sedating neurological activity — helpful in counteracting the excitable, overactive feelings that can accompany anxiety, one of the first alcohol withdrawal symptoms you might feel. 

Lorazepam is effective for the short-term relief of severe anxiety or conditions like panic attacks due to its fast-acting nature. Beyond anxiety, its sedative properties make it useful for treating insomnia, especially when anxiety is the underlying cause of sleeplessness.  

Ativan/lorazepam is also used for insomnia and depression brought on by anxiety, and prior to surgery. It’s also effective in treating a type of longer-lasting seizure called status epilepticus.  

As such, taking Ativan for alcohol withdrawal may prove helpful in mitigating and managing the anxiety, irritability, or agitation, and in more severe cases, seizures or tremors symptomatic of alcohol withdrawal.  

Other Common Benzodiazepines   

Ativan is just one in a class of several different benzodiazepines, some of which you might recognize from their brand names. They all share the same fundamental purpose of bolstering GABA’s effects in the brain, but each one differs slightly in a few ways. Here’s a look at some of the more common ones:  

Xanax (Alprazolam)   

Alprazolam is a benzodiazepine that’s well known as Xanax, an anti-anxiety medication that acts on the brain similarly to Ativan. Though it’s effective in treating anxiety and panic disorders, Xanax could be considered one of the weaker benzodiazepines. It’s often prescribed to be taken three times a day because it has a shorter half-life, meaning its effects wear off more quickly than other benzos, usually within eight hours.  

Klonopin (Clonazepam) 

Clonazepam — marketed as Klonopin — is used primarily to treat people struggling with severe panic disorders and panic attacks. Like lorazepam, clonazepam is also prescribed for the treatment of seizure disorders, including epilepsy, absence seizures, and Lennox-Gastaut syndrome, along with preventing involuntary muscle spasms, which is one reason it can prove helpful during alcohol detox to minimize the likelihood of withdrawal tremors or spasms. 

Diazepam (Valium)   

Whereas other benzos are geared towards treating anxiety with some possible benefits for aiding alcohol withdrawal, diazepam, known popularly as Valium, is often the preferred medication for treating alcohol withdrawal. Diazepam is a quick- and long-acting drug that allows for more rapid and smoother symptom control during alcohol withdrawal. This is because diazepam and desmethyldiazepam, its active ingredient, have long half-lives, facilitating a steady, tapered withdrawal. 

What Is Alcohol Withdrawal?  

Alcohol use disorder is a condition marked by an inability to stop drinking even when it negatively affects your relationships, your performance at work or school, and your physical and mental health. Alcoholism develops when your brain and body start to depend on drinking to function, making it difficult to stop even if you want to. 

If you do stop drinking after misusing alcohol heavily and chronically over a long period, it comes as a shock to the system and begins a series of withdrawal symptoms. It’s a reactive attempt by your brain and body to regain balance from the sudden absence of alcohol — a hyperactivity of the central and autonomic nervous systems, notes the American Academy of Family Physicians (AAFP). 

Alcohol withdrawal syndrome affects about half of alcoholics who abruptly stop drinking or seriously cut back. “When you stop consuming alcohol after prolonged, heavy use, your central nervous system can’t respond or regulate itself fast enough,” says the Cleveland Clinic. “It becomes overexcited because there’s no more alcohol to slow it down. This overload of activity results in withdrawal symptoms.” 

 What determines how severe one’s alcohol withdrawal symptoms will be? One’s pattern of alcohol use, one’s genetic, neurological, and central nervous system makeup, and physical health — including any co-occurring illnesses or conditions — all play a part.