Klonopin and Alcohol Interactions and Private Treatment Options
Anxiety, insomnia, depression, and related illnesses have long been a part of human history. While alcohol is a recreational beverage used for relaxation and increased social interaction, it is also a psychoactive drug, affecting the brain and resulting in sedation, muscle relaxation, and impairment of motor and cognitive abilities (for example, driving).
Since it may temporarily mask the symptoms of anxiety and panic disorder, the use of alcohol in an attempt to self-medicate may contribute to its abuse and to prevalence of alcohol-related disorders.1
In 2013, 24.6% of people aged 18 and older in the U.S. reported having engaged in at least one binge drinking episode within the previous month. Nearly 88,000 people (62,000 men and 26,000 women) in the U.S. die from alcohol-related deaths every year. In 2006, alcohol misuse problems in the U.S. cost $223. 5 billion.2
From 1960 to the late 1990s, benzodiazepines were the drugs of choice for short-term treatment of anxiety and insomnia. They have been used as muscle relaxants, for relieving stress associated with muscle tension, and have been found to be effective in alleviating panic attacks and phobias.1
When taken for long time, benzodiazepine dependence can develop, which includes withdrawal symptoms such as a return or intensification of the condition for which they were prescribed (i.e., rebound anxiety), as well as insomnia, agitation, irritability, and, in some cases, seizures.
While short-term benzodiazepine treatment protocols exist (small doses prescribed for short periods of time), they are often ignored with more and more doctors writing long-term prescriptions, particularly to the elderly.3
And increasingly common are reports that drugs such as Klonopin and other benzodiazepines are being abused in conjunction with other drugs.4
Klonopin is a benzodiazepine drug. It is marketed as both a swallowed pill and orally dissolving tab under its trade name, but also available as a generic tablet (as clonazepam). The drug is prescribed to control both seizures and extreme, sudden-onset panic attacks, according to the National Institutes of Health.5
Like most prescription medications, Klonopin should not be taken with alcohol, and because it is often prescribed for daily use, this means that individuals using it should abstain from all alcohol use. Of course, not everyone follows this rule and the resulting interactions can be quite serious.
Specific Interactions of Klonopin and Alcohol
The combination of alcohol and Klonopin creates a very high risk of overdose death. Benzodiazepines such as Klonopin can increase the clinical effects of alcohol, producing over-sedation and respiratory depression. The additive effect can likewise cause death indirectly through decreased coordination and reaction time while driving a vehicle or operating machinery on the job.
Alcohol can also affect how Klonopin is metabolized by the liver – effectively prolonging the action of this drug in the body. The most commonly reported symptoms related to interactions with alcohol are sedation, tachycardia (rapid heart beat), and increased intoxication.6
Between 2001 and 2014, there was a five-fold increase in the number of deaths from benzodiazepines, with 7,000 fatalities in 2014 compared to 1,700 in 2001.7 Such overdose deaths are rarely the result of benzodiazepines alone, but usually in conjunction with alcohol or other drugs.
Overdose symptoms include the following:
- Ataxia (involuntary movements including problems walking)
- Impaired gag reflex
- Blurred vision
- Impairment of memory and cognition
- Grand mal seizures
- Hypotension (very low blood pressure)
- Respiratory depression
- Loss of consciousness/unresponsiveness
The specific interactions can vary by individual, duration of Klonopin use and the type of alcohol consumed, however, in general, the symptoms of such an interaction include:
- Memory impairment.
- Trouble breathing.
- Problems with motor control. 8
In addition to these less-severe complications when Klonopin is taken with alcohol, there is an increased risk of drug overdose – which can entail respiratory arrest, anoxic brain injury, and death.
Dual Diagnosis for Drug and Alcohol Treatment
Individuals who abuse Klonopin in conjunction with alcohol require private inpatient treatment from a facility that specializes in dual diagnosis recovery. This is especially important for those who have been prescribed Klonopin for a mental health condition such as anxiety.
It is reported that 50-75% of all individuals receiving treatment for substance abuse, such as Klonopin and alcohol addiction, also struggle with another diagnosable mental health disorder. And though the directionality isn’t always clear, individuals who are diagnosed with major depressive disorder or generalized anxiety disorder are also more likely to struggle with substance abuse at some point in their lives – a phenomenon that might help explain the prevalence of dual diagnoses in those with mood and anxiety disorders.9
Ultimately, whether the substance use disorder or mental health issue preceded the other is not so important. In integrated treatment of co-occurring disorders, both disorders are treated as one unit that is causing dysfunction, illness, and despair in a person’s life. 9 Effective treatment assesses and addresses every area that may contribute to the co-occurring disorders. For example:
- Housing problems
- Issues with family
- Finding meaningful activities
- Quality of life issues
Unlike other treatment models for co-occurring disorders, the integrated model of treatment will provide most services at a single treatment facility where all staff work as an integrated team to help patients with multiple issues make progress toward their goals in recovery.10
Types of Rehabilitation Centers
Traditional. Traditional rehabilitation services may be offered in either a residential or outpatient setting. Patient needs for a safe environment, as well as cost and insurance, are determining factors in the decision for residential or outpatient treatment.
A significant number of patients choose inpatient treatment, especially those who might require more physical care and psychiatric attention. And for those individuals who are highly motivated to work a treatment plan in a supportive home environment, outpatient treatment consists of several daily sessions per week, conducted over the course of several weeks to several months (e.g., a 30-to-90-day period).
Most types of traditional rehabilitation programs will include individual and group therapy, education on how to deal with cravings and drug-cue situations, family sessions to help heal relationships and 12-step meetings such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA).
Luxury. Private accommodations, fully furnished rooms or suites, movie theaters, saunas, and any number of other amenities are provided in the luxury rehab facility for those who want the privacy and the care-free comforts of a home-like retreat.
Holistic therapies are offered at many of these facilities, targeting the healing of body, mind, and spirit. Some top-end luxury rehabs also offer life-coaching, neurofeedback, acupuncture, equine therapy, and massage and are often located in exotic destinations (e.g., beach resorts) or in secluded, pastoral settings (e.g., a ranch nestled among gently rolling hills).
While luxury rehab services are very attractive to the person who wants to break the cycle of addiction, it cannot be assumed that these luxury settings offer treatment for co-occurring disorders. In the integrated treatment model for co-occurring substance abuse and mental disorders, the emphasis is on the reduction of the numerous harmful and debilitating effects of these disorders on the client. That is not a luxury, but a necessity in all effective treatment programs, traditional or otherwise.
Since clients with co-occurring disorders often require “time-unlimited” services to allow them to recover, a traditional, community-based inpatient/outpatient program may prove to be the most effective and cost-effective choice for treatment, because the community is the real world in which they live and work and play.
Alternative Medications for the Treatment of Anxiety
Like Klonopin, many of the medications used to manage anxiety disorders have inherent abuse potential. As part of dual diagnosis recovery, new behavioral therapeutic techniques will be taught as a primary approach to managing the symptoms of an anxiety disorder. Additionally, though, there are a number of pharmaceutical interventions that don’t carry the same risk of abuse that the benzodiazepines do. Some of these prescription medications may be better indicated for the management of a variety of anxiety disorders in those who have previously misused Klonopin (with or without concurrent alcohol abuse). They include:
- Zoloft. 11
Of course, negative interactions may continue to occur when the drugs listed above are combined with alcohol, and the underlying abuse issue must be diligently addressed over time.
- Julien, R.M., et al. (2011). A Primer of Drug Use. Twelfth Edition. New York, NY: Worth Publishing.
- National Institute on Alcohol Abuse and Alcohol. (2015). Alcohol Facts and Statistics.
- Hood, S.D., et al. (2014). Benzodiazepine dependence and its treatment with low dose flumazenil. British Journal of Clinical Pharmacology, 77(2), 285-294.
- Jones, J.D. et al. (2012). Polydrug abuse: A review of opioid and benzodiazepine combination use. Drug and Alcohol Dependence, 125(1-2), 8-18.
- National Institutes of Health: DailyMed. (2006). Klonopin.
- Chan, L.N. and Anderson, G.D. (2014). Pharmacokinetic and Pharmacodynamic Drug Interactions with Ethanol (Alcohol). Clinical Pharmacokinetics, 53(12), 1115-1136.
- National Institute on Drug Abuse. (2015). Overdose Death Rates.
- Ciraulo, D.A. and Knapp, C.M. (2009). The Pharmacology of Nonalcohol Sedative Hypnotics. (8) Principles of Addiction Medicine. Fourth Edition. Philadelphia, PA: Lippincott, Williams & Wilson.
- Hazelden and NAADAC. (2010). Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know.
- Mee-Lee, D., et al. Editors (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. Third Edition. Chevy Chase, MD: The Change Companies.
- Bystritsky, A., Khalsa, S.S., Cameron, M.E., Schiffman, J. (2013). Current Diagnosis and Treatment of Anxiety Disorders. Pharmacy and Therapeutics, 38(1), 30-38, 41-44, 57.