Thanksgiving dinner with the in-laws. The alcohol is part of a relaxation
program that increases confidence more than it physically prevents
attacks. Obviously, this works only with people who seldom drink and have
not built up a tolerance. In doses of more than one drink, alcohol quickly
ceases to be a medicine and becomes a disorder itself.
Most people with fear disorders who self-medicate with alcohol don’t
talk to their doctors about it. You’ll see them more than I do. If the dosage
is higher than one drink a day, possibly two, the various side effects are
probably canceling out the benefits. If you have the opportunity, gently
suggest that the doctor can prescribe something more effective.
Benzodiazepines
These are the drugs you think of as tranquilizers. They include Valium,
Librium, Ativan, Restoril, Xanax, Klonopin, Serax, and several others. See
Appendix 1 for a listing of generic and brand names of all the medications
covered in this text. Benzodiazepines are central nervous system depres-
sants that, like alcohol, enhance the inhibitory action of GABA. They have
fewer side effects than alcohol, but still work quickly and well. That is their
benefit, and their danger.
Benzodiazepines are a part of a series of drugs that include barbiturates
and meprobamate (Miltown), which, though they bind to different receptor
sites in the brain, do pretty much the same thing. Each one in its day was
the drug of choice for anxiety, and each one has been abandoned because
of its addictiveness. The first and most popular of the benzodiazepines
were Librium and Valium. In the 1960s they were the most frequently pre-
scribed medications in the United States.
Back then, researchers noted that benzodiazepines bind to different
receptor sites than the addictive substances. There was a theory that anxiety
was caused by an imbalance in the benzodiazepine-GABA receptor com-
plex. It was thought that benzodiazepines mimicked the action of unknown
but naturally occurring chemicals that calmed anxiety. Much was made
of the fact that betacarbolines, that do occur naturally in the brain, act on
the same receptors as benzodiazepines but have an opposite effect—they
cause anxiety. Taking Valium three times a day was supposed to increase
the amount of good transmitter substance relative to the bad.
In the 1960s a lot of people were physically dependent on Valium
and Librium. You’ll remember that to be addictive, drugs have to act fast
Explosions into Fear ❧ 85