Diazepam, most recognizable by the trade name Valium, is a benzodiazepine medication. Benzodiazepines were touted as less addictive alternatives to barbiturates, and their major use is in the treatment of dysfunctional anxiety, for the control of seizures, as sedatives, and as sleep aids.
Despite the initial motivation for benzodiazepines to replace barbiturates, benzodiazepines are significant drugs of abuse. They have a moderate potential for abuse as a group and are generally classified in the Schedule IV controlled substances category by the United States Drug Enforcement Administration (DEA). Drugs in this category have a moderate potential for abuse and are strong candidates to produce physical dependence in individuals who use them on a regular basis for more than just a few weeks. Controlled substances can only be legally obtained with a prescription from a physician and can only be used while under the supervision of a physician.
Valium Use and Abuse
Valium became a frequently prescribed medication for the treatment of anxiety in the 1970s to 1990s. It was even prescribed for people who suffered from everyday fluctuations in their anxiety levels. At one time, Valium was one of the most prescribed drugs across the globe, and the development of physical dependence on Valium and the abuse of Valium became global problems. Eventually, the shorter-acting drug Xanax (alprazolam) was substituted in many cases to treat anxiety, but like all benzodiazepines, it also carries a potential risk for abuse.
Benzodiazepines are useful in the treatment of dysfunctional anxiety that often accompanies formal mental health disorders, but they should never be used to treat everyday fluctuations in anxiety or nervousness. Moreover, benzodiazepines are not normally considered to be long-term solutions for the treatment of dysfunctional anxiety, even in severe anxiety disorders. This is because individuals develop tolerance to benzodiazepines very quickly, and once tolerance develops, people often need higher doses of the drug to experience its medicinal effects. As the person begins to develop higher levels of tolerance, they may also begin to develop issues with withdrawal when the drug is metabolized from their system or when they stop using the drug. Instead, benzodiazepines are most useful when combined with behavioral treatments (e.g., psychotherapy) in the treatment of issues with anxiety and as sleep aids.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the following:
- In 2015, it was estimated that 29.7 million individuals used a benzodiazepine; in 2016, this estimate was 30 million.
- Of the individuals estimated to be using benzodiazepines in 2015, about 7.4 million were estimated to use some form of diazepam product; in 2016, this estimate was 7 million individuals.
- About 2.5 times as many individuals were estimated to have used Xanax in both 2015 and 2016.
- Of the individuals reporting some use of these products in 2015, about 1.3 million reported misusing the product at least once; in 2016, this estimate was 999,000.
- About four times as many people were estimated to misuse Xanax (alprazolam products) in both 2015 and 2016 than diazepam products.
Misuse of a drug refers to an individual not using it according to its prescribed purposes on one or more occasions, whereas abuse of a drug refers to chronic misuse of a drug that leads to significant issues with functioning. Misuse figures can often be used to estimate overall percentages and proportions of abuse. SAMHSA has consistently reported that the majority of individuals who abuse prescription medications do not have a prescription for the medication but acquire the drug illegally.
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The Mechanism of Action of Valium
Benzodiazepines are often referred to as sedatives or central nervous system depressants; many sources also refer to these as tranquilizers. Benzodiazepines, for the most part, all share a very similar mechanism of action. These drugs increase the availability of a neurotransmitter in the brain often referred to as GABA (gamma-aminobutyric acid). GABA is the major inhibitory neurotransmitter in the brain, meaning it moderates the firing rates of other neurons in the brain by slowing down their actions. Thus, when a person takes a benzodiazepine, they are intentionally taking a medication that slows down the functioning of the cells in their brain. This is how benzodiazepines can treat issues with anxiety, seizures, and act as sleep aids and even muscle relaxants.
This mechanism of action also results in mild to moderate feelings of euphoria, relaxation, wellbeing, dampening of inhibitions, and overall effects that are very similar to the effects of alcohol, which is also a central nervous system depressant. Other effects that can occur when a person takes Valium include decreases in speed of thought, breathing rate, heart rate, and blood pressure. In addition, Valium can lead to problems with movement and coordination.
Some of the benzodiazepines have longer-lasting effects on others. For instance, Valium stays in the system longer than Xanax does, and this quality of the drug is believed to be partially responsible for the greater tendency for Valium to be abused compared to Xanax (at least in theory). Most benzodiazepines are not used as primary drugs of abuse, but instead are used in conjunction with other drugs of abuse, such as alcohol, other benzodiazepines, narcotic pain medications (e.g., Vicodin, OxyContin, etc.), cannabis products, and even stimulants like Ritalin or cocaine. Thus, abuse of benzodiazepines often occurs as a result of individuals mixing drugs.
SAMHSA and other professional sources consistently report that developing any type of substance use disorder (the clinical designation for an individual who has a substance abuse or addiction issue) is far less likely to occur as a result of using a prescription medication under the supervision of a physician than it is for individuals who obtain these medications from illicit sources and use them for their psychoactive effects and in manners that are contrary to the instructions provided on the labels of these medications. Most, but not all, individuals who are prescribed benzodiazepines do not develop a substance use disorder to them (an addiction). Some individuals may wind up abusing the drug and eventually developing a diagnosable substance use disorder. Organizations like the National Institute on Drug Abuse (NIDA) have consistently found that abuse of benzodiazepines can occur across any age group, but the most common group to abuse this class of drugs includes those in the 18-35 age range, and the majority of these individuals do not have a prescription for these drugs.
Signs of Abuse
Some of the signs that someone might be abusing Valium include:
- A person who does not have a prescription for Valium frequently using the drug
- Coming across prescription bottles for Valium on the person, in their possessions, in their trash, etc.
- Finding out that the person frequently uses Valium in conjunction with another drug
- A person with a prescription for Valium attempting to get numerous prescriptions from different doctors
- A person feigning injury or a psychological disorder in order to get more Valium
- A person who is known to use Valium often appearing as if they are intoxicated on alcohol
- A person who is known to use Valium displaying significant problems with attention, memory, motor coordination, etc.
- A person who is known to frequently use Valium displaying periodic issues with flulike symptoms, trembling, insomnia, etc. (potential signs of withdrawal)
The formal diagnostic criteria that are used to diagnose a substance use disorder as a result of Valium abuse, which would be normally classified as a sedative, hypnotic, or anxiolytic use disorder, include:
- Frequent nonmedicinal use of the drug that results in the person experiencing problems with functioning or significant distress
- Continued use of the drug despite suffering negative consequences that can occur over numerous situations, including in relationships, at work or school, related to personal obligations, etc.
- Issues controlling use of the drug in numerous contexts
- Nonmedicinal use that results in the development of significant tolerance
- Nonmedicinal use that results in the development of withdrawal symptoms
The development of physical dependence on any drug (displaying both tolerance and withdrawal symptoms) is not used as an indicator that the person has a substance abuse issue if the person uses the medication under the supervision of a physician and according to the physician’s instructions. For individuals who require medications for the chronic treatment of various issues, such as seizures, pain, anxiety disorders, etc., the development of physical dependence is considered to be a side effect of treatment, but it does not necessarily indicate that the person is abusing the drug unless other indications (as listed above) occur.
When individuals who use drugs for nonmedicinal reasons develop tolerance and withdrawal symptoms to them, then these issues are considered to be signs that the person may have a substance use disorder. In addition, the level of tolerance and the severity of the withdrawal syndrome that occur in abusers is often far more severe and lengthy than the development of these issues in individuals who have used the medication strictly for medicinal reasons.
Withdrawal from Valium
The withdrawal syndrome associated with Valium is well documented. The most common symptoms associated with withdrawal from Valium most often include at least some of the following:
- Irritability, restlessness, and anxiety (often referred to as rebound anxiety because this anxiety re-occurs as a result of symptoms that the medication is designed to control)
- Appetite loss, insomnia, nausea, vomiting, muscle cramps, and stomach cramps
- Fever, chills, sweating, alterations in blood pressure and heart rate
- Hallucinations, delusions, shakiness, and tremors, particularly in the arms and hands when one is extending their arms away from the body)
- Confusion, difficulty concentrating, and mood swings
- The potential to develop seizures
The timeline for an individual who is withdrawing from Valium without the use of medical assistance can be somewhat variable but generally will have the following presentation:
- Symptoms begin to appear within 1-3 days after stopping use.
- Symptoms typically will reach their peak within a few days (3-5 days) after they appear.
- The actual symptoms that occur in any individual can be variable and will depend on the numerous factors that can include:
- How long the person abused Valium
- How much Valium the person typically used
- If they combined Valium with the use of other drugs
- If they have any other mental health or physical issues
- Individual differences in metabolism
- A waxing and waning course will generally take place, where people may initially experience very severe symptoms, followed by a lessening of symptoms, and then an exacerbation of symptoms after several days.
- The overall length of the withdrawal syndrome can last between ten days and as long as several weeks.
- Cravings to use Valium will always accompany untreated symptoms, and cravings may continue even after the withdrawal syndrome has subsided.
Because the withdrawal syndrome is potentially hazardous due to the potential to experience seizures during withdrawal, it is important that anyone considering treatment for Valium abuse consult with a physician.
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Treatment for People Who Abuse Valium
Whenever a person is suspected of having a substance use disorder of any type, it should be understood that this represents a very severe manifestation of a psychological disorder. The first step in helping a person with any type of substance use disorder is to fully understand their problem. This means that the person should have a comprehensive evaluation by mental health professionals to identify all the issues that need to be addressed in the treatment process.
The importance of a full assessment cannot be overestimated. Individuals with suspected substance use disorders should have physical examinations, mental health examinations, and evaluations of their social situation and social functioning. The findings of the overall comprehensive assessment can then be used to develop a personalized treatment plan that can address all the needs of the individual in a manner that both relies on standard empirically validated treatment practices and personal adjustments that fit the person’s needs.
A major concern with an individual who has developed a sedative, hypnotic or anxiolytic use disorder is that the person has developed physical dependence on the benzodiazepine. Physical dependence on benzodiazepines is a serious issue because the withdrawal process associated with benzodiazepines is very similar to the withdrawal process that occurs with alcohol. Individuals withdrawing from benzodiazepines may develop severe confusion, psychosis, and seizures, which can result in significant brain damage and even be fatal. Thus, anyone who has a suspected abuse issue with Valium would most likely need to be closely observed in the early stages of recovery and placed in a program of withdrawal management or medical detox.
The individual may be prescribed a longer-acting benzodiazepine, such as Librium, that would be sufficient to control any withdrawal symptoms. At specific intervals and under the supervision of a physician only, the dose will be slightly lowered in order to habituate the person to gradually dealing with smaller and smaller amounts of the drug in their system. This tapering system weans the person off the benzodiazepine. When done under the supervision of a physician trained in the procedure, complications can be avoided, including relapse during early recovery. Attempting to withdraw from the benzodiazepine without being under the supervision of a physician can be potentially dangerous and is never recommended.
As part of their overall recovery, the person should also be involved in substance use disorder therapy, which will most often be of a cognitive-behavioral nature. Clients can benefit from both individual therapy and group therapy or a combination of individual sessions and group sessions. Therapy is the backbone of recovery and helps individuals to understand their motivations for drug use, foster coping skills, devise a plan to deal with triggers and prevent relapse, and develop more functional relationships and living habits. Social support groups like 12-Step groups can supplement therapy and also serve as long-term interventions to help the person remain focused on their recovery for decades after stopping use of Valium.
In addition to medical detox and substance use disorder therapy, it is extremely important that any co-occurring mental health disorders that were identified in the assessment be treated along with the individual’s Valium abuse. Research has demonstrated that attempting to only treat the substance use disorder without addressing co-occurring conditions like anxiety disorders, eating disorders, trauma- and stressor-related disorders, clinical depression, etc., will not be successful and will result in an exacerbation of both the substance abuse and other mental health problems. Other problems should also be addressed, such as issues with relationships, one’s living situation, occupation, etc.
Moreover, there are numerous complementary therapies that can work in conjunction with medication management, therapy, and support group participation. The majority of these complementary therapies are not designed to be the only focus in the treatment; rather, they are designed to complement treatment. These can include interventions like exercise programs, yoga, meditation, music therapy, art therapy, etc. When they can be implemented in conjunction with other forms of treatment, they can be very useful.
Treatment for a substance use disorder is not considered to be a short-term process; it is considered a long-term intervention. The idea that someone can be “cured” of a substance use disorder has never been supported by evidence, and legitimate treatment providers never assume that anyone is fully cured of a substance abuse issue. This means that treatment for any substance use disorder, including Valium abuse, is long-term and requires that the person stay focused on the principles they learned in treatment throughout their lifetime. Many individuals maintain some form of participation in treatment, such as continuing to attend support groups, for decades in order to ensure they maintain recovery.