Diazepam, better known by its brand name Valium, is one of the most recognized of all drugs. Valium belongs to the benzodiazepine class of drugs. Benzodiazepines were developed as alternatives to the barbiturate drugs, which were commonly used for the treatment of anxiety, seizure control, as muscle relaxants, and as sleep inducers; however, barbiturates were considered to be highly addictive and potentially dangerous drugs of abuse. Benzodiazepines like Valium were developed for the treatment of the same issues but as alternative and potentially less addictive drugs.
Valium and other benzodiazepines are generally classified as Schedule IV controlled substances by the United States Drug Enforcement Administration (DEA). This means that these drugs have a moderate potential for abuse and the development of physical dependence. Benzodiazepines can only legally be obtained with a prescription from a physician.
Valium was once one of the most commonly prescribed drugs for anxiety; however, it became a significant drug of abuse, and other drugs, such as Xanax (alprazolam), are now more often prescribed, even though these drugs are also potential drugs of abuse. Valium and other benzodiazepines are commonly abused with other drugs, such as alcohol, other benzodiazepines, narcotic drugs, cannabis, and stimulants. The tendency for this class of drugs to be abused in combination with other drugs often results in very complicated and serious potential health and abuse issues.
In general, the initial effects of Valium include:
- Anxiety reduction
- Feelings of euphoria
- Loss of inhibitions
As individuals continue to use the drug, tolerance develops rapidly. Over time, individuals may develop withdrawal symptoms when they attempt to discontinue using the drug or cut down the dosage they have been taking. This results in the development of physical dependence.
The term detox refers to a normal process that occurs as a result of an individual metabolizing drugs and their system eliminating drugs and waste products. Even a person who is actively using Valium will continually undergo the natural process of detoxification, which is primarily a function of the liver. The World Health Organization, the American Society of Addiction Medicine, and other professional organizations have agreed to refer to the process of managing withdrawal symptoms from specific drugs as withdrawal management and use the terms detox or detoxification to refer to this natural bodily function.
Simply developing physical dependence on Valium is not necessarily a sign that a person has a substance use disorder. A person with a substance use disorder engages in the nonmedicinal use of drugs or alcohol, develops issues with controlling their use, and suffers a number of negative ramifications as a result of their use of these substances. People who use these drugs under the supervision of a physician and according to their prescribed purposes are not considered to have substance use disorders even if they developed physical dependence on the drugs. Because abuse of drugs like Valium is often associated with large doses of these drugs and polydrug abuse, the associated withdrawal process is often much more serious and complicated.
The withdrawal process from Valium is well researched. Early research investigating withdrawal from Valium indicated that the most common symptoms associated with withdrawal included:
- Loss of appetite
- Difficulty sleeping
- Muscle cramps
- Stomach cramps
Early research indicated that the withdrawal process from Valium and other benzodiazepines is very similar to withdrawal from moderate to severe chronic alcohol abuse. The onset of the symptoms would occur between one day and two weeks following discontinuation and could last anywhere from one week to several weeks. However, much of this early research was complicated by the tendency of individuals who abuse Valium to abuse other drugs like alcohol or have significant co-occurring psychological disorders.
Later research that was able to investigate the withdrawal process in individuals without any significant co-occurring psychological issues who abused only Valium indicated that symptoms typically peak within a few days after discontinuation, became less intense for one or two weeks, and then peaked again before subsiding. Most of the individuals in these studies were relatively symptom-free following five weeks of abstinence. This study indicated that symptoms that were common among almost all of the individuals withdrawing from Valium included:
- Issues with irritability, restlessness, and agitation
- Significantly reduced appetite and weight loss
- Sweating excessively
- Shakiness and tremors (typically postural tremors that occur when one is trying to hold a position without any resistance, such as holding the arms away from the body)
- Myoclonic jerks (jerky movements of the arms and legs muscles are contracting)
- Rebound anxiety (an anxious state that occurs when one discontinues drugs that are designed to control anxiety)
- In rare cases, seizures
The timeline for Valium withdrawal will vary depending on the individual. Factors, such as how much of the drug one typically used, how long they were using the drug, if they used the drug in combination with other substances, the typical way they abused the drug (taken orally, snorting, or injecting it), the person’s metabolism, and the person’s psychological makeup, can all affect the severity and length of the withdrawal syndrome from Valium.
Typically, the timeline for Valium withdrawal takes the following course:
- Days 1-5: The onset of withdrawal symptoms will typically occur within 24-96 hours after the person has stopped using the drug. The symptoms generally peak within a few days and can be a combination of any of the above symptoms as well as changes in heart rate, blood pressure, mood swings, depression, cravings, and cognitive issues, such as issues with attention and memory. In some cases, individuals may develop hallucinations. Seizures may also occur in this acute phase. The symptoms any individual will experience will vary, and some individuals may only experience a few of the above mentioned symptoms, whereas others may experience most or all of them.
- Days 6 and beyond: After 5-7 days, the individual will typically experience a lessening of symptoms, though they may continue to experience symptoms with nausea, anxiety, irritability, etc. Seizure potential remains. Typically, the individual will not experience any new symptoms following the first week of discontinuation unless they experience seizures. Seizures can occur at any time during withdrawal but appear to be more likely to occur early in the withdrawal process.It is not uncommon for individuals to experience very intense acute symptoms, a period of one or two weeks when the symptoms begin to subside, and then an exacerbation of symptoms for several days. The symptoms then will typically decrease in their intensity. The duration of withdrawal symptoms can be variable and will typically last from 10 days to several weeks.
Cravings to use Valium will occur intermittently over the entire course of the withdrawal process. In many cases, they will continue to resurface intermittently for months and even years following discontinuation.
Many sources continue to refer to post-acute withdrawal syndrome, or PAWS, as a manifestation of the withdrawal syndrome. PAWS can be quite long-lasting and often consists of mood swings, irritability, issues with motivation, depression, and cravings that increase the potential for an individual to relapse. The syndrome is believed to occur following withdrawal and may continue on an intermittent basis for months and even years following discontinuation of drugs like Valium.
Even though many individuals in recovery do experience issues with mood swings and cravings for months and even years following discontinuing their drug of choice, PAWS has never been formally identified as a manifestation of withdrawal, and the majority of professional organizations do not consider it to be part of the withdrawal syndrome. These emotional and cognitive issues are often related to more longstanding issues with adjustment and even with formal mental health issues as opposed to being a manifestation of the withdrawal process.
Comprehensive Detox Treatment for Valium Addiction
The potential to develop seizures as a result of the withdrawal process from Valium and other benzodiazepines represents a potentially fatal complication. Individuals suffering from seizures are at risk for serious neurological damage and even death. Because of this serious potential issue, it is strongly recommended that anyone attempting to discontinue Valium or any other benzodiazepine should discuss their plans and goals with an addiction medicine physician prior to doing so. Because it is impossible to predict with certainty that any person will or will not develop seizures as a result of withdrawing from benzodiazepines, it is also strongly recommended that individuals attempting to recover from abuse of these drugs become involved in a formal physician-assisted withdrawal management program. Being involved in an inpatient program is preferred as it allows for closer supervision, management of any issues much more quickly, and assists the person to better focus on recovery; however, in some cases, withdrawal management from Valium may be achieved as an outpatient.
The strategy used by addiction medicine physicians to control withdrawal symptoms from Valium is a tapering strategy. Physicians will typically administer a long-acting benzodiazepine or may even administer Valium to the person on a tapering schedule. The physician will closely monitor the recovering person’s symptoms and slowly taper down the dose of the drug at specific intervals to allow them to adjust to the declining levels of the drug. This will reduce the severity of any withdrawal symptoms and also reduce the risk of potentially fatal complications, such as seizures. A similar strategy is often used for individuals who are prescribed Valium and no longer need it to treat their anxiety or other issues, as many of these people also develop issues with physical dependence on the drug.
The physician can also use other medications to control any symptoms that do occur during detox, including cravings, anxiety, physical discomfort, etc. Some of these medications might include:
- Baclofen, a muscle relaxant that can be used to reduce cravings for alcohol or benzodiazepines
- Antidepressant medications, such as selective serotonin reuptake inhibitors, to reduce the intensity of withdrawal symptoms
- Melatonin, which can help with insomnia and other withdrawal symptoms
- Anticonvulsant medications to reduce any residual withdrawal symptoms
- Other medications for specific symptoms, such as headaches, nausea, etc.
Because every case is different, the supervising physician will follow a specific overall plan and then adjust the plan to fit the needs of the individual. However, simply going through detox is not sufficient treatment for recovery. The primary intervention is some form of substance use disorder therapy that helps the individual address their reasons for abusing substances, develop positive coping skills, understand how to avoid relapse in the future, and assist them in developing strong support from others in recovery, friends, and family members.
Individuals who simply go through the withdrawal process and do not seek any form of aftercare will relapse at rates that approach 100 percent. Instead, it is imperative that anyone with any type of substance use disorder seek out professional treatment and support in order to increase their chances of a successful recovery. Very often, individuals in recovery continue to engage in interventions, such as social support groups, for years following discontinuation of the drug.