Valium (diazepam) is a drug that belongs to the class of drugs known as benzodiazepines. This is a large class of drugs that was developed to provide an alternative to another class that has similar mechanisms of actions and similar uses: barbiturates. Barbiturates were developed to treat issues with anxiety, for the control of seizures, to induce sleep, and for other clinical uses; however, these drugs were frequently abused, and their use resulted in significant physical dependence. Benzodiazepines were developed to treat the same issues but without the serious potential for abuse and physical dependence. Nonetheless, benzodiazepines are drugs that have moderate potential for abuse and for the development of physical dependence. The United States Drug Enforcement Agency (DEA) classifies benzodiazepines, including Valium, as Schedule IV substances, indicating that the substances do have potential for abuse and the development of physical dependence.
Valium became a very popular drug to treat anxiety. At one point, it was one of the most prescribed drugs in the world. Its prescription expanded beyond the treatment of anxiety to address normal issues with nervousness and worry that occur in individuals who did not have formal mental health disorders. Because these drugs are often prescribed by a psychiatrist and other physicians to individuals who are complaining of feeling anxious and who are not formally assessed for specific disorders, their prescription is questioned by many. Due to its high rate of prescription and availability, Valium became a significant drug of abuse, and other drugs such as Xanax (alprazolam) have replaced diazepam as the primary treatment for anxiety. This is because some of these drugs are much shorter-acting and believed to have less potential for abuse; although, again, this is questionable.
How Does Valium Work?
Benzodiazepines like Valium are classified as central nervous system depressants or as tranquilizers. Taking these drugs results in the availability of an inhibitory neurotransmitter increasing in the brain. The particular neurotransmitter that benzodiazepines affect is known as gamma-aminobutyric acid (GABA), the most abundant inhibitory neurotransmitter in the brain. This neurotransmitter is designed to modulate the function of the neurons in the brain and spinal cord (the central nervous system) by slowing down their firing rate; hence, the designation of these drugs as central nervous system depressants, because they slow down or depress the rate of activity in the central nervous system. The subjective effects of taking diazepam often include:
- Reduction in the subjective experience of stress or anxiety
- Reduction in the activity of all other physical symptoms (e.g., decreased breathing rate, decreased heart rate, decreased blood pressure, etc.)
- Decreases in reflexes, coordination, and the speed of thought
- Relaxation at lower doses; sedation or lethargy at higher doses
- A loss of behavioral inhibitions
As a result of these effects, individuals often have feelings of mild euphoria, general wellbeing, contentment, happiness, giddiness, etc. When Valium is taken at higher doses, the euphoria and sedation can be transformed into lethargy and extreme intoxication that is similar to the type of intoxication one sees with alcohol.
Different types of benzodiazepines produce their effects in different manners. Valium has effects that are long-acting, and the drug has a long half-life, meaning that it stays in the system for a relatively long time compared to some other benzodiazepines, such as Xanax. This is believed to increase the abuse potential of Valium compared to Xanax.
Who Abuses Diazepam?
It is not uncommon to hear or read that addiction to diazepam often begins when a person is prescribed the drug and then becomes addicted to it. However, the research findings and actual figures on the abuse of benzodiazepines, including Valium, suggest that this is not true. The abuse of a substance like diazepam is most often not associated with individuals who take the drug under the supervision of a physician and according to its prescribed instructions. These individuals may develop physical dependence on the drug if they use it for a period longer than 4-6 weeks; however, the development of physical dependence on any drug does not constitute addiction on its own.
The latest figures from the Substance Abuse and Mental Health Services Administration (SAMHSA) bear out the above findings. According to survey data by SAMHSA in 2015, it is estimated that nearly 30 million people in the United States used benzodiazepines, but only approximately 5.5 million of these individuals abused the drugs. Thus, the vast majority of individuals using benzodiazepines did not abuse them.
Drug abusers more commonly obtain the drug through illicit methods, use the drug for reasons other than its intended use, and experience stress or impairment as a result of this behavior. Thus, while it is true that a smaller proportion of individuals who are prescribed benzodiazepines may go on to abuse them, there are other factors that are associated with the risk to develop substance use disorders. This is not to infer that physicians should not be more judicious in their prescribing practices, as it is clear that they should; however, it should be understood that the majority of individuals who use benzodiazepines according to their prescribed purposes do not develop substance use disorders.
Finally, information from SAMHSA and the National Institute on Drug Abuse (NIDA) indicates that while abuse of benzodiazepines occurs across all ages, those 18-35 years old abuse the drugs most frequently. In addition, benzodiazepines are very often abused in conjunction with other drugs of abuse, such as narcotic pain medications, other benzodiazepines, alcohol (the most common co-occurring drug of abuse), stimulant medications, and cannabis products.
Diagnosis of a Substance Use Disorder
The American Psychiatric Association (APA) presents formal diagnostic criteria for the development of a substance use disorder. An individual with a substance use disorder as a result of abuse would be classified as having an anxiolytic use disorder (technically a sedative, hypnotic, or anxiolytic use disorder). This formal diagnosis would require the individual to satisfy at least two of a number of symptoms over a 12-month period. The formal diagnostic criteria will not be presented here as a substance use disorder can only be diagnosed by a licensed and trained mental health care clinician; however, the identification of a formal substance use disorder may result when the factors outlined below are present.
- The person is engaging in nonmedicinal use of a substance that leads to significant distress or impairment in their functioning.
- The person demonstrates a number of issues with controlling their use of the substance. These include:
- Repeatedly being unable to control the amount of the substance they use or the length of time they use it
- Continuing to use the substance even though it results in issues with work, in relationships, at school, or in other important areas of functioning
- Continuing to use a substance even though they realize that its use is resulting in physical or emotional damage
- Giving up important activities in order to continue to use the substance
- Wanting to stop or cut down on use but being unable to do so
- Repeatedly spending significant time using the substance, trying to get the substance, or recovering from its use
- Repeatedly experiencing cravings to use the substance
- Displaying tolerance for the substance
- Displaying withdrawal symptoms when cutting down on use of the substance
An individual need not demonstrate all of the above signs. They typically only need to demonstrate two of 11 formal diagnostic criteria in order to receive a formal diagnosis. Thus, displaying signs of physical dependence (both tolerance and withdrawal) is neither necessary, nor sufficient, to be diagnosed with a substance use disorder. The severity of the individual’s substance use disorder depends on the number of symptoms they express. Obviously, individuals expressing more diagnostic symptoms have more severe substance use issues.
Treatment for Valium Addiction
Substance use disorders represent severe manifestations of mental health disorders that very often do not remit without formal intervention; these disorders do not just “go away.” Individuals with substance use disorders do not often readily recognize the severity of their issues. They are often very reactive and opposed to attempts by others to point out these behaviors to them. In some cases, such as when individuals are required to get treatment via legal system, individuals can be mandated to get help. Other times, individuals with substance use disorders enter treatment for other co-occurring issues, such as depression or anxiety, or they have become convinced by others that their behavior is problematic.
Convincing someone with a substance use disorder that they are in need of help is not an easy task. It is strongly suggested that loved ones perform a formal intervention. Formal interventions often require the assistance of licensed professionals, such as substance abuse counselors, physicians, or professional interventionists. Loved ones can learn more about interventions via the Association of Intervention Specialists.
The treatment process for individuals with anxiolytic use disorders as a result of abuse of Valium or diazepam will follow a similar blueprint. These individuals will need to become involved in a formal physician-assisted withdrawal management program, often referred to as medical detox. Individuals who have used benzodiazepines for periods of more than four weeks may have developed physical dependence. The withdrawal process from benzodiazepines has the potential for the development of fatal complications (the development of seizures), and anyone discontinuing benzodiazepines should only do so under the supervision of a physician.
Medical detox is a targeted intervention to address withdrawal symptoms. For Valium withdrawal, the supervising physician would generally administer another benzodiazepine (or could administer Valium) on a tapering schedule. This requires that the medication is slowly reduced in its dosage over a specific period of time to allow the individual to wean off the drug. This tapering schedule reduces the potential for seizures, lessens the distressing withdrawal symptoms associated with the drug, and allows for the individual to adjust at their own pace.
Withdrawal management is only the first step in recovery from Valium abuse. Individuals require some type of formal therapy. Therapy is delivered by a licensed therapist who uses empirically validated principles to assist the client. It can be delivered in groups, on an individual basis, or as a combination of group and individual therapy. Substance use disorder therapy should be the main component of the recovery program.
Because many individuals who abuse Valium often have other co-occurring issues, such as depression or anxiety, it is important that these issues are also addressed at the same time. This requires the care of a multidisciplinary team.
An integral component of a successful recovery program is the length of time in treatment. Research continually demonstrates that remaining in treatment for longer periods of time is far more beneficial compared to short and intense therapies. Individuals in recovery from Valium abuse should continue some form of ongoing care for years after detox.