Valium is one of the best recognized drugs in the world and at one time was the best-selling drug in the United States. It is used to treat anxiety and anxiety disorders, treat withdrawal syndromes to other benzodiazepines and alcohol, manage seizures, treat restless leg syndrome, treat muscle spasms, and in the treatment of insomnia. Due to its high potential for abuse and addiction, it is no longer a first line choice in the treatment of anxiety, but still continues to be used for a number of treatment options.
Potential for Abuse and Addiction
Benzodiazepines like Valium are considered to have significant potential for the development of abuse and for the development of physical dependence. The United States Drug Enforcement Agency lists them as Schedule IV controlled substances, indicating that these can only be purchased legally with a prescription. Valium has an interesting history of being acknowledged as a drug that has a high level for abuse and dependence in both professional and lay circles. Benzodiazepines are notoriously culprits that contribute to polydrug abuse and addiction because many individuals will mix them with alcohol, narcotic pain medications, and other drugs to enhance the euphoric effect of other drugs, to get a different type of euphoric effect from combining unlike drugs, or to take the edge off the effects of certain stimulant medications such as cocaine.
Mixing benzodiazepines with other drugs is a serious situation, opening up the potential for adverse reactions to a mixture of drugs, polydrug addiction, and increasing the potential for overdose. Overdose fatalities from benzodiazepines in the United States have risen sharply between the years 2011 in 2014, indicating that benzodiazepine abuse is a growing health issue. To complicate the matter, Valium and other benzodiazepines will inevitably produce physical dependence in those who take them for a significant length of time.
This makes them particularly hard to stop using without professional help.
Physical Dependence and WithdrawalPhysical dependence refers to a condition that occurs with many drugs, consisting of tolerance to the drug and withdrawal symptoms when going without it. Simply stated, tolerance occurs when a person requires a higher dosage or more of a drug to achieve the same effects, therapeutic or otherwise, that had been achieved at lower doses previously. The development of tolerance is a common occurrence with many drugs that people take regularly for periods of more than a few weeks. When tolerance occurs in conjunction with withdrawal – a series of negative symptoms that occur when the person stops taking the drug or lowers the dose abruptly – the person has developed a physical dependence on the drug. Not every drug will produce withdrawal symptoms.
It is also important to note that even though physical dependence is considered to be a symptom of a substance use disorder (drug abuse or addiction), physical dependence on any drug is neither necessary nor sufficient to be diagnosed with a substance use disorder. Many individuals use drugs under the supervision of a physician for medicinal purposes for lengthy periods of time and develop a physical dependence on them; however, they do not abuse the drugs (use them for nonmedical reasons), and they technically do not qualify for a diagnosis of addiction (which is a syndrome of nonmedical drug use that leads to a number of dysfunctional consequences). Thus, an individual who is using Valium for seizure control under the supervision of a physician and uses it within the prescribed boundaries will inevitably develop physical dependence over time, but the individual would not be diagnosed with a Valium use disorder (addiction or abuse to Valium).
People who demonstrate withdrawal from Valium may or may not qualify for an abuse or addiction diagnosis; however, the withdraw process follows a relatively similar progression in most individuals, with some deviation due to individual differences. Withdrawal from benzodiazepines has been described in research literature based on the clinical observations of patients’ benzodiazepine addictions. The classic and most enduring model of Valium/benzodiazepine withdrawal is a stage model that includes two basic withdrawal stages. The stages are differentiated by the number and intensity of the symptoms and their length:
Acute stage: About 1-4 days following a person’s last use of Valium, the individual will begin to experience the effects of acute withdrawal. Valium has a variable half-life that can be as high as 48 hours, so for some individuals there may be no significant symptoms for a day or so, but by day 3-4, the person will begin to experience acute withdrawal symptoms. The determination of how soon after stopping Valium these symptoms will appear depends on how much and how often the person took Valium, the length of time Valium was abused, whether or not other drugs were also abused, and individual differences in metabolism and emotional and psychological stability. For instance, some individuals who are prone to anxiety and depression may begin to experience rebound anxiety (a return of the anxiety that was present before the person started taking the drug) after a relatively short period of not using Valium.
The symptoms of acute withdrawal will typically include some combination of:
- Physical symptoms that can include combinations of headaches, nausea, vomiting, stomach pains, cramps, and even tremors (most often, these tremors will occur in the hands)
- Cardiovascular symptoms that could be associated with rebound anxiety or just be part of the general withdrawal process (increased blood pressure, increased heart rate, and so forth)
- Neurological symptoms, such as confusion and the potential to develop seizures (the occurrence of seizures during the acute phase of withdrawal is a serious condition that can be potentially fatal and needs immediate medical attention)
- Psychological symptoms that can include cravings, mood swings, depression, panic attacks, and rebound anxiety
General withdrawal: After a period of 3-4 days of acute symptoms, the person will tend to experience a more lengthy withdrawal phase that will continue for 10-14 days in most cases. During this period, the person will experience increased cravings for Valium, lightheadedness, mild headache, mild fever, periods of nausea, potential chills, depression, and continuing bouts of anxiety. These symptoms will be significantly less intense than the acute symptoms. In general, the person will experience flulike symptoms, general feelings of dissatisfaction, and an overall sense of melancholy. In some individuals, there may be an additional period of rebound anxiety between 10 and 14 days.
Following the withdraw period, individuals will slowly stabilize but may still experience issues with anxiety and depression, and general feelings of being “out of sync.”
Certain references also refer to post-acute withdrawal syndrome, which is a longer period of more generalized psychological symptoms that may occur in some individuals following recovery from drug abuse. The symptoms are typically described as issues with mood, irritability, problems experiencing pleasure to the same extent that one was able to experience pleasure prior to drug abuse, and general feelings of dissatisfaction and variable motivation. Post-acute withdrawal syndrome has been characterized as a lengthy period that can last from weeks to years that requires ongoing treatment (mostly in the form of therapy); otherwise, it can lead to an increased potential for relapse. The syndrome is not universally accepted among addiction researchers and mental health workers.
Understanding the withdrawal process from Valium is important, because individuals who are going through withdrawal are at a higher risk for relapse. The sudden appearance of rebound anxiety and physical symptoms can be almost immediately countered if the individual begins to take Valium again. This makes it extremely difficult for individuals to discontinue Valium “cold turkey” on their own without professional assistance.
Medications to Assist in Withdrawal from ValiumValium is often used as a replacement medication to assist in withdrawal from other benzodiazepines. Individuals with a physical dependence to some other benzodiazepine would be administered Valium instead of that benzodiazepine and then the physician would slowly taper down the dosage to allow the person to adjust accordingly. Once the dosage reaches a certain level, the medication is discontinued altogether, and the individual has managed to negotiate the withdrawal phase without experiencing serious effects. Likewise, physicians can initiate a tapering strategy for Valium for people who have a physical dependence on Valium. This may be the most effective strategy to negotiate withdrawal from a physical dependence on Valium.
Other medications that might be used include the following:
- Selective serotonin reuptake inhibitors are antidepressant medications that have been shown to be useful in some instances in the withdrawal process from benzodiazepines and may be useful in addressing rebound anxiety.
- Melatonin is a hormone that can ease symptoms of anxiety and induce sleep in some cases and may also address tolerance and withdrawal symptoms.
- Anticonvulsant medications would be used in the event that an individual develops seizures. Some anticonvulsants also appear to be useful in addressing the overall symptoms experienced during withdrawal from Valium.
- The muscle relaxant baclofen (known by the brand names Kemstro, Gablofen, and Lioresal) has been demonstrated to reduce cravings for a number of different drugs of abuse, including benzodiazepines.
Other specific medications for nausea, headache, and so forth can be added at a physician’s discretion.