Classified as an anticonvulsant, muscle relaxant, sedative-hypnotic agent, and a Schedule IV Controlled Substance, Valium is one of the most common pharmaceutical drug names in the country. It’s also one of the most highly abused drugs, most frequently found sold on the illicit drug market.
What is Valium, how does it work, its addiction potential, and recovery from Valium abuse are some of the things covered in this article.
What is Valium?
Introduced into the pharmaceutical market in the year 1963 with the trade name Valium, Diazepam was the second successful drug from the benzodiazepine family. This class of pharmaceutical medications is known to suppress the central nervous system and its function in order to induce calming effects in the body.
Quickly becoming the most widely prescribed medicine in the US, over 2.3 billion pills of Valium were sold in one fiscal year during its peak period.
Diazepam, as Valium and other alternatives, is still one of the most heavily prescribed CNS depressant drugs by doctors today to treat conditions, such as generalized anxiety, anxiety disorders, and seizures. Due to its effectiveness for the treatment of such a vast variety of medical conditions, Valium is listed on WHO’s Essential Drug List as a core medicine.
Indications, Contraindications, and Precautions for Use
Diazepam is prescribed for a wide variety of medical concerns and disorders, including:
- Anxiety and anxiety disorders, such as generalized anxiety disorder, panic disorder, PTSD, obsessive-compulsive disorder, and acute anxiety
- Convulsive disorders
- As a muscle relaxant to treat spastic disorders and muscle spasms in cerebral palsy, paraplegia, and multiple sclerosis
- Restless legs syndrome
- Agitation or other related psychiatric conditions, such as Impulse control disorders, catatonia, psychotic illness
- Anesthetic before or during systemic or dental surgical procedures
- Status epilepticus
- Detoxification and management of withdrawal systems from alcohol and abuse of other substances
The use of Valium is strictly contraindicated to patients who struggle with respiratory conditions, have severe hepatic insufficiently, suffer from sleep apnea syndrome or acute narrow-angle glaucoma, and have a known hypersensitivity to Diazepam. Furthermore, this drug is not recommended for the treatment of pediatric patients under 6 months, and those suffering from clinical depression, in shock, and are comatose.
Due to the nature of the drug, Diazepam and other benzodiazepines in general are used very cautiously in patients suffering from renal insufficiency, myasthenia gravis, and Parkinson’s disease. A proven teratogenic, Diazepam is known to increase the risk of congenital abnormalities in fetuses and other developmental malformations. As such, they are not recommended for use by pregnant women or those of a childbearing age. For geriatrics, it’s suggested that the dosage should be approximately 50% of the average dose.
How Does Valium Work – The Pharmacokinetics and Neurochemistry
Valium is a benzodiazepine derivative, which is either colorless or light yellow and is found as a crystalline compound that is insoluble in water.
Pharmaceutically, Diazepam is available either as a tablet for oral administration or as an ingestible. It is generally available in three dosages, including 2mg, 5mg or 10mg, each indicating the amount of active ingredient, Diazepam, in the formulation.
Valium has sedative, amnesiac, and anxiolytic effects on the central nervous system, mediating these effects by facilitating the potency of GABA – an inhibitory neurotransmitter that reduces or inhibits the activity of excitable nerve cells in the brain.
When orally administered, it is directly absorbed into the plasma within 15 minutes to two hours. A fat-heavy meal will slow down the absorption process, increasing the lag time during administration and effectiveness. Diazepam and all of its residual metabolites are easily able to cross both the blood-brain and the placental barrier. Trace amounts will also be found in a postpartum of woman’s breast milk if she uses Valium while breastfeeding her child.
Valium is classified as a low potency, long half-life benzodiazepine drug – this means that while it does not take effect immediately, it remains in the system for a prolonged period. Though the typical half-life of this drug in a young, physically healthy adult is 24 hours, trace amounts may still be found in a user’s urine sample over 80 hours after its administration. In case there is a long-term drug dependency, Valium can be detected in regular urine scans for up to 6 weeks.
Diazepam inhibits the neuronal activity in all major regions of the CNS, allowing the depression of motor and muscle nerve function. As an anticonvulsant, it affects the electrical neurons by limiting their pathway, thereby diminishing the severity of a seizure or spasm.
Valium also has an inhibitory effect on another popular neurotransmitter, dopamine – the pleasure inducing chemical component of the brain. It minimizes the strength of dopamine, hence proving to be a valuable drug for the rehabilitative treatment of patients who abuse dopamine-inducing substances, such as nicotine and cocaine.
Drugs of Similar Potency
Other common drugs that produce similar effects as Valium include:
- Alprazolam, better known as Xanax
- Lorazepam or Ativan
- Temazepam, also known as Restoril
- Clonazepam or Klonopin
These drugs, though members of the same benzodiazepine family, differ in their potency, half-life, and effectiveness.
Reasons for Abuse and Valium Addiction Potential
Valium is said to be one of the most popularly abused prescription drugs. As a CNS depressant, it qualifies as a mood-altering substance. Its quick onset of action, potency, duration of action, purity, and the ability to cross the blood-brain barrier rapidly all contribute to its potential for abuse and addiction.
The fact that Valium rapidly interacts with other substances of abuse to facilitate their effects, as well as, to produce reinforced effects is another major reason why polydrug abusers and addicts prefer using it.
The long-term high dose use of drugs with a longer half-life results in decreased efficiency of the GABA receptors, leading to the ineffective inhibition of the CNS. This also factors into the tolerance development of this drug over time, leading to a Valium abuser craving for the similar reaction and eventually causing an addiction.
This tolerant effect is known to take place regardless of whether the drug is used as per prescription, or is illicitly abused, thus significantly raising its addiction potential. As the body becomes more tolerant to the drug, an increased dosage is required to attain the same effects. The abuse potential of Diazepam is further elevated due to its binding affinity and short half-life.
As such, according to the FDA, it is inadvisable for physicians to allow continued use of Valium after four months of continuous administration.
Drug-Interactions, Toxicity, and Overdose
Due to their facilitating and reinforcing effects, it is recommended that any and all drug interactions pertaining to Diazepam be strictly monitored by a physician.
For addiction and abuse purposes, especially by polydrug abusers, Diazepam is commonly used in conjunction with methadone and other opioids to enhance their euphoric effect. Cocaine addicts utilize the calming effects of Valium to combat the irritable side effects of its abuse, such as increased agitation and anxiety. This CNS depressant is also a common favorite of alcohol abusers, because it facilitates the alcoholic high and suppresses the unseemly withdrawal symptoms.
Other drugs which may be potentiated, or may potentiate the effects of Valium, include narcotics, antacids, hepatic enzyme inhibitors, analgesics, antidepressants, and sedative antihistamines. The recommended dose is no more than 4 times a day, usually with a combined dosage of not more than 40mg per day.
It is very difficult to overdose on Valium and singular use of this drug is rarely, if ever, fatal. However, the amount needed for over dosage varies from person to person. It largely depends on a person’s developed tolerance to the drug, the size and weight of the individual, and the amount of drug administered. High doses of Valium, as much as over 1500mg, in one day are unlikely to cause permanent damage, if they’re consumed on their own.
Some of the common signs and symptoms of a Valium overdose include the following:
- Increased drowsiness
- Bluish lips
- Extreme lethargy and lack of energy
- Double vision
- Uncoordinated movements
- Extreme difficulty in breathing
- Impaired vision
- Slurred speech
- Increased anxiety
The Road to Recovery from Valium Addiction
Recognizing Valium addiction largely depends on one’s ability to distinguish among abuse, addiction, and dependency.
Valium abuse can be loosely defined as the use of the drug in ways other than directed by the prescribing physician including taking in larger doses and with greater frequency as recommended. Valium addiction, on the other hand, is associated with the lack of control of behavior. Furthermore, it is associated with adopting an obsessive pattern in order to acquire the medication – almost like there is a compulsion to consume increased doses of the drug. It is also related to the onset of withdrawal symptoms when the abuser is deprived of it.
Valium dependency though cannot be mistaken for addiction. Due to the high tolerance of the drug, the physiological dependence does occur even in patients who do not abuse, or use it unless prescribed.
Signs of Diazepam Abuse
Some of the more prominent signs of Diazepam abuse and a possible Valium addiction are discussed below:
Drug Seeking Behavior
A person who actively seeks the drug and demands it with a greater frequency and in higher dosages than recommended displays a drug seeking behavior. This is indicative that the patient is developing or has developed a high tolerance for the medication, is abusing it, and is now spiraling towards an addiction.
Diazepam affects every aspect of the central nervous system. It causes a drastic decrease in the metabolism and psychomotor movement in the body. Some of the more common signs of Valium abuse include psychomotor retardation like muscle weakness, increased lethargy, slow reaction time, impaired muscle and motor coordination and movement, vertigo and ataxia.
Mental confusion, memory loss, increased incidences of forgetfulness, and induced anterograde amnesia are all signs of Diazepam abuse. The amnestic effects make it the preferred choice for doctors to prescribe as a pre-surgical medicine. However, due to these same effects, sexual predators use this drug to induce forgetfulness in their intended victims.
Diazepam, when taken in large doses, is known to cause a rise in paradoxical behavior in abusers. A Valium addict will behave in ways that they normally wouldn’t during sobriety. The CNS depressant diminishes inhibitions and can cause sudden episodes of increased aggression, impulsivity, excitement, and hostility. Patients have also reported to suffer from paranoia, nightmares, and consistent restlessness.
Withdrawal Symptoms and Duration
Because Valium lasts for a longer period in the body, the duration of the withdrawal symptoms is significantly longer as compared to other substances of abuse.
Patients who take as little as 10 to 12 mg of Valium per day for more than six months can start experiencing withdrawal symptoms. They can be divided into acute and long-term symptoms, and can occur for as long as four to six weeks, continuously.
The acute stage begins about one to four days after the administration of the last dose. The acute stage symptoms include a variety of psychological, physical, and neurological symptoms. Some of the common ones are:
- Acute headaches
- Severe nausea
- Stomach pain
- Muscle cramps
- Overall body tremors
- Increased sweating
- Numbness of the extremities
- Dry retching
- Heart palpations and increased heart rate
- Ringing in the ears
- Hypersensitivity to touch and taste
- Violent mood swings
- Panic attacks and rebound anxiety
The most violent of physical withdrawal symptoms are known to taper off after approximately one to two weeks of deprivation. The late withdrawal period can last for up to a few weeks, consisting of persisting psychological symptoms, such as insomnia, suicidal tendencies, anxiety, drug cravings, and consistent stress.
The recovery from a Valium addiction is a long-term, multi-step process that takes places over the course of a few days to several weeks. The complete treatment plan consists of the following steps:
- Inpatient addiction treatment
- Outpatient addiction treatment
As part of the recovery program, the screening process evaluates an individual’s habits to determine their addiction level. The detoxification process follows a medically monitored phase, during which the patient is carefully supervised for any extremely adverse reactions. Medications, such as Flumazenil – a benzodiazepine inhibitor – may be administered as an antidote against Valium addiction during this time. This ascertains that the withdrawal symptoms do not escalate and become life threatening.
After the detox period, the patient can choose to remain in an inpatient recovery program where they are continually supervised and monitored for the selected duration. They can also opt for an outpatient rehab treatment, which allows them to return home and communicate routinely with their physician as needed.