Diazepam Addiction Explained
What Is Diazepam?
Diazepam is a benzodiazepine, a class of medication that depresses the central nervous system and has anxiolytic and hypnotic effects. It is also colloquially known as a tranquiliser, sleeping pill or sedative. (1) Diazepam used to be sold under the brand name Valium, but this is no longer available. The drug has a range of medical uses, but it also has a long history of being misused or abused.
In the United Kingdom, diazepam is used as a premedication and prescribed to people who are suffering from severe anxiety or insomnia. Due to the potential for users to develop a tolerance or substance abuse disorder, it is best reserved for single-use as opposed to continuous treatment. (2) Diazepam is also used to treat people who are suffering from acute alcohol withdrawal. It mimics the action of alcohol because it affects the same neurotransmitters but doesn’t leave the individual inebriated. (3)
Available Forms of Diazepam
Diazepam is available in a number of forms for different purposes:
- An emulsion for injection: As a premedication, for sedation prior to minor surgery, to control acute muscle spasm as a result of tetanus or poisoning, to control convulsions and to manage severe agitation or anxiety such as delirium tremens.
- Oral suspension: This raspberry-flavoured suspension can be used for adults or children. In the latter it can be used to treat night terrors or somnambulism, as a premedication, to control muscle spasms and in some cases, it may be used to control irritability and tension in cerebral spasticity. For adults, this form of medication can be used for the short-term treatment of debilitating anxiety or insomnia. It can also be used as a premedication, sedative or anticonvulsant, to control muscle spasms, to manage alcohol withdrawal symptoms and to treat specific cases of cerebral spasticity.
- Rectal solution/rectal tubes: This form of the drug is used for epileptic and febrile convulsions, to relieve muscle spasms, as a sedative for minor surgical or dental procedures and for the initial treatment of severe, disabling cases of agitation and anxiety.
- Tablets (2 milligrams, 5 milligrams, 10 milligrams): Diazepam in tablet form is used to treat disabling cases of anxiety or insomnia, cerebral palsy, muscle spasm, epilepsy and acute alcohol withdrawal and as a premedication for dentistry or minor surgery. (4)
Medical Uses of Diazepam
As such, it is an effective method for controlling muscle spasms and convulsions and easing illnesses in which tension in the body leads to pain or disability, such as epilepsy or cerebral palsy. Diazepam can be used to treat anxiety, but only for 2-4 weeks and in severe cases occurring alone or in conjunction with insomnia or psychotic, psychosomatic and organic illness. It can also be used to treat alcohol withdrawal because it has similar pharmacological actions to ethanol. Diazepam also causes the neurotransmitter GABA to be released and leads to depression of the central nervous system. Medical staff can administer the drug at tapering doses to ease the symptoms of a patient diagnosed with alcoholism who is going through a medically assisted withdrawal. (5)
Legal Status (UK)
Diazepam is a controlled substance in the United Kingdom, which means it cannot be legally obtained without a prescription. The medication is subject to be categorised in two ways. Firstly, by drug class — there are three classes in the United Kingdom: A, B and C. While benzodiazepines are Class C, it is still illegal to give, sell or possess them in a nonmedical context. The maximum punishment for possession is two years, with the penalty for dealing set at 14 years. (6)
Secondly, controlled substances are put into five schedules that dictate who can import, export, manufacture, supply and possess them. Each of the five levels also requires a specific level of record-keeping that must be adhered to in order to minimise misuse or abuse. Diazepam is a schedule four, drug which means it is the same category as steroids, non-benzodiazepine hypnotics and somatropin. (7)
Routes of Administration
The drug can be administered orally as a solution or a tablet. It can also be administered rectally in the form of a suppository, and medical practitioners can give the drug as an injection.
Pharmacological Actions of Diazepam
Diazepam is a benzodiazepine. These types of medications work by depressing the reticular activating system, a component of the central nervous system. The reticular system is responsible for regulating how active the brain is. The majority of effects the drug causes are as a result of it being an agonist of GABA. This is the neurotransmitter that slows down the transmission of the nerve signals relating to rational thought, memory, emotions and essential functions such as breathing.
The main effects of diazepam are muscle relaxation, sedation and reduced anxiety. (2) As well as being a drug of abuse, individuals can use diazepam in conjunction with other substances to amplify or dull their effects. When taken with alcohol, which is also an agonist of GABA in the central nervous system, it causes extreme relaxation and sedation. When taken after the use of illegal stimulants, it can ease symptoms from the ‘comedown’ such as insomnia and agitation. (8)
Using this drug concurrently with any other substance is extremely dangerous, and anyone who does this or has a loved one who does this should seek help immediately. Likewise, anyone who uses diazepam in any way other than it was medically intended should seek urgent medical attention. The drug is highly addictive and can be very difficult to stop taking. This is because the body quickly develops a tolerance and comes to rely on its chemical effects on the brain.
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Chemical formula – C16H13ClN2O
The full IUPAC name of diazepam is 7-chloro-1-methyl-5-phenyl-3H-1,4-benzodiazepin-2-one. It is a slightly yellow, crystalline powder with practically no odour. It potentiates the activity of GABA by binding to receptors located in the limbic system and hypothalamus. This enables the flow of chloride ions into the neurons and leads to a decrease in neural excitability.
Diazepam Brand and Other Names
The most well-known brand name for diazepam is Valium; however, it is no longer available in the United Kingdom under this moniker. It is available as Diazemuls, Stesolid Rectal Tubes, Diazepam Destin and Diazepam Rectubes. (9)
There are a number of street names for diazepam. These include:
Diazepam Addiction and How It Develops
Diazepam addiction can develop even in those who are using the drug as prescribed by their doctor. One of the main reasons the drug is thought to be so addictive is how quickly the body develops a tolerance to it. Addiction can develop as the body becomes used to a dose of the medication and more is required in order to achieve the same effect. This is the main reason why the drug is very rarely prescribed for more than two to four weeks.
A period of time longer than four weeks can lead to dependence because the body starts to rely on the chemical effects it has on the brain. In the case of diazepam, this is the effect of increased GABA. Upon immediate cessation of the drug, severe depletion of this neurotransmitter occurs, leaving the individual in the opposite state to that brought on by diazepam.
Additionally, chronic use of benzodiazepines is thought to deplete dopamine, serotonin, norepinephrine and acetylcholine. The careful balance of these neurotransmitters is integral in maintaining neuronal network equilibrium. Hence, slowly tapering an individual off these drugs is important to prevent severe withdrawal symptoms. (10)
How Addictive Is Diazepam?
Benzodiazepines were first developed in the 1930s, but it was two decades until they were made available to the public. (11) The first one on the market was Librium (chlordiazepoxide) in 1960, closely followed by Valium (diazepam) in 1966. Prior to their introduction, opiates and barbiturates had been the medication of choice for treating anxiety. Throughout the 1960s and 1970s, the drugs were widely prescribed and treated as wonder drugs.
Medical professionals perceived that they were less toxic than previous drugs and didn’t cause respiratory depression as barbiturates did. It was also mistakenly thought that they were less addictive. It wasn’t until the 1980s when the action benzodiazepines take on the neurotransmitter GABA was discovered. The addictive potential had been grossly underestimated, and stricter regulations were imposed on doctors and pharmacies. (12)
Provided the user is taking the drug exactly as prescribed by the doctor, they shouldn’t develop an addiction. However, tapering off the drug slowly even after a short period of use may be necessary. If an individual is taking more than they were prescribed, seems preoccupied with obtaining the drug or is taking the drug without a prescription, detoxification should be sought as soon as possible.
Causes & Risk Factors of Diazepam Addiction
There are several risk factors that drastically increase the likelihood of an individual developing an addiction to benzodiazepines. It is widely accepted that excessive or long-term use of the medication leads to tolerance. This tolerance necessitates the user taking more and more of the substance in order to obtain the same effect. (13) It is for this reason that diazepam is not recommended to be prescribed for more than four weeks.
Another major risk factor in developing an addiction to diazepam is a previous problem with substance abuse. This is thought to be partially due to the way the medication interacts with other drugs. It can counteract the effects of stimulants and increase the effects of central nervous system depressants such as alcohol or opiates.
Low household income and low levels of education were also risk factors for using benzodiazepines excessively. (13) Conversely, a negative association between homelessness, older age and daily use of crack cocaine and excessive use of benzodiazepines has been found. (14) Evidence shows that women are more likely than men abuse to prescription medication and men are more likely to obtain the drug illicitly. (15)
Common Drug Combinations
Co-Occurring Disorders with Diazepam Use
There are often underlying issues that cause a person to develop a substance abuse disorder. The correlation between depression and the misuse of substances has been widely documented. It has been proven that only identifying one half of a comorbid disorder can lead to an inaccurate diagnosis, poor medication adherence and worsened clinical course. (18)
Anxiety is one of the most commonly found co-occurring disorders associated with benzodiazepine abuse. Diazepam causes an influx of the neurotransmitter GABA to be released in the brain. This causes sensations of well-being, relaxation and, in high doses, euphoria. The relief felt can be too tempting for someone who has access to the drug to resist. It is recommended that the anxiety is medically addressed in order to stop the drive the individual feels to use the substance.
Signs, Symptoms and Effects of Diazepam Addiction
- Hypotension (low blood pressure)
- Slurred speech
- Blurred vision
- Difficulty urinating
- Depressed or irritable mood
- Severe anxiety
- Inability to sleep
- Muscle cramps
- Extreme sensitivity to light
- Slowed breathing
- Reduced heart rate
- Ataxia (impaired muscle coordination)
- Impaired reflexes
Impact of Diazepam Abuse on the Brain
People often underestimate the potency of drugs like diazepam because they are prescribed by doctors. Benzodiazepines have a profound impact on the brain because they affect its main inhibitory neurotransmitter. When a user takes the drug, their brain is flooded with GABA, which inhibits brain activity. This fast-track route to pleasure also causes surges in dopamine. These peaks and troughs in dopamine production in the brain lead to cravings and withdrawal symptoms. (19)
There has been speculation that long-term use of benzodiazepines can cause shrinkage of the brain, similar to long-term alcoholism. According to one controversial study, many long-term users have experienced psychological, physical and cognitive problems as a result of using the drug. (20) Abusing medications such as diazepam can be just as devastating and destructive as abusing illicit substances.
Long-term diazepam abuse effects
- Memory problems
- Rebound symptoms
Diazepam Overdose Explained
The risk of overdosing on diazepam alone would require a high dose of the drug. However, when combined with another central nervous system/respiratory depressant such as alcohol or opiates, the risk becomes very high and the dose would only need to be relatively low. Older people, who often take more than one medication, are at a particularly high risk of overdose. (21)
Misuse of this type of medication is particularly dangerous because it can escalate rapidly. Some people may not even realise they have started abusing the drug. An overdose is highly unlikely to occur in an individual who hasn’t been abusing the drug. Taking more than prescribed, continuing to take the medication after the recommended course and taking the drug without a prescription are all methods of abuse.
There are several signs and symptoms that may indicate an overdose on diazepam:
- Abnormal breathing
- Drowsiness (if an overdose is suspected, ensure the individual stays awake)
- Poor fine motor control
- Slurred speech
- Uncontrollable eye movements
Teen Diazepam Abuse
Young age is a risk factor in developing a substance abuse disorder. (22) Some estimates put the price of street diazepam as low as £1 per tablet. (23) While drug abuse is prolific among some groups of adolescents, young people may not have the same level of access to drug dealers. However, with the influence of the Internet, and particularly the dark web, youths now have unrivalled access to illicit substances of all kinds.
Signs and symptoms of withdrawal
Drug withdrawal symptoms can occur in anyone who has used diazepam for more than a couple of weeks. There are several signs to look out for when assessing whether someone is displaying symptoms conducive to withdrawal. It is important to establish the extent of their problem and seek medical assistance with detoxification and potentially drug rehabilitation if necessary.
Some of the main features to be aware of include:
- Tense muscles
- Muscle cramps
- Anxiety, insomnia and panic
Overcoming Diazepam Addiction
With the correct treatment, overcoming an addiction to benzodiazepines can be done. It is a process that takes more than a few weeks and requires hard work from the individual. Usually, detoxification followed by a combination of therapy and medically assisted treatment are the best first steps to recovery.
Diazepam Withdrawal and Detox
The thought of detox in a clinical environment can be intimidating for some people. There is a common misconception that people who go to rehab are simply given replacement drugs and sent home. This is not the case. First, the individual spends approximately 10 days ridding the body of the drug. This usually involves giving a different benzodiazepine at doses high enough to curb withdrawal but low enough that no euphoric effects are felt.
For some people, detoxification may be all that is needed — this is often the case in process addictions that haven’t developed as a result of a mental health problem. Most of the time, however, it is recommended that an individual follows up with inpatient or outpatient rehab. During inpatient rehab, the service user is entirely immersed in a clinical setting and has no access to triggers at home or the temptation of obtaining drugs.
Early withdrawal stage
While withdrawal from benzodiazepines affects each person differently, the withdrawal process can be split into three stages. The first stage can take from 24-72 hours to onset, although this may be delayed in heavy users due to the long-lasting action diazepam takes on the system. The early signs of withdrawal are characterised by anxiety and restlessness. These feelings may swing between being mild and intense and can be highly distressing.
Acute withdrawal stage
Withdrawal symptoms usually peak around the second week of stopping diazepam. The physical and psychological symptoms are amplified and can include nausea, vomiting, sweating, muscle spasms and insomnia. It is during this time that the individual is usually most tempted to stop the discomfort and pain caused by stopping. Detox in a clinical setting can help to ensure that these negative feelings are minimised and sufficient distractions are provided to help the service user.
Late withdrawal symptoms
The acute stage can last for up to four weeks, but people usually find the symptoms become milder around the fourth week. Without medical treatment, these negative effects can go on for several months. If an individual tries to undergo the process on their own, without medical assistance, they may find themselves stuck in a cycle of relapsing. This is where they try to come off the drug, then start taking it again when the withdrawal symptoms become too much and repeat.
A clinical setting can provide the necessary support and resources to stop the cycle for good. Some users have reported the episodic return of severe withdrawal symptoms several months and even years after cessation of the drug.
Diazepam Addiction Treatment Medications
Some people are offered diazepam in gradually reduced doses in order to help them stop taking the drug. Immediate cessation of diazepam after long-term use can be extremely dangerous. The brain becomes dependent on the medication to produce the neurotransmitter, GABA. If the substance is no longer taken, the body is temporarily unable to produce GABA itself and therefore unable to regulate activity in the brain.
Therapy for Diazepam Addiction
It is extremely important that anyone who is suffering from an addiction to diazepam seeks medical attention. The physical symptoms need to be dealt with through detoxification, and the psychological symptoms should also be addressed. During therapy, the individual and the therapist work together to devise healthy new coping strategies. They also learn how to cope with cravings and thrive in everyday life without drugs.
There are several different angles that doctors take to address addiction, and some methods that work for one person may not work for another. Often, therapy focuses on exploring why the individual has feelings that have led them to substance dependence. The therapist then helps them understand how they have developed certain thought patterns and behaviours. As well as exploring why someone feels a certain way, modern therapy addresses actively making changes.
Dialectical behavioural therapy (DBT)
DBT is an extension of cognitive behavioural therapy (CBT) that was originally developed to treat borderline personality disorder. It has been found to be a useful method for treating people who are suffering from benzodiazepine addiction. Like CBT, it aims to determine the root causes of the negative thought processes that lead to harmful behaviour. Its emphasis is on how equilibrium can be found in opposing forces.
The main goal of DBT is to teach the individual that they can accept who they are whilst also seeking to improve.
Traditional 12-step programmes
Traditional 12-step programmes are widely used and known to be one of the most effective treatments for alcoholism. Diazepam and alcohol have similar pharmacological effects. The programme was developed in the 1930s as an alternative to prison for people who needed to get sober. A mixture of group therapy and self-acceptance in conjunction with surrendering to a higher power and regarding the 12 rules can help give meaning to the lives of those affected by addiction.
Family therapy can be particularly effective for adolescents who are experiencing problems with addiction. Often, subtle changes in the home environment and a synergic approach to addressing the problem can be developed during family therapy. Some triggers may be caused by issues that can be difficult to see without the help of a professional therapist.
Behaviour modification and realignment
Behaviour modification therapy is a more traditional approach with its roots in classical conditioning. In this type of therapy, the client is given positive reinforcement in the form of rewards. These rewards can be material goods such as vouchers or cash, and the therapist ensures they are using praise and helping the service user to focus on their positive traits. (26)
Other Kinds of Intervention
There are several types of intervention that can be effective when dealing with a person who is addicted to diazepam. While a mixture of medically assisted treatment and therapy is recommended, there are other ways to battle the problem. Holistic therapies incorporating techniques such as meditation, yoga and mindfulness can be helpful as a treatment for benzodiazepine addiction.
Some types of intervention are more indirect, helping the drug user to change their environment to make it less conducive to a drug-taking lifestyle. Intervention may need to be forced in the case that an individual won’t accept help and has been repeatedly resisting treatment.
Diazepam Addiction Facts and Statistics
- In Scotland, there has been a drastic increase in the availability of street Valium. Some of these tablets are sold as diazepam but are in fact even more dangerous benzodiazepines such as etizolam. (27)
- One study found that overall, benzodiazepines were present in 57% of drug-related deaths in Scotland in 2018. (28)
- Valium can be obtained for as little as £1 per pill, making the drug accessible to literally any age group in vast quantities.
- In Northern Ireland, drug-related deaths have risen by 98% between 2007 and 2017.
- There were 54 deaths involving diazepam in Northern Ireland in 2017.
- There were 136 drug-related deaths in Northern Ireland in 2017, meaning that diazepam was found in the body of 40% of all people whose death was recorded as drug-related. (29)
- The number of deaths related to diazepam in the United Kingdom peaked in 2016 at 285. In 2017 this fell to 226, the lowest it has been since 2012.
- The number of deaths related to diazepam in the United Kingdom has more than quadrupled since records began in 1993. (30)
- The market for benzodiazepines is expected to reach $3.8 billion in the United States by 2020. (31)
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The idea of starting the process of detoxification and rehabilitation can be daunting and fraught with conflicting information. Anyone who is suffering from a medical issue such as addiction should make it their priority to seek professional advice. Advice from an expert is the most valuable resource, and people do not have to live with their addictions. As much support as is required is given to anyone who decides to take part in a rehabilitation course.
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It is important that someone who is suffering from addiction (or who has a loved one who is) faces up to the reality of the situation and seeks help. Please call UKAT now on 0800 511 8111 to find out how we can help navigate through the journey to recovery. An individual plan is devised for each person that takes into account their unique needs and addresses how to prevent reoccurrence.
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