Librium (chlordiazepoxide) is a benzodiazepine drug used primarily in the treatment of anxiety, the control of seizures, and for withdrawal from alcohol and other benzodiazepines.

Librium was developed by chemist Leo Sternbach (quite accidentally) in the 1950s and became available in the United States in 1960. The processing and marketing of Librium marked the beginning of the development of benzodiazepines, drugs that are commonly used to treat anxiety, seizures, insomnia, and withdrawal symptoms for alcohol and other drugs; as preanesthetic drugs; and as muscle relaxants. The benzodiazepine class includes a number of familiar drugs, such as Xanax, Valium, Klonopin, and Ativan, and remains one of the most prescribed classes of drugs.

Benzodiazepines are sedatives or central nervous system depressants that slow down the functioning of the central nervous system (the brain and spinal cord). Librium is classified as a Schedule IV controlled substance by the United States Drug Enforcement Administration, indicating that it does have medicinal uses but also carries a significant potential for abuse and the development of physical and/or psychological dependence.

Librium has a longer half-life (5-30 hours) and therefore is most useful as a treatment for anxiety disorders, seizures, and for withdrawal syndrome for alcohol and other benzodiazepines. The use of benzodiazepines for the treatment of anxiety disorders should be accompanied with therapy to teach the individual coping skills to better control their anxiety. Long-term use of benzodiazepines alone in the treatment of anxiety disorders will often result in the development of physical dependence on these drugs (the development of both tolerance and withdrawal).

In the 1960s, it was recognized that benzodiazepines had important medicinal uses; however, like the drugs they were intended to replace (barbiturates), they were also habit-forming and prone to abuse. More recent research findings have suggested that benzodiazepines have a high abuse potential because, like other drugs of abuse, they also produce a surge in levels of dopamine, which is associated with the experiences of reinforcement and reward. This effect on dopamine results in feelings of wellbeing, euphoria, and the desire to take more of the drug.

Effects of Librium

 

The effects of Librium include:

  • Reduction in anxiety
  • Sedation
  • Drowsiness
  • Decreased reflexes
  • Loss of muscle coordination
  • Slowed thinking processes


 

Other side effects include:

  • Nausea
  • Vomiting
  • Constipation
  • Fluid retention
  • Rash
  • Decreased sex drive
  • Weight gain
  • Yellowish skin
  • Confusion
  • Memory problems
  • Liver damage
  • Development of physical dependence

Abuse of Librium

 

As mentioned above, it has long been recognized that Librium has a potential for abuse. The American Psychiatric Association lists formal diagnostic criteria for substance use disorders. Diagnostic criteria should only be used by licensed mental health professionals; however, there are some specific signs associated with Librium addiction that one can be on the lookout for.

The signs include:

  • Drowsiness
  • Slurred speech
  • Issues recalling new information
  • Reduced reflexes and reaction times
  • Empty bottles of Librium
  • “Doctor shopping” to get more Librium
  • Mood swings, such as being very pleasant followed by periods of depression, anxiety, irritability, restlessness, or agitation
  • Spending a significant amount of time trying to get Librium, using it, or recovering from its use
  • Mixing Librium with other drugs, such as alcohol, painkillers, or stimulants
  • Isolation
  • Cravings for the drug
  • Deleterious effects as a result of Librium use, such as issues at work, in personal relationships, at school, with the law, with finances, etc.
  • Continued use despite negative effects
  • Using Librium when it is dangerous to do so, such as when driving, mixing it with alcohol or other drugs, using it at work, etc.
  • Defensiveness regarding use
  • Lying about use
  • Making numerous attempts to cut down or even quit using Librium but being unable to do so
  • Needing more Librium to achieve the effects that were once experienced at lower doses (tolerance)
  • Flulike symptoms, mood swings, intense cravings, irritability, or other withdrawal symptoms when without Librium

Any individual who consistently displays two or more of these above signs may have an issue with Librium abuse. Benzodiazepines like Librium are frequently associated with polysubstance abuse and addiction and also often implicated in situations where individuals overdose on other drugs, such as opiate medications or combinations of alcohol and drugs.

Because there is a significant potential that an individual who has a substance use disorder as a result of Librium abuse has developed physical dependence on the drug, medical detox is needed. The withdrawal process from benzodiazepines can be potentially fatal due to the development of delirium and seizures. Individuals who have anxiolytic use disorders (abuse or addiction to benzodiazepines or other anxiety-reducing drugs, such as barbiturates) should initially be placed in a physician-supervised withdrawal management program to avoid this potential issue.

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Helping Someone with a Substance Use Disorder

 

It can be quite disturbing to observe a loved one living with a substance use disorder and act as if nothing is wrong, their substance use is totally functional, or that it is not problematic. Individuals with substance use disorders often develop a system of rationalizations along with a narrowed focus that is very subjective in order to justify their behavior. While it may appear from the outside that the individual is acting in an insane manner, the individual does experience some of subjective positive effects as a result of their substance use that drives their disorder.

The key to helping someone with a substance use disorder is to open up their viewpoint such that they realize that the negative aspects of their substance abuse outweigh whatever positive effects think they are experiencing. Thus, approaching an individual with an accusatory or argumentative attitude will simply produce resistance and most often will be fruitless. There are some general guidelines to consider when approaching someone with a substance use disorder, such as Librium addiction:

  • Never attempt to discuss the issue with the person when they are under the influence of the drug, no matter how ridiculous they may be acting or how serious the issue may be. Individuals intoxicated by benzodiazepines like Librium will not display good judgment or reasoning abilities. If there is some kind of emergency or other issue, do what needs to be done to control the situation and make everyone safe, but do not attempt to discuss an individual’s substance abuse with them while they are intoxicated. Instead, one of the best times to approach an individual with a substance use disorder is when they are recovering from use of the drug (heavy benzodiazepine use often results in hangovers). At these times, these people tend to be a bit more open to suggestions.
  • Often, it is very helpful to discuss your concern with a licensed mental health professional who specializes in the treatment of addiction or substance abuse, a former addict who is involved in recovery, or a social support group for individuals who are relatives of people with substance use disorders such Al-Anon. Groups like Alcoholics Anonymous or Narcotics Anonymous also have members who may be willing to listen and offer advice.
  • When you approach the person, treat them with respect and be open. Point out factual instances that are associated with the person’s substance use and explain how these have affected you.
  • Consider staging a formal intervention. If you take this route, be sure to include a professional interventionist or professional mental health worker who treats individuals with substance use disorders.

It is important to remember that individuals who abuse benzodiazepines, such as Librium, are at risk to develop significant physical dependence on the drug. The withdrawal process associated with benzodiazepines can be potentially serious and even fatal. Before anyone who has abused Librium for a significant length of time attempts to stop using the drug, they should consult with a physician who is trained in addiction medicine. This cannot be stressed strongly enough. Most of these individuals will need to be placed on withdrawal management programs initially.

Simply going through the withdrawal management process alone does not qualify as substance use disorder treatment. Detox on its own without subsequent addiction treatment is almost assuredly doomed to failure, as relapse rates for individuals who do not get involved in formal treatment are nearly 100 percent.