Librium (chlordiazepoxide) is a benzodiazepine. Benzodiazepines are primarily used for anxiety management, seizure control, sleep inducement, and muscle relaxation, though they have other secondary uses. Librium was the very first benzodiazepine to be developed, and it has been used in the treatment of anxiety disorders, the control of seizures, and in the management of withdrawal symptoms from alcohol and other benzodiazepines.
Benzodiazepines are all considered to be drugs that contain significant risks for abuse and the development of physical and psychological dependence by the United States Drug Enforcement Administration (classified as Schedule IV controlled substances). In terms of their abuse, benzodiazepines like Librium are very often abused in combination with other drugs, such as alcohol, other benzodiazepines, opiate drugs like OxyContin and heroin, and stimulants like cocaine. An anxiolytic use disorder is a substance use disorder to drugs which are primarily used in the medicinal treatment of anxiety and anxiety disorders.
Effects of Taking Librium
According to academic texts, such as Stahl’s Essential Psychopharmacology and other sources, the immediate effects of Librium include sedation, a reduction in anxiety, a reduction in the subjective perception of stress, drowsiness or sleepiness, a sense of euphoria, a sense of relaxation, and a sense of wellbeing.
Benzodiazepines like Librium affect the neurotransmitter GABA (short for gamma-aminobutyric acid). GABA is the major inhibitory neurotransmitter in the central nervous system (the brain and spinal cord). Inhibitory neurotransmitters dampen or slow down the activity of the neurons in the brain and spinal cord. This is why these drugs have medicinal uses in the control of anxiety and seizures, as sleep inducers, as muscle relaxants, etc., because they have a calming or sedating effect on the functions of the brain and spinal cord.
The calming and sedating effect can be perceived as euphoric, and benzodiazepines also facilitate the release of the neurotransmitter dopamine, which is involved in the experience of pleasure and reward. Thus, benzodiazepines have the effect of being reinforcing when taken because they make individuals feel relaxed and comfortable, and provide euphoria associated with being rewarded for taking them. Individuals who abuse these drugs are often motivated to take them in increasingly larger doses because tolerance to them develops rapidly, and the drugs have the potential for the development of a withdrawal syndrome.
A withdrawal syndrome occurs when the person’s system has adjusted its functioning to be consistent with the presence of the drug in its tissues. When the levels of the drug drop due to normal metabolic functions (a process known as detoxification that occurs primarily through the liver), the person’s system is thrown out of balance, and they experience a number of ill effects. Individuals who abuse Librium and other benzodiazepines find themselves repeatedly taking the drug once they begin to perceive that they are going through withdrawal, due to minor headaches, irritability, nervousness, nausea, etc. This behavior of using a drug to avoid negative consequences is known as negative reinforcement, and it is a very powerful behavior observed in individuals with substance use disorders to drugs that produce physical dependence. This behavior is very hard to reverse unless the individual is extremely motivated and can receive assistance. Withdrawal from benzodiazepines can also produce a number of ill effects that can include potentially fatal delirium and seizures.
There are some typical signs and symptoms that might indicate an individual is abusing Librium. While only a licensed mental health professional can make a formal diagnosis of a substance use disorder, some of the signs that may indicate that an individual needs to be assessed for potential substance abuse include the following:
- Repeated obtaining Librium illegally
- Repeatedly using Librium for its psychoactive effects and/or in combination with other drugs
- Having a prescription for the drug but using it in manners inconsistent with the instructions on the prescription
- Doctor shopping to obtain more Librium
- Finding empty prescription drug containers in the individual’s clothes, room, car, etc.
- Appearing drowsy or lethargic during the day (e.g., slurred words, falling asleep in public places, moving very slowly, appearing to be intoxicated without the smell of alcohol, etc.)
- Continuing to use the drug despite negative effects on life, career, family, etc.
- Craving for Librium
- Experiencing withdrawal symptoms when going without the drug
A person who exhibits two or more of the above symptoms may be developing or have a substance use disorder. Individuals with substance use disorders need formal treatment.
Treatment Options for Librium Abuse
There are a number of treatment options for Librium abuse. Medical detox is required for Librium withdrawal. This is important because the withdrawal process from benzodiazepines has potentially fatal consequences for some individuals, and there is no way to determine who may develop delirium, hallucinations, and seizures when withdrawing from the drug. Anyone who abuses benzodiazepines should consult with a physician before attempting to discontinue use.
According to professional sources like the American Society of Addiction Medicine, treatment options include the following:
- Inpatient treatment: In an inpatient treatment program, the person remains at the treatment facility 24 hours a day for the duration of treatment. Inpatient treatment is particularly useful for individuals undergoing withdrawal management from benzodiazepines and is also advantageous for individuals who have a number of potential high risk factors for relapse during the initial recovery phase. Individuals who live in homes or areas with high rates of drug abuse, have a peer group that abuses drugs, who are in abusive relationships, or have other toxic environmental factors may wish to initially begin their treatment in an inpatient unit to isolate themselves from conditions that increase the probability of relapse. Those who have attempted rehab before and relapsed as well as those with co-occurring medical or mental health disorders should also likely opt for inpatient care.
- Outpatient treatment: Most individuals will engage in outpatient treatment for the bulk of their recovery. Even individuals who initially choose inpatient treatment will not remain in an inpatient unit for the entire duration of their recovery. Inpatient treatment programs are time-limited, and withdrawal management programs are typically terminated once the withdrawal process is under control or completed. Many individuals can choose to use outpatient treatment programs for the entire duration of their treatment. Inpatient and outpatient treatment programs have specific advantages; however, both are effective.
- Therapy: Substance use disorder therapy should focus on the issues that drove the substance use, the development of positive thinking and coping abilities, stress management, the prevention of relapse, and psychoeducation. Therapy can be performed on an individual or group basis.
Individual therapy has the advantage of being focused, tailored to the specific needs of the individual, private, and allows the individual to disclose most information without fear that it will be released to others. Group therapy has the advantage of allowing the person to learn from others, develop important peer relationships, and get different points of view. It is often less expensive than individual therapy.
- Social support groups: These are not formal therapy groups in that they are not run by professional, licensed, trained therapists. Instead, these groups are run by other individuals with the same or similar presenting problems, such as a substance use disorder. Twelve-Step groups are examples of social support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous, etc.). Other social support groups include community-centered support groups, sober living homes, and even private groups that likeminded individuals form on their own. These groups are ongoing, offer positive social support, and often have their own structured programs of recovery.
- Treatment for co-occurring disorders: This is necessary when a substance use disorder and an additional psychological disorder co-occur.
- Additional activities: Other activities that are not necessarily “therapy” can complement one’s recovery. Meditation, exercise programs, yoga, and volunteer work can be very productive and foster recovery.
There are a number of treatment options that a person can become involved in to address abuse of Librium. The most important thing is that the person in treatment remains committed to their recovery and views any setbacks that occur as learning experiences and opportunities to move forward.