Valium (diazepam) was the second benzodiazepine drug developed (after Librium) in the early 1960s.1 Its use is indicated for the relief of short-term anxiety and panic, epilepsy, seizures, skeletal muscle spasms and restless leg syndrome.1–3
Valium is also used by hospitals and other medical institutions as a sedative to calm patients before or after a major medical procedure like an endoscopy or surgery.1–3 It’s often used in medical detoxification settings to minimize dangerous withdrawal symptoms from alcohol and other drugs.1–3
Valium’s potency and effectiveness in quickly reducing anxiety through depression of the central nervous system was a stark contrast to barbiturates, which came with a high risk of life-threatening overdose and were difficult for doctors to dose and patients to manage.1,4 The efficacy, strength and relative safety of Valium quickly made it a commercial success in the 1970s and these same factors contribute to the potential for abuse, dependence, and addiction.1,4
Some researchers suggest that the drug’s safety profile was taken for granted, resulting in patients being prescribed greater doses for longer durations than were clinically necessary.4 Normal dose dependence wasn’t confirmed until studies published during the 1980s. This led governments and health departments in several countries, including the U.S., to issue warnings and restrict its use as a prescription medication.4,5
Despite this, diazepam (including Valium and its generic versions) was still the fourth most often prescribed benzodiazepine in the U.S. in 2011, according to the Drug Enforcement Administration, with 12.6 million prescriptions dispensed in 2017.5
The body can develop a physical tolerance to some of the effects of Valium, and like all benzodiazepines, there is a physical and psychological dependence that can lead to habitual use as well as addiction.1–4
Long-term, chronic use of Valium as well as other benzodiazepines increases the risk of dependence and withdrawal, however, this is well-known and regularly managed effectively by physicians.4
Valium and other benzodiazepines work by modulating an inhibitory neurotransmitter in the central nervous system, GABA (gamma-Aminobutyric acid). They effectively slow nerve impulses throughout the body and results in increased feelings of relaxation and calmness, resulting in lowered anxiety and muscle relaxing.1,4
Side effects of Valium may include:2,3
- Muscle weakness.
- Impaired muscle control or coordination.
- Diarrhea or constipation.
- Ringing in ears (i.e., tinnitus).
- Blurred vision.
With chronic use of Valium, or when taken at higher doses, these side effects may be felt more intensely.4
An overdose of Valium—in the absence of other CNS depressants—may result in experiencing severe manifestations of side effects.1,4 An overdose may also cause severe respiratory depression, including slow and irregular breathing, lowered blood pressure and in rare cases coma or death.2,4
Serious and fatal adverse events associated with Valium, however, are rare, and deaths involving diazepam are most often a consequence of drug interactions (such as opiates or alcohol).4 Misuse of Valium and other benzodiazepines is commonly seen in individuals with other substance use disorders. They are often used to enhance the effects of other drugs that depress the central nervous system.1 More than half of individuals abusing opioids and approximately 1 in 5 individuals abusing alcohol also abuse benzodiazepines.6
When taken concurrently with alcohol and/or opioids, Valium and other benzodiazepines deliver a more rapid onset of euphoria and a more intense sense of well-being.6,7 Respiratory depression is compounded when these drugs are combined and, along with prolonged seizures that occur with long-term habitual use, are the most common fatal events involving diazepam.1,4,6
More than 30% of overdoses involving opioids also involve benzodiazepines.8 In 2016, 96.5% of drug overdose deaths involving diazepam involved other drugs, with the three most common being prescription and illicit opioids (oxycodone, fentanyl and heroin).9
An addiction to Valium rarely occurs in isolation; it most often occurs when Valium and other benzodiazepines are misused along with other substances.6
Long-term use of benzodiazepines has been linked to long-term or permanent changes in the brain.10
Valium in particular has been associated with long-term cognitive and psychological side effects. One study showed that the risk of Alzheimer’s disease was increased by 43-51% among those who used benzodiazepines in the past.11 The risk was higher for those taking a long acting benzodiazepine like Valium over a longer period of time.
Benzodiazepine withdrawal can be unpleasant and difficult to endure, although it is rarely dangerous. Medical detox, where withdrawal symptoms are managed by healthcare professionals, is designed to get individuals through the process safely and comfortably.
Withdrawal symptoms are similar to those experienced by individuals with a dependence to alcohol and will be more pronounced with longer-term Valium use. Typical withdrawal symptoms include:2
- Muscle pain.
- Abdominal and muscle cramps.
- Restlessness, confusion and irritability.
Severe cases of withdrawal may be accompanied by the following symptoms:
- Derealization and depersonalization.
- Numbness and tingling of the extremities.
- Hypersensitivity to light, noise and physical contact.
- Epileptic seizures.
For individuals being treated for addiction to Valium, cognitive and behavioral therapy will follow medically managed withdrawal. This type of therapy, as well as aftercare components such as mutual help groups, will teach and reinforce coping skills that will help to fight off drug cravings, prevent relapse, and live a happy and productive life away from drug dependency.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Food and Drug Administration. (2016). Drug Label: Valium.
- Hamilton, R. (2017). Tarascon Pharmacopoeia, 18th Edition. Burlington, Mass: Jones & Bartlett Learning.
- Calcaterra, N. E., & Barrow, J. C. (2014). Classics in chemical neuroscience: Diazepam (Valium). ACS Chemical Neuroscience, 5(4), 253–260.
- Diversion Control Division; United States Drug Enforcement Administration. (2019). Benzodiazepines.
- Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A review. The Mental Health Clinician, 6(3), 120–126.
- Ciraulo, D. A., Knapp, C. M., Locastro, J., Greenblatt, D. J., & Shader, R. I. (2001). A Benzodiazepine Mood Effect Scale: Reliability and Validity Determined For Alcohol-Dependent Subjects and Adults with a Parental History of Alcoholism. The American Journal of Drug and Alcohol Abuse, 27(2), 339–347.
- National Institute on Drug Abuse. (2018). Benzodiazepines and Opioids.
- Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2018). Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. Morbidity and Mortality Weekly Report, 67(5152).
- Stewart, S. A. (2005). The effects of benzodiazepines on cognition. Journal of Clinical Psychiatry, 66(Suppl2), 9–13.
- Billioti de Gage, S., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M., … Bégaud, B. (2014). Benzodiazepine use and risk of Alzheimer’s disease: Case-control study. BMJ (Clinical Research Ed.), 349, g5205.