Diazepam addiction

Carlsson C, Fasth BG A comparison of the effects of propranolol and diazepam in alcoholics. Br J Addict Alcohol Other Drugs 71 321-326, 1976... 

Perera KM, Jenner FA Some characteristics distinguishing high and low dose users of benzodiazepines. Br J Addict 82 1329-1334, 1987 Perez MF, Salmiron R, Ramirez OA NMDA-NRl and -NR2B subunits mRNA expression in the hippocampus of rats tolerant to diazepam. Behav Brain Res 144 119-124, 2003... 

Whitwam JG, Morgan M, Hall GM, et al Pain during continuous nitrous oxide administration. Br J Anaesth 48 423 29, 1976 WileyJL, Bale AS, Balster RL Evaluation of toluene dependence and cross-sensitization to diazepam. Life Sci 72 3023—3033, 2003 Wise RA, Bozarth MA A psychomotor stimulant theory of addiction. Psychol Rev 94 469-492, 1987... 

The CNS depressants include barbiturates, nonbarbiturate sedatives, and the benzodiazepines. As the medical use of barbiturates decreased, primarily because of their high addiction liability and the danger of acute lethality, the use of the benzodiazepine anxiolytics increased. The most commonly abused barbiturates are secobarbital, pentobarbital, and amobarbital. Pheno-barbital is not generally abused, because of its slow onset of action. The most commonly abused anxiolytics include diazepam, chlordiazepoxide, midazolam, lo-razepam, and flurazepam. These drugs are readily attainable from illicit sources. 

Bo O, Hafner O, Langard O, et al. Ethanol and diazepam as causative agents in road accidents. In Iraelstam S, Lambert S, eds. Alcohol, drugs, and traffic safety. Toronto Addiction Research Foundation of Ontario, 1975. 

BZDs such as chlordiazepoxide (Librium) or diazepam (Valium) may be prescribed to treat anxiety, seizures, acute stress reactions, and panic attacks, or to alleviate the side effects of drug or alcohol withdrawal. Those BZDs with a more sedating effect, such as estazo-lam (ProSom) or triazolam (Halcion), may be prescribed for short-term treatment of sleep disorders. However, the newer generation of non-BZD agents—zolpidem (Ambi-en) and (Sonata)—are less potentially addictive hypnotic drugs than the BZDs. 

A rare case of physical and psychological addiction to an excessive dose of zolpidem and subsequent detoxification using diazepam has been reported. 

One means of treatment for alcoholism is to give the addict a sedative/ relaxant drug such as diazepam for about seven days. After this time the worst of the unpleasant withdrawal symptoms will have receded. The patient still has to be kept away from alcohol and weaned off it, but the drug helps to reduce the craving. There are other newer drugs that also do this by increasing the substance GABA (see box above), they inhibit the activity of nerves in the brain that would otherwise increase when there is no alcohol present. 

The treatment of addiction to certain drugs utilises substitution therapy. This is where the drug that the patient is addicted to is substituted for another drug that may be prescribed on a prescription form. Drugs allowed as substitutes are (most commonly) methadone, buprenor-phine, dextromoramide, morphine and pethidine. In addition, it is possible for prescribers to prescribe diazepam on instalment prescriptions for the management of side-effects to addiction treatment. 

Although it was once thought that diazepam had no addictive potential, experience has shown that its chronic use carries significant dependence liability and that withdrawal can be quite protracted (Ashton, 1994). Kleinknecht and Donaldson (1975) and Murray (1984) reviewed the effects of diazepam on cognitive and... 

Another consideration in the choice of benzodiazepine is their potential for abuse. Individuals with addictive disorders prefer certain agents to others. Agents with rapid onset of action, such as diazepam or alprazolam, demonstrate higher abuse potential because of their reinforcing effects. Those with slower onset of action, such as chlor-diazepoxide, oxazepam, and halazepam, are less likely to be abused. This consideration may be relevant in an outpatient setting or for patients with a history of benzodiazepine or other substance abuse. ... 

The CNS contains a wide variety of neurotransmitters and high concentrations of receptors. Mechanisms of action of many drugs are often complex combinations of receptor-based actions. Some of the most widely used (and abused) drugs are hypnotics/sedatives, for treatment of insonmia. Barbiturates such as amylo-barbitone have been used for many years, but suffer from side-effects and are addictive. Thiopentone sodium salt (sodium pentothal), however, is very useful as a short-acting intravenous anaesthetic. The benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax), are safer drags for insomnia and also can be used for treatment of anxiety and muscle spasms. Zolpidem (Ambien) is a newer and more selective hypnotic. 

In treatment-resistant cases, benzodiazepines, either long-acting (diazepam, clonazepam, and chlordiazepoxide) or short-acting (alprazolam, oxazepam, and lorazepam) may be used when the patient does not have a history of addictive behavior. Also, they can be combined with SNRIs/SSRIs in the first weeks of treatment before the onset of the therapeutic effects of the latter. Benzodiazepines as monotherapy may not be as robust as assumed. Among patients responding to treatment, less than two-thirds will go into remission, and a number of studies have indicated, despite early improvements in anxiety symptoms, that the effect of benzodiazepines may not be different from placebo after 4-6 weeks of treatment. 

Alcohol, barbiturates, and narcotics—such as diphenhydramine (Benadryl), amobarbital (Amytal), diazepam (Valium), codeine, heroin, methadone, morphine, propoxyphene (Darvon)—that are used during pregnancy can lead to harmful effects on the newborn. Use of these dmgs during pregnancy can create an addiction in the newborn. The baby will go into withdrawal from the drug when they are born. This can result in hyperactivity, crying, irritability, seizures and even sudden death. 

Diazepam is the most abused substance of all the benzodiazepines. Not only drug addicts, who use the substance as a bridging aid and to intensify other drug effects, have experience of diazepam, but so also do most medicament-dependent people and alcoholics. The age of first use is lower than in the case of other benzodiazepines, sometimes as early as childhood. Diazepam is therefore also important in the introduction of drugs to people who later exhibit mono- or polytoxicomania. 

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