Luckily, most of us go through life never having to witness the horror of someone in substance withdrawal. It’s only thanks to films like Requiem for a Dream, Trainspotting, and other titles that deal with addiction that many people even know withdrawal exists. While the withdrawal scenes in these movies might seem shocking, the reality is that substance withdrawal really can be one of the most painful, intense, and uncomfortable things a person can go through.
Many people’s minds first turn to drugs when discussing substance abuse, and while a sudden cessation of certain drugs, such as opioids and amphetamines, does cause severe withdrawal symptoms, it’s alcohol that takes the blue ribbon for dangerous withdrawal.
Librium, the brand name for chlordiazepoxide, has been used to treat the uncomfortable and dangerous symptoms of alcohol withdrawal since the 1960s. Chlordiazepoxide, the first benzodiazepine, helps to calm a hyper-excitable nervous system in withdrawal, reducing the risk of seizure, managing agitation, and soothing anxiety. It’s been found to be an effective therapy for moderate to severe symptoms of alcohol withdrawal (Tiglao et al.)
While Librium has helped see thousands through alcohol withdrawal, what is modern medicine’s view of this almost 70-year-old drug? Is it an effective weapon in the fight for sobriety? Does its own addictive nature outweigh its benefits?
Continue reading to learn more about Librium’s role in modern substance abuse recovery.
Librium is a type of medicine belonging to the benzodiazepine class of drugs. It was the first Benzo and was developed at Hoffmann-La Roche laboratories in 1955. Benzodiazepines have a sedative and anticonvulsant effect on the nervous system, making many of them effective Alcohol Withdrawal Syndrome (AWS) treatments.
Like many other drugs that either sedate or stimulate the nervous system, Librium has the potential for abuse. Its sedative effects are amplified when taken with alcohol or in larger doses, causing a pleasurable high. Although safe for short-term use (often under medical supervision), long-term or continuous abuse can lead to respiratory issues, liver damage, and cognitive impairments. Its high potential for abuse and serious side effects led to Librium being placed on the UK’s Controlled Substances List in 1985. Since then, it has only been available to the public with a physician’s prescription.
Depending on the severity of the withdrawal symptoms, the individual patient’s medical history, and their health profile, Librium doses typically range from 25 mg to 100 mg spread over three to four doses daily (Drugs.com). With time, the frequency of the doses is tapered down as the withdrawal symptoms abate, usually over a period of 7 to 10 days in a controlled setting. Some of the more common side effects over the short term include drowsiness, dizziness, and ataxia, or the loss of muscle contraction. Severe side effects include confusion and respiratory depression; however, these effects are typically only present in cases of ongoing Librium abuse.
Understanding the relationship between GABA, glutamate, and alcohol makes it much easier to understand how Librium counteracts the symptoms of Alcohol Withdrawal Syndrome (AWS).
GABA is one of several neurotransmitters in the brain. Neurotransmitters act as chemical messengers between nerve cells, allowing them to communicate with each other. GABA is an inhibitory neurotransmitter, which means that it sedates or reduces the activity of nerve cells in the brain, causing feelings of relaxation, reduced anxiety, and drowsiness. You can think of GABA as the brain’s brakes, slowing things down and helping us feel peace and calm.
Alcohol enhances GABA’s calming effects by increasing its activity in the brain. This is why alcohol often makes you feel calm, relaxed, and sometimes sleepy. This increased GABA activity is also why alcohol can temporarily relieve anxiety. With regular alcohol misuse, the brain tries to compensate for increased inhibitory neurotransmitter (GABA) levels by reducing its own GABA production and increasing excitatory neurotransmitter (glutamate) levels. Glutamate has the opposite effect as GABA and creates feelings of stimulation, heightened awareness, agitation, and anxiety.
While the timeline for this depends on several factors, eventually, natural GABA production will be extremely low while the brain is constantly overproducing glutamate to deal with the anticipated GABA-flood expected with the next drinking session. If someone in this situation suddenly stops drinking alcohol, this GABA-glutamate imbalance causes extreme mental hyperactivity, restlessness, agitation, sleeplessness, and anxiety. In extreme cases, it can also lead to convulsions, seizures, Delirium Tremens (DTs), and death.
Librium helps to mitigate these symptoms by binding to the GABA receptors in brain cells. This enhances GABA’s inhibitory effects and counteracts the effect of excessive excitatory neurotransmitters during alcohol withdrawal (Chaytor). When you have Librium pumping the brain’s brakes, it makes detoxifying from alcohol, going through alcohol withdrawal, and restoring natural GABA and glutamate levels much safer and more tolerable.
The primary danger of Librium is that it is a habit-forming substance that mimics the effects of alcohol. It is entirely possible to give up alcohol while using Librium as an aid, only to find yourself addicted to Librium a few months down the line. While Librium is effective at mitigating the symptoms of alcohol withdrawal, it doesn’t completely remove them, and in an attempt to increase its effect, some patients increase their dosage. Going off-schedule with Librium significantly increases the chances of developing a tolerance and dependence. Since both alcohol and Librium affect the brain’s ability to produce GABA, giving up Librium will produce the same anxiety, sleeplessness, and agitation as quitting alcohol use does.
Long-term Librium abuse can also cause physical harm in the form of respiratory issues and liver damage (especially when prolonged alcohol abuse has already affected the liver); cognitive impairments such as memory loss, brain fog, difficulty concentrating, and confusion; mood disorders and behavioural changes such as irritability, aggression, and social withdrawal; and affect the ability to perform in the workplace (Ahwazi et al.).
It’s important to note that despite its potential for abuse and the serious effects thereof, Librium can be used safely when following the prescribing physician’s schedule and usage instructions, especially under controlled circumstances.
Consuming alcohol and Librium simultaneously has a synergistic effect, meaning that the effects of both substances are amplified. This is dangerous and may lead to loss of consciousness, coma, overdose, and death. The same is true for mixing alcohol with any type of benzodiazepine.
Librium is largely considered to be a safe and effective treatment for the uncomfortable symptoms of alcohol withdrawal for the vast majority of adults, and is one of the safest and most effective benzodiazepine composites (Ahwazi et al.), assuming that it is not misused or mixed with other substances for its narcotic effect. It can also be safely used to treat anxiety and patients who require short-term sedation, especially under medical supervision.
There are, however, people who should avoid benzodiazepine-based treatments for the symptoms of AWS. These include:
While benzodiazepines like Librium are effective for managing AWS, non-benzodiazepine alternatives such as gabapentin, carbamazepine, clonidine, valproic acid, and baclofen offer additional options. These alternatives can be particularly useful for patients who have contraindications for benzodiazepines or are at risk of developing dependence. Always consult a physician when giving up alcohol and looking for something to ease the discomfort of AWS.
Over the past two decades, Gladstones Clinic has helped hundreds of patients from all walks of life and backgrounds overcome alcohol abuse, often relying on Librium to see our patients through detox. We have an incredible amount of firsthand experience seeing how effective Librium can be in bringing calm and comfort to those in extreme duress during the often painful alcohol detox. In cases where the patient has a tolerance to Librium or cannot take it for other reasons, we administer either diazepam or oxazepam, both of which are also benzodiazepines and have similar calming effects.
Unfortunately, Librium alone is never enough to make a permanent switch from alcohol abuse to sobriety. While it takes the edge off, those serious about putting the bottle down for good can dramatically improve their chances by removing themselves from temptation completely and receiving effective clinical therapy for substance abuse in a residential setting.
Gladstones Clinic offers 4-week residential stays for alcohol addiction rehab treatment at our facility located in the beautiful Cotswolds. Our experienced addiction recovery team combines modern and evidence-backed therapies and medication with proven alternative therapies to provide holistic treatment that addresses all parts of addiction, including its root causes and triggers.
If you or a loved one is struggling with alcohol abuse and would like more information about Gladstones Clinic, our facilities, or our treatment methodologies, please feel free to reach out to us at 0808 258 2350 or contact us through our online portal.
For more information on alcohol abuse, check out these Gladstones blog posts:
If you would like more information on our addiction rehab programme, feel free to contact Gladstones Clinic at 0808 258 2350 for an obligation-free discussion or advice.
Ahwazi, H. H., et al. “Chlordiazepoxide.” StatPearls, 2024. National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK547659/. Accessed 24 May 2024.
Chaytor, A. “Chlordiazepoxide.” xPharm: The Comprehensive Pharmacology Reference, 2007. Chlordiazepoxide, https://www.sciencedirect.com/topics/neuroscience/chlordiazepoxide. Accessed 23 May 2024.
Drugs.com. “Librium Dosage Guide.” Drugs.com, Drugs.com, 16 November 2023, https://www.drugs.com/dosage/librium.html. Accessed 24 May 2024.
Tiglao, S. M., et al. “Alcohol Withdrawal Syndrome: Outpatient Management.” American Family Physician, vol. 104, no. 3, 2021, pp. 253-262. American Family Physician, https://www.aafp.org/pubs/afp/issues/2021/0900/p253.html. Accessed 24 May 2024.
