Xanax is in a class of drugs called benzodiazepines. These frequently prescribed medications are used to treat a range of physical and mental health conditions. Specifically, Xanax (also known by its generic name alprazolam) is used in the treatment of anxiety and panic disorders.1,2 When it is used as prescribed as a short-term anxiolytic agent, Xanax can be an effective medication; however, this substance can be addictive. Physiological dependence may develop among both prescription and illicit users. When a dependent user attempts to stop, they will face uncomfortable and, in some cases, severe withdrawal symptoms.
Xanax is widely used in the United States, with nearly 50 million Xanax prescriptions written every year.1 Its high rates of use, coupled with its marked potential for dependence, has contributed to an epidemic of widespread benzodiazepine misuse and numerous accompanying health issues. The Drug Enforcement Administration reports that:
- Xanax is in the top 3 drugs diverted from the illicit market.
- More than 20 million people in the U.S. admitted to abusing benzos at some point in their lives.
- In 2010 alone, benzos were related to about 81,500 calls to poison control centers and 345,000 emergency room visits. Xanax, specifically, accounted for more than 1/3 of these visits.
It is clear that abusing Xanax can cause significant harm. Because of its inherent withdrawal risks, should you decide to stop using this drug, you must do so carefully.
What Is Xanax Withdrawal Like?
To better understand Xanax withdrawal, it is helpful to understand:
- What happens when it is consumed.
- Xanax tolerance.
When Xanax is consumed, it enhances the activity of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA).1,3,4 GABA works to inhibit or slow down certain pathways of communication within the central nervous system (CNS), which triggers feelings of relaxation. When Xanax is first used, the effects that arise from enhanced GABA activity are experienced strongly. However, as time goes on, the brain adapts to the inhibitory effects of the drug and the medication is no longer able to elicit these results to the same degree. This process is referred to as tolerance.1,4 Due to diminishing drug effectiveness caused by tolerance, the user will need to use Xanax more often or in higher doses to recreate (or come close to) the effects that were initially induced when they began taking the drug.
With continued use of Xanax, the brain begins to slow down its own GABA production.4 This occurs because the system essentially grows so accustomed to the presence of increased GABA from Xanax that it no longer needs to produce as much naturally in order to balance the opposing levels of excitatory neural activity. At this point, the user has become dependent on the drug to regulate the system and achieve a balance between brain excitation and inhibition.4 Dependence can occur in people who abuse Xanax, but it is also common among those who take the substance as prescribed.
Once someone is dependent on Xanax, they will only feel good when they’ve taken the drug at an adequate dose to match their normal usage. If someone chooses to stop or dramatically cut down their use, net inhibitory brain activity will drop dramatically, allowing the opposing excitatory signaling to go unchecked—resulting in unpleasant symptoms and withdrawal effects that are sometimes dangerous, like seizures.4
How Dangerous Is Xanax?
Xanax withdrawal will not typically culminate in life-threatening effects like those which are possible with alcohol or barbiturate withdrawal.5 Even so, withdrawal from Xanax can be accompanied by a range of physical health and mental health side effects that can be extremely uncomfortable and sometimes even dangerous, especially in the case of seizures. Due to discomfort and possible complications, someone experiencing Xanax withdrawal symptoms or seeking to quit usage soon should seek medical treatment immediately or speak with an addiction expert.5
Part of what makes withdrawal from Xanax problematic is the uncertainty surrounding symptoms. The severity of symptoms can change rapidly, so even if they are not very intense at one moment, they can quickly escalate. As such, medical and mental health symptoms should be observed and regularly assessed as part of a supervised detox program.6
The greatest risks of Xanax withdrawal come from the possibility of:7
- Falls due to poor coordination, especially in older adults.
Another concern is that the anxiety symptoms which Xanax is designed to treat could return with amplified intensity and last longer when the medication is stopped.7
Xanax Withdrawal Symptoms and Signs
Xanax is a short-acting benzodiazepine. This means that the effects of Xanax use are present for a relatively short duration when compared to longer-acting benzos like diazepam (Valium). This also typically means that the onset of symptoms will be relatively quick—beginning within two days after last use and lasting for up to a month.6 In contrast, withdrawal symptoms for long-acting benzos like Valium may be delayed by up to a week after last use and may continue for two months.6
There may be few externally observable signs of Xanax withdrawal, as many of the symptoms will be subjectively experienced by the users themselves.6 These effects of Xanax withdrawal include:1,6
- Depressed mood.
- Inability to sleep.
- Feelings of irritation or agitation.
- Inability to pay attention.
- Poor memory/forgetfulness.
- Muscle aches and tension.
The duration and severity of Xanax withdrawal symptoms will largely depend on factors like:
- The dose and frequency of use.
- The duration of use.
- The use of other substances in combination with Xanax.
Unfortunately, the effects of Xanax withdrawal do not always end with these acute symptoms. Quitting benzodiazepines, including Xanax, is sometimes associated with ongoing symptoms called post-acute withdrawal syndrome (PAWS). PAWS (sometimes called “extended” or “protracted” withdrawal) refers to symptoms that exist long after the physical impact of the substance should have subsided.8
PAWS symptoms may be challenging to identify because they will be inconsistent and irregular. Usually, they will present as new, intense anxiety symptoms that can mimic anxiety disorders.8
Other issues complicating the recognition of PAWS are the phenomena of symptom rebound and symptom reemergence.
- Symptom rebound—Refers to the return of acute withdrawal symptoms like anxiety, insomnia, and restlessness during the PAWS timeframe.8
- Symptom re-emergence—Refers to the return of symptoms that Xanax was intended to treat. If someone was using the medication to treat anxiety, these symptoms of anxiety will likely return without Xanax addiction treatment. Symptom re-emergence is not a sign of PAWS but may be confused with it.8
To prevent symptom re-emergence tied to the anxiety disorder that Xanax may have been originally treating, the individual may benefit from alternate anti-anxiety medications that are safe and non-addictive or non-pharmacologic interventions.
The Xanax Detox Process
Professional or medically supervised detoxification is a set of treatment interventions meant to increase the comfort and safety of someone withdrawing from a substance.7
For someone withdrawing from Xanax, the safest form of detoxification is an extended taper where the substance is given in steadily decreasing amounts over a period of time.6 The taper may prove more difficult in the case of a short-acting benzo like Xanax, so depending on their level of use and any previous history with withdrawal, the individual may first be switched to a long-acting benzo before the taper begins. This stabilization phase helps to better manage symptoms by creating more consistent, easier-to-taper levels of benzodiazepines in the body.6 In rarer cases, the patient may be switched to a long-acting barbiturate like phenobarbital prior to the initiation of a taper protocol.7
Once a therapeutic, symptom-relieving dose of diazepam or phenobarbital is reached, the stabilizing drug will be reduced in a systematic way based on the presence of any withdrawal symptoms. More time between dose reductions may result in a safer, more comfortable detox but will naturally prolong the detox process.6
Other medications that may be used to alleviate Xanax withdrawal symptoms include:7
- Carbamazepine, valproate, or trazodone. These anticonvulsants and sedating medications may reduce symptoms in those with mild dependence; however, they may not be effective on their own at decreasing symptoms in those with very severe withdrawals. They may be better utilized in combination with phenobarbital or a long-acting benzodiazepine rather than as a standalone treatment.
- Clonidine. This medication that is frequently used in opioid withdrawal can treat autonomic symptoms of Xanax withdrawal, such as tremors.
Withdrawal and detox from Xanax can be all the more frustrating and problematic because symptoms may fluctuate in an unpredictable manner.6 Getting care for withdrawal from Xanax under medical supervision will ensure that your symptoms are monitored regularly and treated as needed. Learn about 3-day, 5-day, and 7-day detox programs.
American Addiction Centers maintains a strong partnership with a large group of health insurance companies at our addiction treatment facilities. Start the journey to recovery and find out instantly if your insurance provider may be able to cover all or part of the cost of rehab and associated therapies.
What Can I Expect After Xanax Detox and Withdrawal?
Behavioral therapy will be helpful in managing the effects of Xanax withdrawal and will be a mainstay of treatment after detox is complete. Good options for therapies addressing addiction and drug abuse include:9
- Cognitive behavioral therapy (CBT)—Helps to address faulty thinking and behavior patterns that lead to substance use and addiction.
- Contingency management (CM)—Offers rewards for healthy behaviors like attending treatment and abstaining from substances.
- Motivational interviewing (MI)—Has the goal of boosting drive within the individual to become sober and stay in recovery.
Inpatient and outpatient rehab programs provide safe environments where people struggling with substance misuse can learn about the nature of addiction and begin the journey to lasting recovery.
- Inpatient treatment programs. Substance abuse treatment for Xanax addiction may take place in a hospital or other inpatient facility. Recovering individuals temporarily stay in the treatment facility, where they participate in daily therapy sessions. Residential centers—a form of inpatient treatment—offer more home-like environments for longer durations (usually 30 days–90 days). They may also offer other amenities, such as nutritional guidance, meditation, exercise classes, and equine therapy.
- Outpatient treatment programs. In some cases, this type of care is a step down from inpatient treatment. However, some people with relatively less severe addictions may seek outpatient treatment as their primary method of recovery work. Outpatient treatment involves a certain number of therapy sessions each week. Rather than staying at a facility, individuals in outpatient programs live at home and have additional time to attend to personal obligations such as work or school.
Tips to Handle Cravings
Xanax cravings are a normal part of withdrawal and recovery. To avoid relapse, these cravings must be appropriately managed. To best handle your cravings:
- Change your behaviors by:
- Delaying your decision to use Xanax.
- Engaging in healthy, drug-free behaviors. This is a great way to distract yourself from your cravings.
- Deciding that listening to the craving would be destructive.
- Change your thinking by using more positive self-talk that emphasizes your power and control over your cravings.
- Change your feelings by using relaxation and guided imagery skills to improve your mood and decrease your anxiety.
How to Find Xanax Addiction Treatment
If you or a loved one is struggling with an addiction to Xanax, help is available and recovery is possible. Professional treatment can start anyone battling substance misuse on the path to a happier and healthier life. Rehab facilities are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. Many state government websites will provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.
American Addiction Centers (AAC) is a leading provider of addiction treatment programs and has trusted rehab facilities across the country. To learn more about treatment options with AAC, please contact one of our caring admissions navigators free at . You can also check your insurance coverage online now.
Xanax Addiction Treatment Levels of Care
- Inpatient Rehab Programs
- Outpatient Rehab Programs
- 3-Day, 5-Day, and 7-Day Detox Programs
- Sober Living Housing
- Aftercare Programs
- Therapy in Xanax Addiction Treatment
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