Why Is Xanax So Addictive?
Xanax, also known by its generic name alprazolam, belongs to a class of prescription drugs called benzodiazepines. For some people, Xanax can be an effective treatment for anxiety and panic disorders. However, Xanax users are at high risk for addiction when taking the drug:
- Taking the drug for or a long period of time.
- Using high doses.
- Mixing it with other drugs.
Xanax Abuse: A Growing Problem
Recent studies show that Xanax abuse and addiction is a growing concern in the United States:
- Prescription drugs, like Xanax, are the most commonly abused drugs other than alcohol and marijuana among people over the age of 14, per the National Institute on Drug Abuse (NIDA).
- According to a national survey of emergency room departments, in 2011 there were more than 150,000 emergency hospitalizations for misuse of Xanax in the United States.
- NIDA found that, though prescription drug abuse affects many different groups of people, adolescents and women are especially at risk for developing an addiction.
Addictive Properties of Xanax
A larger-than-usual surge of dopamine...may trigger a strong, pleasurable high that reinforces the desire for repeated use.
Benzodiazepines are central nervous system depressants that slow brain functioning. Xanax specifically works by increasing the activity of a brain chemical known as gamma-aminobutyric acid (GABA). GABA is a neurotransmitter that dampens neural excitation and suppresses communication between the different neurons in the body. When this occurs a user can experience some or all of the following:
- Decreased tension and anxiety.
- Loss of coordination.
- Impaired judgment.
Xanax causes addiction in much the same way that other drugs, including opiates like oxycodone, cause addiction. Essentially, the substance alters neuronal signaling throughout the brain in a way that “turns up” dopamine release. Dopamine is a naturally occurring chemical associated with feelings of pleasure and relaxation. A larger-than-usual surge of dopamine – such as that which accompanies some drug use – may trigger a strong, pleasurable high that reinforces the desire for repeated use.
Medical and mental health professionals use the term Anxiolytic Use Disorder to diagnose Xanax addiction. Tolerance to a drug is one symptom that indicates that a person may have such a disorder. There are two primary signs of tolerance:
- Needing to take more of the drug in order to feel the desired effect.
- Experiencing less of an effect with the same amount of the drug.
Some people develop a tolerance after taking Xanax for extended periods of time or in high doses. This may occur even when taking it as prescribed by a doctor. Tolerance may begin quickly or set in slowly depending on the dosage, how a person metabolizes the drug, and whether or not he or she is taking other medications. For most people, tolerance develops within days to weeks of regular use. Tolerance to Xanax also usually accompanies the onset of physical dependence and the associated arrival of withdrawal symptoms, making it especially difficult to quit (Ashton, 2005).
Methods of Use and the Effects of Xanax
Xanax is most commonly swallowed in pill form, but some users crush it up and either snort or inject the drug—hoping to hasten or otherwise enhance its effects. Common short-term side effects of Xanax include:
- Difficulty concentrating.
- Slurred speech.
- Impaired memory.
- Low blood pressure.
- Slowed breathing.
Benzodiazepines like Xanax have also been associated with depressive and even suicidal thoughts, especially when taken in excess.
Xanax can be especially dangerous when taken with other prescription drugs, over-the-counter medications and/or alcohol. Mixing these drugs can slow a person's heart rate and breathing; when this happens, the user is at high risk of respiratory arrest, impaired oxygen exchange, coma and even death. If you are prescribed Xanax, it is extremely important to tell your doctor about any other drugs you are taking.
What Does It Mean to Be Addicted to Xanax?
The pleasant sensation that results from many types of drug use is attributed to a surge of neurotransmitters, including dopamine. While these surges are temporary, persistent use of such addictive drugs may alter the brain's reward system in an enduring fashion. Studies indicate that as an individual progresses towards addiction to Xanax or other benzodiazepines, certain changes in neuronal cell surface receptor types could actually result in progressively greater dopamine surges when the drug is taken repeatedly. In this manner, the potential to experience the pleasant rewarding sensation is amplified—further solidifying compulsive drug use behavior.
Addiction to Xanax can be physical and psychological:
- Physical addiction to Xanax refers to transformations that occur in the body as it adapts to the presence of the drug. Without the drug, the body does not feel like it’s functioning normally and withdrawal symptoms present.
- A person who is psychologically addicted to Xanax anticipates the feeling of malaise that will occur if he or she does not take it. This person believes that without the drug, he or she will be unable to function appropriately. In this sense, psychological addiction also includes a fear of withdrawal symptoms and/or the return of symptoms for which the drug had been prescribed or used.
Questions to Ask Yourself
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you may be addicted to Xanax if you answer yes to at least two of the following questions:
- Have there been times when you have used more Xanax than you wanted to?
- Have you tried to cut down your use but failed?
- Do you spend large amounts of time acquiring, using, or recovering from Xanax?
- Do you experience strong cravings or urges to use Xanax?
- Have you kept using even when it has caused problems in your relationships?
- Have you given up on activities that were once important to you?
- Do you ever put yourself in risky situations while using Xanax?
- Do you continue to use even after experiencing emotional symptoms like depression, anxiety, and/or mood swings?
- Do you need more of the drug to experience the desired effect? Or do you feel less of an effect with the same dose?
- Have you experienced withdrawal symptoms when you stop taking Xanax?
Withdrawal from Xanax
Experiencing physical and mental withdrawal symptoms when stopping Xanax can be an indication that a person is addicted. The most common withdrawal symptoms include:
- Panic attack symptoms—such as shortness of breath, trembling, chest pain, and excessive fear.
- Feeling agitated and restless.
- Muscle pain.
Withdrawal symptoms that are less common but can occur in some cases include:
- Feeling as if one's skin is crawling.
- Sensitivity to sound and light.
Quitting Xanax abruptly or going "cold turkey" is dangerous due to the severity of withdrawal symptoms, which can in some cases be fatal. It is highly recommended that users taper off of the medication under the supervision of a doctor or at a detox center.
How to Get Help for Xanax Addiction
Research has found that a combination of medication and therapy is the most effective way to increase recovery chances when quitting Xanax. For some people, long-term or multiple treatments are needed to maintain stable recovery.
Medications for Xanax Addiction Treatment
Medications can be prescribed during treatment to help manage withdrawal symptoms or as a long-term treatment for anxiety. Diazepam, also known by its brand name Valium, is a long-acting benzodiazepine that is sometimes used to manage severe withdrawal symptoms – such as seizure – or is substituted for Xanax use during the process of the benzodiazepine tapering.
Since many people who become addicted to Xanax experience anxiety, doctors often prescribe non-addictive medications to help manage anxiety over a long period of time. However, most medications with anti-anxiety properties are also abused substances, so many opt for non-pharmacologic interventions to manage their anxiety in the long term. If you suffer from anxiety, discuss your symptoms and your addiction history with your doctor to determine the right course of treatment.
Behavioral Treatments for Xanax Addiction
In addition to medications, behavioral therapy is an effective form of treatment for prescription drug addiction.
Behavioral therapy involves focusing on the causes of addiction and finding healthy ways to cope with stress and difficult emotions. Some goals of behavioral therapy include:
- Identifying triggers and risky situations for drug use.
- Developing a plan to avoid situations that could lead to a relapse.
- Finding healthy ways to cope with urges and cravings.
- Teaching tools to handle emotions more effectively without drugs.
- Improving relationships with others.
- Increasing a person's ability to function at work, school, and in other settings.
There are several different approaches to behavioral therapy that have been found to be effective for treating addiction:
- Cognitive behavioral therapy, or CBT, focuses on unhealthy beliefs that lead to addiction. The goal of CBT is to help people understand how certain events or situations lead to negative beliefs and how these beliefs impact emotions and behavior. CBT also helps people anticipate certain situations or thoughts that could lead to a relapse and assists in developing a relapse prevention plan.
- Contingency management is a form of treatment used in some rehab centers. This approach to treatment is based on the idea that people will perform behaviors that are rewarded. Some rehab centers offer rewards for good behavior, like negative drug tests.
- Couples therapy and family therapy involve family members in the treatment process. The focus is on improving communication between the person in recovery and his loved ones.
Xanax Addiction Treatment Centers
Treatment for Xanax addiction can be found in different settings, including:
- Detox centers, which are residential programs that are staffed with medical professionals who prescribe medications to ease withdrawal symptoms. Attending a detox center is especially recommended when detoxing from Xanax because of the potential for dangerous side effects.
- Inpatient treatment allows people to temporarily leave their home environment and reside at a treatment center. Inpatient treatment centers have staff available 24 hours a day and offer a drug-free environment with group, individual, and family therapy.
- Outpatient treatment offers group and individual therapy for a set number of hours per week. People attending outpatient treatment reside either at their home or at a sober living facility.
Seeking help for Xanax addiction is difficult because of the strong dependence, tolerance, and cravings that can occur. Fortunately treatment centers can be helpful at any stage in the process. Whether you or a loved one are unsure about quitting or feel ready to take action, treatment is available to provide tools and help resolve any ambivalence about recovery. Learn how to help a Xanax addict today.
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- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18, 249-255.
- National Institute on Drug Abuse. (2016). Commonly abused drugs charts.
- Mahendran, R., & Liew, E. (2010). A case of suicidal thoughts with alprazolam. The Primary Care Companion to the Journal of Clinical Psychiatry, 12(3).
- Carroll, K. M., & Onken, L. S. (2014). Behavioral therapies for drug abuse. American Journal of Psychiatry, 162(8), 1452-1460.