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 disorder 1,2. When 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 in both prescription and illicit users. When a dependent user attempts to stop, they will face uncomfortable and, in some case, severe withdrawal symptoms.
Physiological dependence may develop in both prescription and illicit users.
Xanax is widely used in the United States, with nearly 50 million 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, however, because of its inherent withdrawal risks, should you decide to stop using this drug, you must do so carefully.
What Is Xanax Withdrawal?
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 the enhanced GABA activity are experienced strongly. However, as time goes on, the brain adapts to inhibitory effects of the drug, and the medication is no longer able to elicit these results to the same degree—a process referred to as tolerance 1,4. Due to the 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, it no longer needs to produce as much naturally 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 that 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 sometimes-dangerous withdrawal effects like seizures 4.
Is It Dangerous?
Acute withdrawal from drugs and alcohol can be an unpleasant experience. More importantly, however, certain withdrawal syndromes can be quite dangerous and require careful treatment. Read More
Xanax withdrawal will not typically culminate in life-threatening effects like the ones possible from alcohol or barbiturate withdrawal 5. Even so, the withdrawal 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 the discomfort and possible complications, someone experiencing Xanax withdrawal or seeking to quit usage soon should seek medical treatment immediately or speak with an addiction expert 5.
Part of what makes Xanax withdrawal 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 from poor coordination, especially in older adults.
Another concern is that the anxiety symptoms the Xanax is designed to treat could return in amplified intensity and duration when the medication is stopped 7.
Signs and Symptoms of Withdrawal
Xanax is a short-acting benzodiazepine. This means that the effects of the drug 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 last for up to a month 6. In contrast, the timeframe for withdrawal symptoms from long-acting benzos like Valium may be delayed up to a week after last use and 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 user himself 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 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 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 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 the level of use and any previous history with withdrawal, the individual may be first 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 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 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 withdrawal. These 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 under medical supervision will ensure that your symptoms are monitored regularly and treated as needed.
What Can I Expect After 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 the drive within the individual to become sober and stay in recovery.
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.
- Decide 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.
- Drug Enforcement Administration. (2013). Benzodiazepines.
- U.S. National Library of Medicine: MedlinePlus. (2010). Xanax.
- National Institute on Drug Abuse for Teens. (2016). Prescription Depressants.
- Medscape. (2016). Withdrawal Syndromes.
- National Institute on Drug Abuse. (2014). Research Report Series: Prescription Drug Abuse.
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
- National Institute on Drug Abuse. (2016). Drug Facts: Treatment Approaches for Drug Addiction.
- Australian Government: The Department of Health. (2003). Phase 4: Strategies to Cope with Cravings.