Xanax is the brand name of alprazolam, which is a benzodiazepine prescription medication. Benzodiazepines (BZDs) have been used for decades to treat a variety of conditions. BZDs are one of the most widely prescribed drugs in the US. In 2007, 112 million prescriptions for BZDs were dispensed.
Xanax is typically used to help people with anxiety or panic disorders. It works by interacting with the brain’s receptors to inhibit brain activity related to anxiety and other conditions. Addiction may result when the drug is misused. Treatment can help support recovery from xanax use disorder.
History of Xanax
Alprazolam was formulated in the 1960s by Upjohn Laboratories. It was first marketed as a sleep aid. However, over time, Upjohn saw that it was more effective as a medication to treat anxiety, mood and panic disorders.
Upjohn submitted a new drug application to the DEA for the new brand name “Xanax”. The application claimed that Xanax was a more effective anti-anxiety drug compared to what was on the market at that time. Once the DEA approved the application, Xanax was sold as an anti-anxiety medication. During the early 1990s, alprazolam grew in popularity in the US psychiatric community for the treatment of panic disorder.
For most people, taking the recommended dose of Xanax is safe. According to The Ochsner Journal, the recommended dose to treat anxiety starts with 0.25 to 0.5 mg tablets taken 3 times a day.1 The maximum recommended daily dose should not exceed 4 mg. To treat panic disorders, the same daily dose is recommended with the maximum set at 6 to 10 mg a day.
This medication can be addictive because of a common issue called rebound anxiety. If the drug is stopped, anxiety may return worse than it was before. This results in taking Xanax again for relief from the rebound anxiety. This cycle develops due to the drug’s short half-life.
The half-life of Xanax is 6 to 27 hours. A drug’s half-life describes how long it takes for half the dose to be metabolized and eliminated from the bloodstream. In other words, the half-life of a medication is the time period needed for the drug to be reduced by half in the body.
Repeated doses can carry the risks of tolerance, dependence and withdrawal with long-term use. SAMHSA (Substance Abuse and Mental Health Services Administration) issued a report stating that about 29% of all emergency room visits in 2011 were benzodiazepine-related. Xanax was the benzodiazepine found in about 10% of these visits.
Currently, according to the DEA (Drug Enforcement Agency) that schedules drugs from least to most dangerous, Xanax is a Schedule IV drug. Schedule IV substances are described as having a low potential for abuse and low risk of dependence. Other examples of Schedule IV medications are: Ativan, Darvocet, Valium, Tramadol and Ambien.
Despite the DEA determination of a low potential for abuse and dependence, most addiction specialists deem Xanax to be highly addictive. One reoccurring issue is that doctors tend to prescribe Xanax for longer periods of time than recommended.
Alprazolam is the most commonly prescribed BZD. It is also the most commonly prescribed psychiatric drug in the US with more than 48 million prescriptions filled in 2013. The safety of this medication is questioned by specialists in the substance use disorder field. This is supported by research that shows alprazolam:
- Has a high misuse risk
- Results in a more severe withdrawal syndrome than other BDZs
- Can cause more severe withdrawal symptoms even wwhen it is tapered down according to manufacturer guidelines
In addition, 2013 data showed that:
- Alprazolam is the second most common prescription drug involved in medication-related emergency room visits
- Alpazolam is the most common BDZ to be involved in emergency room visits that were related to drug misuse
- BDZs are involved in about one-third of intentional overdoses or suicide attempts
Other Safety Issues Regarding Benzodiazepines
When an individual has a toxic accumulation of benzodiazepines, it can cause a loss of inhibition. This can lead to uncharacteristic behavior due to this impairment. This can appear as having unsafe sex or driving recklessly. One study reported that using BZDs can double the risk of driving accidents. It is important to exercise extreme caution when driving if you are taking or tapering off from any BDZ.
Benzodiazepines have street names. These street names include:
- Nerve Pills
Xanax street names include:
- Totem Poles (after the bar shape of some Xanax doses)
- Blue Footballs
Xanax is used to treat anxiety disorders, such as GAD (generalized anxiety disorder). It is also used as a short-term treatment for symptoms of anxiety. Anxiety or tension that comes with daily life is not typically treated with anti-anxiety medication.
Generalized anxiety disorder is when a person has excessive or unrealistic anxiety and worry about two or more things encountered in everyday life, for 6 months or longer. During this time period, the person has anxiety and worry more days than not.
The symptoms of GAD can include:
- Muscle tension
- Aches or soreness
- Shortness of breath
- Choking sensations
- Rapid heart rate
- Cold clammy hands
- Dry mouth
- Digestion issues
- Frequent urination
- Trouble swallowing
- Feeling on edge
- Concentration problems
- Exaggerated startle response
- Sleep problems
Xanax is also used to treat panic disorder. The symptoms of panic disorder include a sudden, intense fear or discomfort that reaches a peak within 10 minutes that can come along with:
- Shortness of breath
- Choking sensations
- Chest pain or discomfort
- Abdominal pain
- Feeling like fainting
- Feeling disconnected from reality
- Feeling detached from oneself or “out of body”
- Fears of losing control or dying
- Hot or cold flushing
Xanax works as a depressant to the body’s central nervous system. Therefore, the most common side effects are mostly those that are nervous system-related, such as:
- Speech difficulties
- Memory problems
Long-term use of Xanax is controversial and not recommended by many healthcare professionals. One reason is that tolerance can develop fairly quickly for its hypnotic and sedative effects. Tolerance is when a person needs more and more of a substance to feel the same previous effects.
Physical dependence, which comes along with withdrawal symptoms including severe ones such as seizures, can happen without tolerance developing. On the other hand, tolerance may develop without physical dependence symptoms.
In addition, it could take as long as 6 months for cognitive functions to recover (such as thinking, reasoning or remembering) after a BDZ taper off has taken place. Afterwards, there may be permanent impairments for some people.
Feeling like fainting
Feeling disconnected from reality
Feeling detached from oneself or “out of body”
Fears of losing control or dying
Hot or cold flushing
It is possible for you to overdose on Xanax, especially if it’s taken with other prescription or illicit drugs. Xanax mixed with alcohol can also be deadly.
The amount of Xanax that will result in an overdose depends on different factors, including:
- How the body metabolizes the drug
- Pre-existing medical problems
- If Xanax was combined with alcohol or other drugs
Overdose is possible at any dose higher than the prescribed amount. If you are older than 65, there is a higher risk of overdose. People in this age group are usually prescribed lower Xanax doses, because there is a higher risk for side effects or overdose.
It’s important that you speak with a doctor or treatment center before you attempt coming off of Xanax. It’s dangerous and unhealthy to do so on your own.
A healthcare professional, in combination with a slow taper off of Xanax, may also prescribe a substitute medication that has a longer half-life compared to Xanax. This helps prevent intoxication and withdrawal signs. During this time, it’s crucial to enter a “whole person” or holistic treatment program to work through the mental and emotional issues that led to dependence.
The treatment program may determine if there is a need for drug maintenance therapy. Drug maintenance therapy may be recommended, especially if:
- High doses of Xanax were being taken
- There are signs of drug abuse behaviors
- There is an unstable lifestyle
- There are other mental health issues
- Alcohol dependence is present
Maintenance therapy may continue until there is a period of stability where none or a lower dose may be considered. If you have medical conditions or a seizure history, it may be recommended doing this type of tapering and maintenance therapy within a residential treatment program.
Xanax withdrawal can happen even when taking the drug for as little as a week. That’s because Xanax when compared to other BDZs, involves a more complex taper because of the rebound of anxiety that can happen.
One study reported that people that took Xanax for panic disorder treatment and then tapered off:
had rebound anxiety that was worse than anxiety experienced before treatment
Others in the study who tapered off Xanax over an 8 week period experienced the following withdrawal symptoms:
- Worsening anxiety
- Sleep problems
- Homicidal ideation
- Dissociative reactions
- Suicidal ideation
- Though rare, there have been some cases of delirium and psychosis
Tapering off Xanax in a supervised detox program is only the first step in treating an addiction. The mental and emotional effects must also be addressed.
Cognitive Behavioral Therapy (CBT) has been shown to be effective in helping people struggling with benzodiazepine use. CBT is where a therapist helps reveal how patterns of thought and behavior led to Xanax abuse and addiction. A therapist works closely with the client to create new, healthier and more positive ways of handling the causes behind Xanax abuse. CBT also teaches coping skills and methods for dealing with future cravings for Xanax.
CBT also works well in cases of a co-occurring disorder or what is also known as dual diagnosis. A dual diagnosis is present if the person has both an addiction along with a mental health disorder. Research provides support for using CBT to treat co-occurring disorders.
The first step towards recovery is to safely stop Xanax by undergoing a medical detox. While detox is an important first step, it is not a standalone treatment. After detox, it’s vital to address the psychological and behavioral issues that led to Xanax misuse and addiction.
The main choices for continued treatment are inpatient and outpatient. What will be the best treatment for you will depend on your unique situation and needs.
Inpatient rehab is where you live at the facility while in treatment. This is the best option if you are looking to totally focus on recovery without outside distractions or commitments interfering. Most treatment centers offer 24-hour medical care. A wide range of therapy and medication services are provided.
The stay will vary according to your needs. Some treatment centers offer short stays from 3 to 6 weeks. Others offer stays of 28 days, several months or longer. Most people transition into an outpatient program after completing residential rehab.
An outpatient program (OP) takes place several times a week and you return home afterwards. Just as you will find with inpatient rehab, OPs offer many different levels of therapies and program lengths.
Despite the name, most PHPs do not take place in a hospital. PHPs can be within a clinic setting or treatment facility. PHPs typically require 30 hours of treatment each week. They offer individual and group therapy services.
IOPs are a step-down from PHPs. IOPs provide a mix of individual and group therapies over a 6 to 9 hour week.
Standard outpatient programs offer 45 minutes to one hour sessions of individual, group or family therapy. The frequency of these meetings will depend upon individual needs.
When choosing the best treatment option for you, talk to an addiction treatment specialist to assess the situation. From there, a customized plan will provide the best road to a successful recovery.
Your answers to the following questions can help you decide what the best treatment option is for you:
- How long have I struggled with my Xanax use?
- Is it possible to stay sober without inpatient rehab at first?
- How many times have I tried to stop and then relapsed?
- What is the level of severity of my Xanax addiction?
Rehab programs are personalized to address individual concerns. For example, you could move from an inpatient detox to a residential detox. Then you could enter an outpatient program to keep on the road of recovery. If your Xanax misuse is at a low level, you may consider entering an outpatient detox and rehab program. It is best to talk with an addiction treatment specialist to weigh all your options.
Professional treatment can keep you safe as you progress in the recovery journey. Take the first step today to begin a healthy sober life.