When the lead singer of Korn Jonathan Davis called benzodiazepines “the devil”, he was not far off in regards to their effect on the brain with long-term use. The beginnings of use are such a miracle of relief, that ending use is something that does not occur to anyone until the drug always has a hold. In addition, it becomes so easy to add on an extra dose, that abuse will not be apparent in small time frames. Since Xanax is the most prescribed of these drugs, its addiction is one that is well known to the public now.
- Xanax (Alprazolam) Addiction
- Xanax (Alprazolam) Withdrawal
- Sources & Resources
Xanax (Alprazolam) Addiction
Xanax Addiction Symptoms
The first sign of what can become an addiction to Xanax is typically an extra dose, when the prescribed amount does not quite curb the anxiety it was intended to treat. This extra hit starts to reinforce the habit of excess use. This will lead to a more uniform amount of sedation throughout the day.
People who are using Xanax on a constant basis will be perceive as low in energy, while the real explanation is that they are constantly at a low level of sedation that happens to make them appear that way. Social isolation becomes common at this stage, as does excess amounts of sleep. When dependent users are around people, they can often seem intoxicated, with common signs being slurred speech, impaired walking, and drowsiness. A person with a severe addiction will start to have hallucinations and distortions of reality.
Aside from the physical symptoms, an addict of any substance has several characteristics that are pretty consistent. They typically will need more and more financial help to afford their habit, which can lead to illicit practices and stealing/selling valuable goods in order to afford.
A fully addicted person typically knows at some level they should be avoiding questions about their use, so evasive answering and irritability are often common. As the habit becomes all-consuming, the person will begin to sacrifice their health, hygiene, and personal responsibilities in favor of obtaining the drug. They also will increase their tolerance for risky behaviors, such as impaired driving. These are all signs that someone has developed a significant problem with using.
Tolerance to Xanax happens very quickly, which is why these drugs are no longer prescribed for regular use lasting more than a few weeks in most cases. While addiction is not a sure outcome with Xanax use, the risk factors for someone becoming addicted to the drug (anxiety, stress, mental health disorders, history of trauma) are probably not a coincidence also the reasons someone would be prescribed a benzo in the first place. So, it is good practice for a physician to assume that all patients receiving a prescription of Xanax have the potential to addiction.
The actual amount of time it can take for an individual to become addicted varies by individual. Tolerance, or the need to use extra doses for the same effect, can happen as early as the first week. Dependence, or the inability to act without some of the drug in the body, can occur as early as a couple weeks. It is generally agreed by the medical community that 3-4 weeks of prescription starts to carry a risk of addiction to benzodiazepines. This was the principle reason that, over the last two decades, these prescriptions were decreased to less than 2-3 weeks in duration.
Xanax Addictive Potential
Benzodiazepines themselves tend to fall pretty high on the risk for addiction. While they do not outpace the well known illegal drugs, such as heroin and methamphetamines, or even the legal drugs of nicotine and alcohol, when lists are expanded beyond the top 5 or 6 most addictive known substances, benzos are often mentioned in the second highest category. Xanax itself is thought to have a slightly higher risk for addiction than most other benzodiazepines.
There are several reasons that people believe this is the case, mostly related to its chemical structure. Because it is a shorter acting drug and very potent, the drop from its highest point to the wearing off of effects is very fast, meaning it will be more noticeable by the individual and may induce more anxiety to go without it. Additionally, Xanax increases release of the reward circuit of the brain at a low level, much like cocaine does at a high level. This creates a powerful habit to use.
Xanax at low doses carries milder risks than higher doses, which makes logical sense. However, as mentioned previously, one of the dangers of these drugs is how important it seems to the patient to increase their dosing to achieve the same effects. Thus, it is better to believe that no real dose of Xanax is safe from the effects of tolerance/dependence/addiction.
Xanax Addiction Treatment
Xanax addiction is treated professionally by a licensed physician due to the serious risks of withdrawal syndrome. A doctor will typically use a similar or identical benzo and proceed with a taper, which gently decreases the dose over a period of time. This helps minimize the side effects associated with Xanax withdrawal.
A typical taper is usually scheduled for 8-12 weeks when non-urgent, meaning there are no side effects present at the moment. This can vary from patient to patient, and any duration of taper that prevents withdrawal and prevents the patient from cravings can be successful. There are some reports of up to a year of taper that have shown the ability to wean a patient off of Xanax. The reductions in dosing are usually from 5-25% of the dose currently prescribed, and your physician will reassess the situation every 1-4 weeks.
Xanax (Alprazolam) Withdrawal
Benzodiazepine withdrawal is one of the more dangerous drug withdrawals in medicine. This all relates to the over-activity of the brain. Since benzos naturally calm the brain, an absence of their presence after prolonged use leads to a gradual building up of activity, sending the brain into a sort of fight or flight response known as “rebound activity”. Since Xanax (alprazolam) is the most prescribed drug of this class & Xanax addiction is so common, withdrawal from it is a commonly encountered problem in medicine.
What is Xanax Withdrawal?
Xanax withdrawal can start as early as a few hours after the last dose, as levels of the drug begin to drop within the body. This is one of the most significant reasons why patients increase their use of these drugs above the provided dosing when given benzos. Since they were typically prescribed to treat anxiety, which is a powerful ancient circuit in the brain in motivating and driving behavior, patients will seek relief even when the signs of anxiety are just beginning.
The psychological anxiety combined with the actual chemical processes lead to a ramping up of anxiety within the brain and body, and if a drug is not consumed, tremors and headache will begin to set in. Panic can become common during this stage, and by the end of the first day a patient can be in severe autonomic withdrawal.
Xanax Withdrawal Timeline
Days 1- 2
The first symptoms of a complete withdrawal from Xanax are anxiety-based, namely trouble sleeping, nervousness, headache, and loss of appetite. As mentioned above, these can start as early as a few hours after the last ingestion. These will be the predominant symptoms over the first 1-2 days.
From day 3 through the first week, a second wave of symptoms is common to arise, which is considered the most severe point of withdrawal from benzos. This is when anxiety can become uncontrollable, and signs such as agitation, sweating, high blood pressure, and complete inability to sleep are present, as the brain becomes used to its new neurochemistry.
During this phase, seizures can become a complication of withdrawal. Seizures are the most concerning complication of withdrawal from sedatives, and can cause a serious adverse outcome. It is because of this complication that professional medical help is necessary when withdrawing from benzos. Problems with seizures can have long-lasting or permanent effects.
After day 7, the first dangerous period of withdrawal from Xanax is typically considered over. In some cases, this can persist for up to 2 weeks, but this is fairly rare. A third wave of serious effects also presents around days 10-14. A reoccurrence of seizures and hallucinations can increase in prevalence during this time, which will require medical management. Muscle tremors, dizziness, sweats, and distortion of visual perception can also happen at this time.
After 14 Days
After day 14, the most acute phase of withdrawal is generally considered to be over. The effects on mood and disposition can take a while to readjust, as the brain forms new pathways that are in existence without help from the drug. The severe effects, such as seizure and hallucinations, however, is typically over at this point.
There is some fairly recent data on withdrawal from Xanax that suggests it could be longer than previously thought. The reason for this is that, after withdrawal, most patients begin to re-experience anxiety that they assume was what they had prior to starting the drugs. It is now thought that this could be a rebound increase in this state, and the mood symptoms of withdrawal such as anxiety, sleep problems, depression, and trouble thinking, can take up to a year to fully re-acclimatize.
These symptoms by themselves are not as harmful as the acute withdrawal, but they can increase the temptation to reuse. The best method of approach is a combination of therapy, or a brief prescription of an antidepressant, to allow the person a chance to adjust to their new life free of benzos.
The presence of anxiety can be a mixture of a fear of losing the effect of the drug as well as the physical effects of increased activity. If a person is without a next dose and starts to feel anxiety, tremors, sweating, or fast heart-beating, they should consult a physician immediately, in an ER if necessary. If a person plans to withdraw, they should contact their physician with the amount of drug they’ve been taking, how much they have left, their wish to discontinue, and when they can do so.
How Bad is Xanax Withdrawal?
When drugs like Xanax were first created, they were touted mainly for their safety profile. They were assumed to be infallible in regards to overdose and addictive tendency. The first problem to emerge was the possibility of overdose, followed then by increasing case reports of illicit use and abuse of prescriptions.
In the last few decades, the emerging story is now how bad withdrawal can be, and how serious it can become. The acclimation of the brain happens more subtlety than previously thought, so while a person may not believe their withdrawal will highlight a large dependency, in more cases than not it will. Additionally, as more information is known about these drugs, the duration of withdrawal slowly keeps getting more extended, with cases lasting months now not as uncommon of a finding. Finally, these two symptoms also do not mention the lethality of the withdrawal, which is a real and serious concern.
What helps With Xanax Withdrawal?
The best thing that helps with Xanax withdrawal is receiving professional help. Quitting cold turkey does not have to be an option, and all doctors are now being trained in the seriousness of benzodiazepine withdrawal and the essential use of a taper, which is a gradual decrease in dosing until a person can safely come off of the drug.
When a person comes into a hospital in active withdrawal, they will often receive a dose of a short-acting benzo in order to temporarily stave off symptoms. They will then begin the taper. This can be done over a period of weeks/months, and while there may be some mild symptoms, it avoids the serious and horribly unpleasant outcomes. Doctors are available and willing to help those who wish for it.