Xanax Overview

Xanax is the brand name of alprazolam, a fast-acting benzodiazepine. While useful as a fast-acting treatment for anxiety, its use is associated with significant potential for abuse and dependence.

Tolerance to Xanax develops quickly, and if used for an extended period of time the user can become dependent on it. Once dependent on Xanax, a user can suffer life-threatening withdrawal symptoms such as seizures if the drug is discontinued.

In 2016, Xanax was the 19th most prescribed drug in the United States, with more than 27 million prescriptions being filled. Its use has been associated with an increasing number of emergency room visits, more than doubling from 57,419 in 2005 to 124,902 in 2010.

Xanax also goes under the street names zannies, zanbars, handlebars, and totem poles.

How Xanax Works in the Brain

Xanax works by enhancing the activity of a chemical in the brain called GABA (gamma-aminobutyric acid), the primary inhibitory neurotransmitter of the central nervous system. By enhancing GABA, Xanax acts in a very similar way to alcohol, slowing down brain activity and exerting a calming effect. While this is effective for treating anxiety and panic disorders, the relaxing effect can be addicting.

Medical Uses for Xanax
  • Generalized Anxiety Disorder (GAD) – Generalized anxiety disorder is a type of anxiety disorder characterized by a chronic state of worrying, often about trivial things that do not warrant the degree of anxiety experienced.
  • Panic Disorder – Panic disorder is a type of anxiety disorder characterized by episodes of debilitating anxiety, often accompanied by increased heart rate and profuse sweating. Xanax’s fast onset of action helps those suffering from panic attacks regain control.
  • Agitation – Sometimes patients with dementia or drug-induced psychosis experience episodes of agitation. Xanax’s fast onset can quickly calm these people down so they are no longer harmful to themselves or others.
  • Insomnia – Insomnia is difficulty getting to sleep and/or staying asleep. Xanax is often used short term to help people get to sleep. Because tolerance develops rapidly to Xanax’s sleep-inducing effects, its use in insomnia should be limited to no more than 1-2 weeks. 
Xanax Side Effects

Xanax is associated with a significant amount of side effects. Some side effects are short term and only last while under the effect of the drug while others are seen when taken for a long period of time.

  • Amnesia – While taking Xanax, users may have a difficult time retaining memories of what happened while under the influence the drug.
  • Drowsiness/tiredness – Xanax can make a user feel incredibly tired. While this is useful as a sleep aid, those who abuse the drug may fall asleep at work or even while driving.
  • Confusion – Because Xanax slows down brain activity, it can make users feel confused and slow down their reaction time. 
  • Agitation/nervousness – While most people feel calm and relaxed after taking Xanax, some users experience an opposite reaction and can feel agitated or nervous.
  • Depression – Long term use of Xanax is associated with significant depression and loss of motivation.
Xanax Overdose

Xanax can be dangerous if too much is taken. The amount of Xanax that results in an overdose ranges from person to person. Some factors that affect the severity of an overdose include:

  • Body weight – The effects of Xanax will be stronger in an individual with lower bodyweight, and vice versa. For example, a normal dose for a 250 lb male may result in a dangerous overdose for a 100 lb female. 
  • Age – The effects of Xanax are stronger in the elderly compared to younger users. 
  • Liver function – Xanax is processed through the liver. In older individuals or those with impaired liver function, Xanax can build up over time, causing increasingly severe side effects and eventual overdose.
  • Drug mixing – While Xanax alone is unlikely to cause death, even in cases of overdose, the combination of Xanax with other central nervous system depressants such as alcohol or opioids can result in death due to respiratory depression.

The symptoms of Xanax overdose are similar to the expected side effects except more pronounced. Symptoms of Xanax overdose may include:

  • Excessive confusion
  • Slurred speech
  • Slow reflexes
  • Unconsciousness
  • Respiratory depression

Despite Xanax overdose being dangerous, death is unlikely if it is the only drug involved. When combined with other central nervous system depressants such as alcohol or opioids, the risk of death increases dramatically. Benzodiazepines should never be mixed with alcohol and its use with opioids should be limited.

Xanax Abuse and Addiction

The relaxing effects of Xanax can be addicting. A 2018 study found that of those prescribed benzodiazepines such as Xanax, 17% had misused them. When asked why they misused benzodiazepines, the most common reason was to “relax or relieve tension.”

Addiction to Xanax sometimes starts out taking it as prescribed. Over time, a user may take more than what their doctor told them to. As the user takes more, their body becomes adjusted to the higher dose and they take more to feel the same effect. Because tolerance develops quickly, it does not take long to develop an addiction to Xanax.

Signs of Xanax Addiction

Signs of addiction may vary from individual to individual, however every user will experience side effects that are difficult to hide. The following are warning signs that may signal abuse of Xanax.

  • Constantly feeling tired – While Xanax is expected to cause drowsiness when used as directed, constant tiredness due to overuse may indication addiction.
  • Depression – Long term benzodiazepine use is associated with depression. A user may have a lack of motivation to do things they used to and neglect responsibilities at work or school.
  • Drug craving/drug seeking behavior – If a user is dependent on Xanax and not able to acquire it, they may exhibit drug seeking behavior such as drug craving, lying or stealing from a friend or family member.
 Tolerance and Dependence

Tolerance to Xanax develops quickly. Tolerance is when the body adjusts to the drug and more is required to achieve the same effects. This will often lead to users taking larger doses or taking it more often to feel the relaxing feeling. Over time, a user may become dependent on Xanax to function normally; this is known as dependence. Once a user is dependent, withdrawal symptoms are experienced if they do not take it.

Xanax Withdrawal

Users who are psychologically dependent on Xanax require it to feel normal and may experience the following if it is stopped:

  • Anxiety
  • Insomnia
  • Irritability
  • Panic attacks

Long term use can also cause physical dependence, which is significantly more dangerous. If a user who is physically dependent on Xanax does not take it, they can experience the following:

  • Sweating
  • Muscle pain
  • Sensitivity to light and noise
  • Seizures

Of the physical withdrawal symptoms, seizures are by far the most dangerous as they can be life-threatening.

Treatment for Xanax Addiction

Treatment for Xanax addiction focuses on both the mental and physical health of the user.

Control of the mental cravings will focus on behavior modification therapies such as cognitive behavioral therapy, counseling sessions and group therapy.

If admitted to a treatment center, the first goal will be controlling withdrawal symptoms. Many times, a user will be switched to a longer-acting benzodiazepine such as Valium (diazepam), as it can provide longer control of withdrawal symptoms than Xanax due to its longer half-life.

Some users may attempt to suddenly discontinue Xanax after long term use. This dangerous practice known as “cold turkey” can result in life-threatening seizures and should never be attempted. Going cold turkey been shown to be less effective than slowly decreasing the dose over time (tapering).

Substance use disorders such as Xanax addiction are a difficult challenge to overcome. An addiction specialist can help you along the path to recovery to begin a drug-free life.

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