Xanax is the brand name of a prescription drug with the generic medication, alprazolam, as its active ingredient.
Xanax, like other benzodiazepines, is indicated for the treatment of anxiety disorders, panic disorders, and the anxiety component of certain forms of depression. Although Xanax is considered to be a helpful medication for these and other disorders, it presents a risk of addiction when abused. In fact, the abuse of Xanax and other benzodiazepines is a main contributor to the prescription drug abuse epidemic in America.
Understanding Xanax Dependence and Addiction
As the National Institute on Drug Abuse explains, there is an important distinction between physical dependence and addiction. An understanding of the difference between these two biological states is especially important in the context of prescription pill use and abuse. Again, Xanax is a prescription medication that has a known therapeutic use while at the same time having the potential to be addictive. It is well established in the medical community that a person who takes Xanax in accordance with the prescribing doctor’s orders will like not develop an addiction. However, over time, this person will become physically dependent on the drug. Stated another way, all individuals who are addicted to Xanax, or other physically addictive drugs, will be physically dependent but not all people who are physically dependent are addicted.
The two main markers of physical dependence are tolerance and withdrawal. Tolerance is a natural process whereby the body needs more of a drug to deliver the desired effects over time. In the case of Xanax abuse, the desired effect is usually a Xanax high. Withdrawal is also a natural process. When a person stops taking Xanax, or significantly reduces the regular dose, the body will manifest withdrawal symptoms in response to not having the drug. Xanax withdrawal can be especially dangerous.
Again, addiction not only includes physical dependence but also psychological attachment. A person who is addicted to Xanax (in clinical terms, the person has a sedative use disorder) will demonstrate behaviors and thoughts that are disproportionately geared toward getting, using, and protecting the drug abuse. These types of behaviors reflect neurobiological changes in the brain; some research shows that the addicted brain may be physically altered in a way that narrows the person’s focus to getting and using drugs.
Xanax Withdrawal Symptoms
Typically, the last dose of Xanax a person takes remains in the body for 2-4 days. In some cases, withdrawal symptoms may emerge when the body is fully detoxed from Xanax, but in other cases, the symptoms may manifest even while there is some of this sedative drug in the body. However, literature that discusses detoxification from Xanax may focus on prescribed users. Since individuals who abuse Xanax typically use larger amounts of this drug, a full detox can be dangerous.
There are numerous Xanax withdrawal symptoms, and they may be mild, moderate, or severe. One of the dangers inherent in any withdrawal process is that individuals never know exactly how the body will react. The following is an explanation of some of the known psychological symptoms associated with Xanax withdrawal (this is a partial list):
- Anxiety: Xanax works in the brain by binding with GABA receptors, which has the effect of calming down nerve activity; hence, the person feels relaxed. When Xanax abuse stops, the person may experience severe anxiety, the opposite effect. Further, a person who does not have the psychological tools or support network to cope with this severe anxiety may find it painful, even unbearable. This severe anxiety may subside over time.
- Inability to concentrate: There have been numerous reports of people in withdrawal not being in possession of their normal level of concentration. Studies show that this symptom of withdrawal may persist for weeks.
- Depression: According to studies, it is extremely common for individuals in Xanax withdrawal to experience depression. There are different potential sources of this depression. For some, Xanax was a relief from underlying depression, the symptoms of which re-emerge when the Xanax abuse ends. In other instances, the uncomfortable coexistence of all the withdrawal symptoms can cause a person to feel depressed.
- Hallucinations: When a person stops abusing Xanax, neurons in the brain may become overexcited. This is especially true when Xanax use abruptly ends (i.e., tapering off the drug does not occur). As a result, a person may experience hallucinations. Though considered to be rare, these are serious symptoms.
- Memory problems: Research shows that long-term Xanax use can lead to the onset of dementia. Relatedly, Xanax withdrawal is associated with memory problems during withdrawal. Typically, these problems will be reversed within a few months of beginning withdrawal.
- Suicidal ideations: The severe anxiety, stress, and nervousness that are associated with Xanax withdrawal can trigger suicidal thinking. Although this symptom will typically improve over time, a person may not have the resources and tools to effectively cope with these thoughts, which can present obvious dangers.
- Psychosis: Even if a person has never experienced a psychotic episode, withdrawing from Xanax can lead to one. Essentially, the withdrawal process itself induces psychotic symptoms. There is a risk for psychosis particularly when a person withdraws from Xanax too quickly. Further, treatment needs to be tailored to the withdrawal scenario. General antipsychotic medication may not be effective in this context, but a qualified doctor should know how to treat psychosis associated with Xanax withdrawal.
Xanax withdrawal is also associated with a host of physical symptoms that range in intensity. The following is a partial list, and explanation, of some of the known physical side effects:
- Convulsions: These occur when a person’s muscles very quickly and repeatedly contract and then relax. Convulsions are most common when a person abruptly stops taking Xanax (i.e., goes cold turkey). Tapering can avoid the onset of convulsions or lessen the intensity of the convulsions.
- Headaches: Severity varies. Some individuals may experience minor headaches while others have major migraines.
- Sweating: There may be intense sweating. The sweating may occur day and/or night. Night sweats may be more extreme than day sweats.
- Tingling: A person may feel tingling sensations throughout the body. It may be difficult to cope with this uncomfortable feeling. This symptom is well documented and among the more common symptoms.
- Tremors: This symptom involves uncontrollable shaking, particularly of the hands and arms. Tapering off the drug can help to stop tremors or avoid them in the first place.
- Vomiting: Xanax withdrawal can cause intense nausea. A person may experience vomiting.
- Palpitations: A person may experience a rapid heartbeat. It may be difficult for a person to relax and cope with this side effect, especially because it may feel like something even more severe is occurring. A person may not be able to distinguish between palpitations during Xanax withdrawal and the symptoms of a heart attack, which can drive up stress considerably.
As the foregoing symptoms reference, sudden withdrawal from Xanax can precipitate severe symptoms. As will be discussed in the next section, this is the specific reason why medical detox is advisable. Severe withdrawal symptoms may be avoided, or at least effectively and safely managed, during the Xanax withdrawal process.
Quitting Xanax Cold Turkey vs. Medical Detox
One reality of Xanax is that many individuals who abuse this drug are likely to be in the dark about its dangers. Xanax is a sedative drug, which may make it seem rather benign, but this is not the case. As mentioned, withdrawal from this calming drug can be fraught with severe anxiety. Just as a person may have a lack of knowledge about the dangers of Xanax abuse, so too may a person not understand the dangers of withdrawal. Individuals who do not have insight into what happens during withdrawal may think that going cold turkey is a viable option. However, the cold-turkey approach is rife with problems.
- Going cold turkey does not involve the recommended tapering process.
- When a person goes cold turkey, the suddenness of the withdrawal may precipitate severe withdrawal symptoms.
- A person may not have the personal skills or supportive network to navigate the potential discomfort, pain, or dangers that may be presented during withdrawal. As a result, the person is at risk of a relapse.
- The cold-turkey method does not have any of the safeguards of medical detox, including the care of professional medical staff members who are prepared for any emergencies that may arise.
During medical detox, a person enters a specialized inpatient or outpatient program that is geared toward weaning the recovering person off Xanax. As discussed, a tapering approach can avoid the onset of severe withdrawal symptoms or effectively manage those that arise. Medical detox can occur at a rehab center that offers a full continuum of care, including detoxification. Alternatively, it can take place at a hospital or dedicated detox center.
A team of doctors and addiction specialists will work together to initiate the recovering person into the tapering process. There is no one-size-fits-all approach. The benzodiazepine dosage will need to be tailored to accommodate several factors, including the person’s physical state, the volume of Xanax abused, length of abuse, and whether any other drugs of abuse are in the body. As the tapering process continues, the dosing will be incrementally adjusted downward until the person is safely detoxed (i.e., there is no more Xanax in the body). The tapering timeline is different for everyone. As this is a tailored process, and a transparent one, the supervising doctor should fully discuss the detox process with clients.
As the National Institute on Drug Abuse notes, there is a 40-60 percent relapse rate for substance abuse. This statistic can be considered a reflection of the reality of recovery for some. Since relapse is a possibility, medical detox from Xanax can be seen as a way of making a concerted effort to effectively taper off this drug. On the other hand, going cold turkey, considering all its inherent problems, seems to run headlong into the possibility of a relapse. While a person is not forced to remain in a medical detox program, the ongoing supervision and care available create an incentive to complete the program. The cold-turkey approach simply does not have this safeguard in place.
Ultimately, the decision as to whether to undergo medical detox is a personal one that relies on many factors. Concerns about paying for detox should not be one of them. Private insurance may cover this service. The best practice is to contact the insurance carrier directly for information. For individuals without insurance, detox programs may be publicly funded or a detox/rehab facility may accept state-sponsored health insurance (such as Medicaid). In addition, many treatment centers also offer payment plans. In view of the potentially severe symptoms that can emerge during Xanax withdrawal, it is important to understand the risks and make an informed decision about how to manage this process.
While this discussion has focused on Xanax withdrawal and medical detox, it is critical to note that detox alone is never enough. In short, detox is necessary but not sufficient to treat addiction. As the National Institute on Drug Abuse discusses, after detox, a person will require primary care treatment for the addiction. The main pillar of treatment is therapy, on both the individual and group level.
As noted earlier, addiction has a strong psychological component. Therapy can help a person to identify the root causes of the addiction (i.e., the thoughts and emotions that underlie the abuse) as well as to develop new coping strategies to avoid relapse. The reality is that, after recovery, individuals will experience drug use triggers. The key is having a new way of thinking and behaving in place in order to pick an alternative course of action.