Xanax is the brand name of the prescription benzodiazepine alprazolam and is approved for use in the management of anxiety and panic disorders.
Although Xanax is considered to be a helpful medication for these disorders, it presents a high risk of addiction and is commonly abused, often with alcohol or other CNS depressants.
Understanding Xanax Dependence and Addiction
As the National Institute on Drug Abuse explains, there’s 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 drug use and abuse.
Xanax is indicated for short-term therapeutic use and shouldn’t be prescribed for longer than one month, as it can be habit-forming due to a high risk of dependence and addiction. When taking Xanax in accordance with the prescribing doctor’s orders, a person is less likely to develop an addiction. Despite not being addicted, the person will still become physically dependent on the drug.
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. 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 and even life-threatening, especially if it’s being misused in conjunction with alcohol or other CNS depressants.
Addiction not only includes physical dependence but also psychological attachment. A person who’s addicted to Xanax (in clinical terms, the person is said to have 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 associated with repeated drug use and addiction.
Xanax Withdrawal Symptoms
There are numerous Xanax withdrawal symptoms, which may be mild, moderate, or severe. One of the dangers inherent in any withdrawal process is that individuals never know exactly how the mind or body will react.
The most common psychological withdrawal symptoms of Xanax are:
- Anxiety and panic disorders: Xanax works in the brain by enhancing the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, and that leads to a reduction in panic and anxiety—hence, the person feels relaxed. When the body is subsequently deprived of Xanax, the person may experience severe anxiety, the opposite effect. Further, a person who doesn’t have the psychological tools or support network to cope with this severe anxiety may find it painful, even unbearable.
- Restlessness, agitation, and reduced concentration: 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, mood swings, and suicidal ideations: It’s extremely common for individuals in Xanax withdrawal to experience depression. For some, Xanax was a relief from anxiety and 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. In extreme cases, the severe anxiety, stress, and nervousness that’s associated with Xanax withdrawal can trigger suicidal thinking.
- Hallucinations: Although rare, when a person stops abusing Xanax, neurons in the brain may become overexcited, leading a person to experience disorders of perception or hallucinations.
- Memory problems: Research shows that long-term Xanax use may carry an increased risk of dementia. Xanax withdrawal is associated with memory problems during withdrawal; however, these problems are typically reversed within a few months.
- 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. A person is at a higher risk for psychosis particularly when they withdraw from Xanax too quickly.
The physical symptoms of withdrawal range from mild (e.g., muscle tension, weakness, headaches, spasms, pain, sweating, shivering, nausea, vomiting, and having “pins and needles) to severe and potentially life-threatening:
- Seizures: Seizures are quite common when a person abruptly stops taking Xanax (i.e., goes cold turkey). These occur when a person’s muscles very quickly and repeatedly contract and then relax. Tapering can avoid seizure onset or lessen the intensity of the seizures.
- Increased heart rate and 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.
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
Xanax is a sedative drug, which may make it seem rather benign, but this isn’t the case case. Abuse of Xanax can be extremely dangerous, if not fatal. Those who decide to quit without understanding that they are physically dependent on the drug may think that quitting abruptly (i.e., “cold turkey”) is a viable option. However, the cold-turkey approach is rife with problems:
- Going cold turkey doesn’t involve the recommended tapering process.
- When a person goes cold turkey, the sudden abruptness of withdrawal often precipiates severe and potentially life-threatening withdrawal symptoms.
- A person may not have the personal skills or supportive network to navigate the psychogical discomfort, pain, or dangers that may be presented during and after withdrawal. Cognitive behavioral therapy (CBT) supports the positive changes and skills an individual needs to have to succeed in overcoming their addiction. Without CBT, the person is at risk of a relapse.
- The cold-turkey method doesn’t have any of the safeguards of medical detox, including the care of professional medical staff members who are prepared and ready for any emergencies that may arise.
During medical detox, a person enters a specialized inpatient or outpatient program that’s geared toward weaning the recovering person off Xanax. A team of doctors and addiction specialists will work together to initiate the recovering person into the tapering process.
There’s 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’s no more Xanax in the body). This 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’s a 40–60% relapse rate for substance abuse. Since relapse is a possibility, medical detox from Xanax—with it’s ongoing supervision, care and support—can be seen as a way of making a concerted effort to effectively taper off this drug. On the other hand, going cold turkey without the oversight and safeguard of the medical detox staff, seems to run headlong into the possibility of a relapse.
Although this article has focused on Xanax withdrawal and medical detox, it’s critical to note that detox alone is never enough. In short, detox is medically necessary but not sufficient to treat addiction, which has a strong psychological component. Primary care treatment, specifically cognitive behavioral therapy, plays a strong role in helping 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 successfully navigate drug-use triggers and avoid relapse.
Going cold turkey key doesn’t provide the time a person needs to develop a new way of thinking and behaving in order to stay clear of the abused substance and move toward an alternative course of action.