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February 2019: xanax Addiction

Xanax Addiction

Xanax is the brand name for alprazolam, a drug which is prescribed to treat anxiety and panic disorders. It is the most prescribed psychiatric medication in the United States. Xanax belongs to a group of drugs known as benzodiazepines (“benzos”), which are a group of drugs that are primarily used to treat anxiety and panic attacks.  

Xanax can be highly addictive, and yet prescription rates have been steadily increasing annually from 8.1 million in 1996 to 13.5 million in 2013 (67% increase). From 2005 to 2015, continuing prescriptions increased by 50 percent. Alongside the increase in prescriptions has been a steady and significant increase in the number of overdose deaths. Between 1999 and 2017, overdose deaths involving benzos has increased by nearly eight-fold with 11,537 deaths in 2017.  

A key driver in the increase in the number of prescriptions, and related increase in addiction rates and overdose deaths, may have to do with who is prescribing most of the benzo prescriptions in the United States. More than half of all benzo prescriptions, a medication prescribed for a psychiatric condition, are not being prescribed by a psychiatrist.  

The majority of benzo prescriptions are actually being prescribed by primary-care physicians. According to one study, 55% of benzodiazepines were prescribed by a primary-care physician, 27% were prescribed by physicians of other specialties, and only 18% were prescribed by psychiatrists. This may contribute to the findings of a 2018 University of Michigan study which found one in four older adults prescribed a benzo by a primary-care physician went on to develop risky long-term use. The study also found, “those whose initial prescriptions were written for the largest amounts were also more likely to become long-term benzodiazepine users. For just every 10 additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year”. Another study also found that clinicians prescribed benzos more frequently to patients with greater risks for benzo-related adverse events. Additionally, of the 65,000 patients included in the study, 52% of the patients prescribed high-dose benzos were concurrently prescribed antidepressants (more on depression and xanax can be read here).  

Xanax & Opiates 

Using benzos and opioids together can be extremely dangerous and lead to overdose death. Recent CDC guidelines recommend avoiding concurrent opioid and benzodiazepine prescribing. This is likely in response to the significant increase in their co-prescriptions which quadrupled between 2003 and 2015. More than 30% of overdoses involving opioids in 2017 also involved benzodiazepines. 

A study recently published in January, 2019 reviewed benzo prescriptions in ambulatory care visits between 2003 and 2015. The study reinforced the increasing prescribing by general-care physicians (prescribing by psychiatrists remained stable), but also found that benzos were increasingly prescribed for chronic pain. Prescription rates for  back or chronic pain increased from 3.5% in 2003 to 8.5% in 2015, more than doubling. This was the largest percentage increase across all conditions treated, and yet, recent studies indicate that benzos are not effective in treating pain. Long term use may in fact result in hyperalgesia which increases the feeling of pain by lowering the pain threshold. 

Abusing opiates and benzos together can be incredibly dangerous. Users describe how combining the two drugs together enhances the opioid painkiller “high”. Combing the drugs together however further depresses the respiratory system and sedation effects which can lead to depressed breathing and death. 

Risks of Combining Xanax & Other Drugs

Alcohol & Xanax

Both Xanax and Alcohol are depressants which is why mixing the two can be very dangerous. Both drugs have the effect of creating drowsiness but also decreasing heart rate and respiration which can lead to a fatal overdose. Mixing Xanax and alcohol in particular is dangerous as Xanax is a more faster acting benzo. 

Xanax & Other Benzos

Some people think taking two different benzos at the same time can help their condition, but doing so carries much greater risks of benzo overdose. A common pairing is Xanax and Klonopin, which can lead to life-threatening complications such as coma, cardiac arrest, and death. Additionally, mixing multiple benzos can lead to an addiction and make it much harder to recover from a benzo addiction.

Signs of Xanax Addiction

Whether in a teen or adult, it’s important to see and understand the signs of Xanax abuse. The drug has become more widely available with an increase in its prescribing over the last decade, and its recent presence in pop-culture. If your teen or loved one is using or abusing Xanax, they may exhibit some or all of the following symptoms:

  • Drowsiness and sedation
  • Memory problems and lack of concentration 
  • Lack of coordination and/or focus
  • Nausea and/or headaches
  • Slurred speech
  • Blurred or double vision

Some of the visible physical signs of Xanax use include slurred speech and lack of coordination. It may appear as though the individual is intoxicated by alcohol. The symptoms are more likely to be visible with greater levels of consumption. Xanax abuse can result in acute overdose from respiratory depression resulting in coma or death. 

Long-term effects of Xanax abuse can include seizures and psychotic reactions. Also as the brain and liver become adjusted to frequent Xanax use the drug becomes less effective. The brain produces less GABA which is responsible for regulating over-activity in the brain. Long-term use can lead to panic attacks and anxiety. 

If you or someone you love is suffering from Xanax addiction, it’s important to receive clinical help for detoxing. Individuals should not attempt to abruptly discontinue their use without medical supervision as withdrawal can have dangerous side effects. 

Quick Facts on Xanax

Prescription rates of Xanax have been steadily increasing annually from 8.1 million in 1996 to 13.5 million in 2013. (NCBI)

Between 1999 and 2017, overdose deaths involving benzos has increased by nearly eight-fold with 11,537 deaths in 2017. (NIDA)

More than 30% of overdoses involving opioids in 2017 also involved benzodiazepines. (NIDA)

The 2017 Monitoring the Future Study reported 4.5% of twelfth grade students had used tranquilizer such as benzos. (Monitoring the Future)

A University of Michigan study found one in four older adults prescribed a benzo by a primary-care physician went on to develop risky long-term use. (Science Daily)

In 2011, Xanax accounted for just under 10% of emergency department visits from non-medical use of pharmaceuticals. (Drug Abuse Warning Network)

Frequently Asked Questions

What is Xanax?

Xanax is the brand name for Alprazolam, a drug which is prescribed to treat anxiety and panic disorders. It is the most prescribed psychiatric medication in the United States. Xanax belongs to a group of drugs known as benzodiazepines, which are a group of drugs that are primarily used to treat anxiety. Other benzodiazepines include: Diazapam (Valium), Oxazepam (Serax), Clorazepate (Tranxene), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Flurazepam (Dalmane). Each drug differs in how quickly the drug works, how long it works, and the specific condition they are most commonly prescribed to treat. 

How does Xanax affect the brain?

Xanax is designed for short-term use to treat the acute onset of anxiety or panic attacks. It works by helping the chemicals in your brain that are responsible for calming down. Specifically, there is a neurotransmitter in the brain known as GABA (gamma amino butyric accid). It is the most abundant inhibitory “calming” neurotransmitter in the brain. The primarily role of GABA in the brain is to prevent over-stimulation in the brain, offsetting the neurological component of anxiety or panic attacks. What’s important to know is that Xanax doesn’t add GABA to the brain, it helps your existing GABA work more strongly. While this can be effective in alleviating symptoms, it also causes a chain of bodily reactions that make Xanax less effective for long-term use.

You may notice or been told that Xanax isn’t as effective two weeks after the first dose, but why is that? First, the brain recognizes that it’s calmer and reduces the production of GABA as it tries to re-stabilize. With less GABA to help assist, you’ll notice the effect of Xanax are less effective. Second, comes down to how the liver works. The liver is responsible for filtering out drugs and toxins from the blood. With continued use, the liver adapts and creates additional enzymes that break down and remove the drug from the blood stream. If it feels like Xanax isn’t have the same effect over time on your body, you’d be right. Not only are there less GABA inhibitors in the brain, but your liver is filtering out the drug from your system more quickly. 

Is Xanax addictive?

Xanax is classified as a Class IV drug with a low potential for abuse and dependence, yet the statistics speak for themselves: more than 30% of overdoses involving opioids also involved benzodiazepines, a national survey found 4.7% of twelfth graders had used these type of drugs in 2017, and one study found that up to 44% of chronic users become dependent. As most prescribed psychiatric medication in the United States, this is cause for concern.

Why are people becoming addicted to Xanax? In part, the medication is fast-acting and, as noted above, the drug has a more limited effect on the brain over time. This can lead to greater and greater use to achieve the same “high”. All of this leads to the challenges of stopping. The withdrawal symptoms and effects become more severe with greater and longer use. Abrupt cessation after chronic use can have severe and potentially dangerous withdrawal symptoms. It takes the brain time to re-balance and produce greater levels of GABA (the calming agent enhanced by Xanax).

How is Xanax addiction treated?

If you or someone you love is suffering from Xanax addiction, it’s important to receive clinical help for detoxing. Individuals should not attempt to abruptly discontinue their use without medical supervision as withdrawal can have dangerous side effects including seizures which can be lethal. Also as the brain and liver become adjusted to frequent Xanax use the drug becomes less effective. The brain produces less GABA which is responsible for regulating over-activity in the brain. Long-term use can lead to panic attacks and anxiety. 

Addiction detox and treatment facilities can help you or a loved one get the help they need to end their Xanax addiction in a safe environment. Contact us today to learn more about treatment options. 

Xanax Withdrawal

Xanax has a short half-life (about 11.2 hours), meaning it exits the body quickly (faster than other benzodiazepines). Individuals should not attempt to abruptly discontinue their use without medical supervision as withdrawal can have dangerous side effects including seizures which can be lethal. 

Long-term use conditions the brain to operate with the presence of the chemical. The brain produces less GABA, the chemical enhanced by Xanax to calm over-active parts of the brain, when frequent use. As a result, sudden cessation can shock the brain and send it into a panic. 

Psychological Withdrawal Symptoms

It is better to slowly come off of the drug in a controlled setting monitored by a healthcare professional. Withdrawal can have psychological effects including anxiety and panic. While the severity of symptoms vary person to person, they can be made worse based on the amount of the drug the person was taking prior to withdrawal. Other psychological effects include:

  • Paranoia and fear
  • Depression 
  • Anxiety and panic
  • Insomnia

If you or someone you love is suffering from Xanax addiction, it’s important to receive clinical help for detoxing. Individuals should not attempt to abruptly discontinue their use without medical supervision as withdrawal can have dangerous side effects and in very rare occasions has resulted in death. 

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