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Xanax (Alprazolam) Abuse, Addiction, And Treatment Options

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 1, 2019

Xanax is intended to provide short-term relief from anxiety. Abusing it, however, can cause it to have the opposite effect, and increases a person’s risk of overdose, dependence, and addiction.

Xanax (alprazolam) is a benzodiazepine drug prescribed to treat anxiety issues, such as panic disorder and generalized anxiety disorder (GAD). It is intended to be used for temporary relief, and may be less effective after several weeks.

In order to feel the effects of Xanax more strongly, an individual with a prescription may increase their dose or frequency of use without consulting their doctor. This is dangerous, as using Xanax outside of prescription guidelines can lead to addiction and physical dependence.

Xanax has the potential for abuse not only by individuals who have been prescribed the drug for anxiety, but also by people who do not suffer from an anxiety disorder. Some individuals who do not have a prescription for Xanax find ways to obtain it illegally, whether online, from a friend, or on the street.

The allure of Xanax is that it slows down the central nervous system, which allows the body and mind to relax. It also produces a sense of euphoria in some people. These effects reduce everyday stress as well as severe anxiety, and are therefore desirable even to people without a diagnosable mental disorder.

How Does Xanax Work?

Xanax works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. Neurotransmitters are chemicals that carry messages to different parts of the brain. GABA is responsible for controlling brain activity, preventing too much excitement or overstimulation.

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The standard version of Xanax takes effect right away, which is why this drug is attractive as an anxiety treatment and a substance of abuse. Unfortunately, Xanax also has a short-half life, which means it does not stay in the body very long.

There is also an extended release (XR) version of Xanax that enters the system more slowly. This allows it to be effective for several hours longer, reducing the frequency of doses and lowering the likelihood of abuse.

How Do People Abuse Xanax?

The most common way to abuse Xanax (alprazolam) is to take it orally by swallowing it or dissolving it beneath the tongue (sublingually). Xanax comes in tablet form and is intended to orally consumed, but some individuals may snort it, inject it, or smoke it.

Snorting (insufflation) consists of crushing the Xanax tablet into a powder and breathing it in through the nose. This may be done directly in the nostril or through a tube-like object, like a straw. While snorting takes Xanax to the bloodstream more quickly, less of the drug may be absorbed in the nose, rendering it less effective.

To inject Xanax, the tablet must be crushed and mixed with a solvent like propylene glycol to turn it into liquid form. Propylene glycol can cause injection to be painful, but Xanax does not dissolve well in water because it is fat-soluble. There is also a liquid form of alprazolam (Alprazolam Intensol) that may be more effective when injected than the dissolved tablets.

Some people smoke Xanax by heating the liquid on tinfoil and inhaling the vapors. Other individuals mix Xanax with other drugs like marijuana to smoke it, which can be very dangerous.

All of these methods pose additional risks of physical harm, as Xanax and its inactive ingredients (fillers) are not meant to be consumed in any way other than orally. Abusing Xanax in these alternative ways may also raise the chance of overdose, dependence, and addiction.

Signs Of Xanax (Alprazolam) Abuse

If someone is abusing Xanax, it may show in their behavior, mood, and lifestyle. They may act differently than they used to and surround themselves with people who also participate in substance abuse.

Signs of Xanax (alprazolam) abuse may include:

  • an unusual level of sedation
  • running out of prescriptions early
  • unmarked pill bottles
  • a residue of powder on belongings
  • straws, hollow pens, rolled paper (signs of snorting)
  • needles, tourniquet, spoons (signs of injecting)
  • tin foil, lighters (signs of smoking)

Side Effects Of Xanax Abuse

All prescription drugs like Xanax (alprazolam) carry the risk of side effects. Not everyone experiences these when taking the drug as prescribed. However, abusing Xanax often means taking it in higher, more frequent doses, which increases the opportunity for side effects to occur.

Side effects of Xanax abuse may include:

  • drowsiness
  • dizziness
  • depression
  • insomnia
  • headaches
  • dry mouth
  • constipation or diarrhea
  • impaired coordination
  • memory problems or confusion
  • changes in appetite
  • sexual dysfunction

Since Xanax is a short-acting benzodiazepine, a dose may wear off before someone takes another. This can cause “rebound anxiety,” a recurrence of anxiety symptoms that may feel even more intense than before. This causes many people to take more frequent doses to prevent this.

Besides these side effects, different modes of intake carry unique consequences that can be profoundly unpleasant. Snorting Xanax can damage the inside of the nose, causing nosebleeds and eroded tissue. Injecting it can cause abscesses and bacterial infections. As with any drug, smoking or inhaling Xanax can be harmful to the lungs.

Risk Of Xanax Overdose

More than 10,000 drug overdose deaths in the United States in 2016 involved benzodiazepines like Xanax (alprazolam). It is possible to overdose on this drug alone, especially with abuse. If someone takes frequent, high doses of Xanax, the drug builds up on their system, and the longer they take it, the more it builds up. This raises the chance of toxicity reaching dangerous levels.

The most common cause of Xanax overdose, though, is mixing the drug with other central nervous system depressants. This includes alcohol, opioids, barbiturates, and other benzodiazepines. About 80 percent of the 10,000 overdose deaths mentioned above also involved opioids.

Because these substances have similar effects on the brain and body, combining them can cause too much sedation, resulting at times in inability to breathe, loss of consciousness, coma, and death.

Polysubstance use with drugs that do not have similar effects is dangerous as well. It can be difficult for someone to measure how much of each substance they can take without overdosing. Because some drugs, like stimulants, have opposing effects to Xanax, a person may think they are less intoxicated than they actually are.

Unfortunately, an individual may experience overdose because of Xanax abuse even if they are careful. Several reports have surfaced about fake Xanax pills being sold on the street that contain the deadly opioid fentanyl, which is up to 100 times stronger than morphine. Many people have been hospitalized and several have died from unknowingly overdosing on fentanyl.

Xanax Withdrawal And Detox

Benzodiazepines like Xanax (alprazolam) are not generally prescribed for long-term use because most people develop a tolerance to them after a few weeks. The body likes balance, so it reduces some of its normal functioning to counteract the functioning of Xanax. This makes the body less responsive to the drug.

If a person increases their dosage in response, the body will likely continue to adapt, leading to physical dependence. When someone stops taking Xanax after their body has significantly adjusted to it, they will experience withdrawal symptoms. Benzodiazepine withdrawal can be unpleasant, severe, and even deadly.

Doctors usually taper patients off of Xanax to reduce the occurrence and severity of withdrawals. This may be done within a medically supervised detox program. These programs are staffed with medical professionals who keep a person safe through the withdrawal process. Medical detox involves stabilization, nutrition, and hydration.

These programs may also include medication that eases withdrawal symptoms and counseling that begins to deal with issues surrounding Xanax abuse. Because Xanax affects brain function as well as bodily function, the brain can become dependent on it too. Changes in brain structure occur as it attempts to balance the effects of Xanax and prevent oversedation.

Without Xanax, the brain has to relearn how to naturally regulate GABA, which takes time. Meanwhile, a person experiences strong psychological cravings that make it hard to stop taking Xanax.

Signs Of Xanax (Alprazolam) Addiction

An individual who has developed a Xanax addiction is no longer in control of their drug use. Since Xanax becomes less effective over time, continuing to abuse it may cause paradoxical symptoms like anxiety and panic. Even so, a person who is addicted will continue to take it despite obvious negative results.

Signs of Xanax (alprazolam) addiction may include:

  • multiple prescriptions from various doctors (“doctor shopping”)
  • spending time with people who use Xanax frequently
  • depending on Xanax to get through the day
  • taking another dose of Xanax every time it wears off
  • missed obligations
  • less interest in social activities
  • distance in formerly close relationships
  • financial difficulties
  • job loss

Even if the individual recognizes their Xanax use as a problem and tries to cut back, they will likely be unable to stop or reduce Xanax use without relapsing. This is because addiction is a mental disease that cannot be overcome by willpower alone. It is beneficial for most individuals to seek help through a formal treatment program.

Treatment For Xanax (Alprazolam) Addiction

Treatment for Xanax (alprazolam) addiction should be comprehensive. Addiction does not only affect one area of life, but can alter and destroy relationships, health, productivity, and hope. An individualized treatment program focuses on the areas that are unique to each person: the struggles that led them to addiction, and the suffering that addiction has caused in their life.

These programs may take place in an outpatient setting, which allows flexibility for individuals to stay at their jobs and continue their family responsibilities. However, these roles are part of the problem for many people and can interfere with treatment progress. Inpatient addiction treatment removes these distractions and places people in a supportive community of like-minded peers.

Many individuals who abuse Xanax and become addicted to it are unable to manage stress in a healthy way. Both the body and mind can be negatively affected by stress. Addiction treatment programs address this by teaching coping skills, encouraging fitness, providing nutritional meals, and fostering positive relationships.

Individuals who have been diagnosed with an anxiety disorder could benefit from dual diagnosis treatment as well. This deals with co-occurring disorders which can cause or result from substance abuse.

Counseling and behavioral therapy are important aspects of Xanax addiction treatment as well. These methods work with individuals to pinpoint negative thought patterns that lead to unhealthy behaviors. Examining and resolving underlying issues during treatment is vital to preventing relapse and promoting complete recovery.

U.S. National Library of Medicine: DailyMed - Label Xanax - alprazolam tablet

U.S. National Library of Medicine: DailyMed - Label Xanax XR - alprazolam tablet, extended release

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