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Xanax Abuse and Addiction

Xanax (alprazolam) is a member of the benzodiazepine class of drugs. There are more than 15 different types of benzodiazepines, and together, these drugs represent some of the most commonly prescribed medications in the United States. 1

Addiction to and abuse of benzodiazepines like Xanax has skyrocketed in recent years, with the number of overdose deaths from benzodiazepines rising 830% from 1999 to 2017 in women aged 30 to 64.2 According to a 2016 study, admission to drug treatment programs due to benzodiazepine abuse tripled between 1998 and 2008.3

Keep reading to learn more about what Xanax is, what substance abuse looks like, and the available treatment options for Xanax addiction.

What is Xanax?

box of xanaxXanax and other benzodiazepines first entered the market in 1960. Although it may have other illegal or nonclinical uses, Xanax is legally prescribed to treat anxiety disorders, panic disorder, and anxiety caused by depression. 3

It works by decreasing abnormally high levels of excitement in the brain, which helps you feel more relaxed and increases feelings of calmness.4 Xanax is one of the most frequently prescribed benzodiazepines, accounting for more than 48 million prescriptions in 2013.5   

How Xanax Works

Xanax (and all benzodiazepines) stimulate neurons in the brain that release or have receptors for the neurotransmitter gamma-aminobutyric acid (GABA). GABA is the primary inhibitory neurotransmitter in the central nervous system and neurons for GABA are prevalent throughout the cerebral cortex.3

An inhibitory neurotransmitter reduces the firing of other types of neurotransmitters in the brain when it’s released. Thus, Xanax acts as a central nervous system depressant by way of its agonistic effect on GABA neurons in the brain.3

Taking Xanax leads to a decrease in the excitability of other neurons in the brain, and this produces a reduction in anxiety and an increased feeling of relaxation.3, 6

Xanax is classified by the US Drug Enforcement Agency as a Schedule IV drug. These drugs are said to have a low potential for abuse and physical dependence. 7 However, many prescribers believe Xanax has a high potential for abuse and addiction because of its severe withdrawal syndrome, even when tapered off according to manufacturer guidelines.5

Signs of Xanax Abuse Or Addiction

Xanax and other benzodiazepines are frequently abused because they are so commonly prescribed and therefore easily available. The severe withdrawal syndrome associated with Xanax abuse can make it difficult for people to stop using.5

Xanax is a short-acting drug, so the effects wear off quickly, which can cause people to want more frequent administrations or higher doses. Additionally, because Xanax affects the system of the brain, which produces dopamine (your brain’s reward chemical), you can become addicted to the feel-good “high” and relaxation associated with Xanax use.5

Some of the common signs of Xanax abuse and addiction include:8

  • Taking Xanax in increasing amounts or for longer periods of time than originally intended.
  • Being unable to reduce Xanax use despite a desire to do so.
  • Spending a lot of time trying to get, use, or recover from the effects of Xanax.
  • Feeling cravings, or a strong desire to use the drug.
  • Being unable to fulfill major obligations at work, home, or school because of Xanax use.
  • Continuing to use Xanax despite having interpersonal or social problems that are likely due to drug use.
  • Giving up important social, work, or recreational activities because of Xanax use.
  • Repeatedly using Xanax in situations where it is dangerous to do so, such as driving or operating machinery.
  • Tolerance, which means you need to take higher amounts or more frequent doses to feel the same effects.
  • Withdrawal, which means you experience unpleasant physical and mental symptoms when you stop using the drug.

Who Abuses Xanax?

Nonmedical use of prescription drugs is a major concern in the U.S. The National Institute on Drug Abuse reports that 18 million people over 12 years of age admitted using prescription drugs for nonmedical reasons at least once in their lifetime.9

Statistics indicate that non-white Hispanics have a higher rate of Xanax abuse than people from other demographics. Gender does not seem to play a significant role. Young adults between age 18 and 35 have the highest rate of benzodiazepine abuse. 3

People with a co-occurring psychiatric disorder (like depression or bipolar disorder) have a higher rate of abuse as well, with a reported rate of around 40%. Finally, people who have a history of alcohol dependence or antisocial personality disorder have also been reported to have a higher risk of benzodiazepine abuse.3

Recreational use of Xanax alone is comparatively rare: It’s more common for people to mix Xanax with other drugs of abuse. Opioids and alcohol are most frequently the primary drugs of choice—around 1 in 5 people who abuse alcohol also abuse benzodiazepines. 3

In addition, people who abuse certain types of drugs, such as cocaine, may also abuse Xanax to ease the effects (such as insomnia) associated with the comedown from these drugs.3

Recreational users of Xanax may procure the drug from some illegal source, such as buying it on the street or getting it from a person who has a prescription. People may also buy it through illegal websites, the dark web, or social media apps. 3

However, many people originally receive it via prescription for medical use and then begin to take it for nonmedical reasons. Around one-third of people who abuse benzodiazepines obtain the drug from multiple or illegal sources.3

Xanax Overdose

Overdose may occur from Xanax alone, but the risk of overdose is higher when combined with other substances, such as opioids and alcohol, as this can increase the chance of respiratory depression. This is a significant concern for many people, as benzodiazepines and opioids are commonly prescribed together. Respiratory depression causes slow and ineffective breathing, potentially causing a person to die in their sleep.3

According to the National Institute on Drug Abuse, the total number of overdose deaths involving benzodiazepines nearly tripled from 2007 to 2017, with 4,500 deaths in 2007 compared to 11,537 in 2017.10

The key signs of benzodiazepine overdose include:11

  • Excessive sedation.
  • Anterograde amnesia, meaning an inability to recall the recent past.
  • Coma (usually due to high doses or when combined with other substances).
  • Respiratory depression.
  • Death (due to respiratory depression).

Treatment for Xanax Abuse

Seeking help for Xanax abuse is one of the most advisable ways to overcome addiction. People who are addicted to sedatives such as Xanax are advised not to stop using on their own, as this can cause painful and sometimes dangerous withdrawal symptoms. 12

Many people first enter detox, which helps manage withdrawal symptoms as the drug is cleared from your body.

Research has found that a combination of behavioral therapy and medication is a beneficial way to treat prescription drug addiction. Behavioral therapy helps you identify and change dysfunctional or negative thinking patterns and teaches you healthier coping behaviors, while medication can help ease withdrawal symptoms and make it easier for you to avoid relapse.12

If you choose to enter treatment for your recovery, know that with a quality facility dedicated to a continuum of care, you have several options.

You may choose outpatient treatment, where you live at home and travel to a treatment center on a regular schedule, or inpatient treatment, where you reside at a rehabilitation facility for the duration of treatment.

Regardless of the type of treatment you choose, know that you’re not alone. Recovery from Xanax addiction is possible, and with proper treatment, you can begin to live a happier, healthier, and drug-free life.

 

References

  1. American Chemical Society. (2014). Alprazolam.
  2. VanHouten, J.P., Rudd, R.A., Ballesteros, M.F., & Mack, K.A. (2019). Drug overdose deaths among women aged 30-64 years—United States, 1999-2017. Morbidity and Mortality Weekly Report 68(1), 1-5.
  3. Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A reviewThe Mental Health Clinician6(3), 120–126.
  4. Medline Plus. (2017). Alprazolam.
  5. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawalJournal of Addiction Medicine12(1), 4–10.
  6. Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effectsThe Ochsner Journal, 13(2), 214–223.
  7. United States Drug Enforcement Administration. Drug scheduling.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA, US: American Psychiatric Publishing.
  9. National Institute on Drug Abuse. (2018). Misuse of prescription drugs: what is the scope of prescription drug misuse?
  10. National Institute on Drug Abuse. (2019). Overdose death rates.
  11. Gahlinger, P. (2019). Benzodiazepine overdose. BMJ Best Practice.
  12. National Institute on Drug Abuse. (2018). Misuse of prescription drugs: How can prescription drug addiction be treated?
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More