Xanax Addiction: Signs, Symptoms, and Treatment

Xanax (alprazolam) is a prescription benzodiazepine that is used to treat panic and anxiety disorders.1 Though its chances for misuse are lesser than the misuse profiles of other benzodiazepines, addiction science specialists consider it likely to cause dependence and addiction.1, 2 The co-occurrence of substance use disorders with mental health disorders can magnify the severity of both disorders and complicate recovery. It is vital to know the symptoms and signs of Xanax addiction. In doing so, you can know if you or someone you know should seek medical treatment, especially if Xanax is being used to treat mental health issues.

In this article:

Signs and Symptoms of Xanax Addiction

When used as prescribed, Xanax treats symptoms of mental health disorders.1 However, though Xanax treats these symptoms effectively, Xanax addiction has its own symptoms.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is used to diagnose several categories of substance use disorder. It classifies Xanax addiction as a sedative, hypnotic, or anxiolytic use disorder. This manifests with the following signs and symptoms:3

  1. You use Xanax longer than intended or in large quantities
  2. You want or try to control or minimize your Xanax use, but are unable to do so
  3. You spend lots of time using or getting Xanax, or recovering from its use
  4. You have strong urges or cravings for Xanax or other benzodiazepines
  5. You ignore or forget major responsibilities at home, work, or in school while continuing Xanax use
  6. You persist in using Xanax despite interpersonal or social problems it causes
  7. You discard or reduce participation in activities you valued previously
  8. You repeat Xanax use at times or in places that are physically dangerous
  9. You continue to use Xanax even though you know it causes psychological or physical issues for you
  10. You have built tolerance to Xanax, meaning you need more to achieve the same effects, or you feel diminished effects when using the same amount
  11. You experience Xanax withdrawal symptoms when you abruptly stop or reduce use

Two or three of these diagnostic criteria exhibited within a 12-month period after Xanax use indicate a mild use disorder. Four to five of these markers indicate moderate addiction. However, with six or more of these indicators, this may signal a severe use disorder.3

Any severity of diagnosis is serious. You should seek immediate clinical analysis if you suspect you have an addiction.

How to Identify Xanax Withdrawal

Xanax withdrawal can begin soon after you stop using it. Acute benzodiazepine withdrawal symptoms can last 5 to 28 days after your last use of Xanax.4 Prolonged withdrawal can last even 12 months or longer after you stop using the substance.5

The DSM-5 lists several indicators of withdrawal from sedatives, hypnotics, or anxiolytics, which include Xanax. These should be linked directly to stopping substance use and not better explained by signs or symptoms of another mental health disorder. If two of these withdrawal indicators arise within several hours to a few days after stopping Xanax, this may suggest a diagnosis of Xanax withdrawal:3

  • Anxiety
  • Issues with falling asleep
  • Unintended motions caused by anxiety or mental tension
  • Hand tremors
  • Pulse rates exceeding 100 BPM or sweating
  • Vomit or persistent nausea
  • Grand mal seizures (intense muscular contractions or loss of consciousness)
  • Illusions or hallucinations that are tactile, visual, or auditory in nature

Is Xanax Addictive?

Withdrawal itself is a good indicator of the addictive qualities of any substance. Moreover, the addictive characteristics of Xanax have been well attested to in literature on the subject.1

Alprazolam (Xanax) is not more liable to be abused than comparable benzodiazepines, such as Klonopin or Ativan.7, 8 However, its addictive profile remains present. In 2010, upwards of 2.4 million people 12 or older were shown to be dependent on prescription drugs such as Xanax.9 Studies have indicated panic disorder patients have increased vulnerability to Xanax withdrawal.10

For persons who have histories of substance misuse, the reinforcing effects of Xanax, being a benzodiazepine, can cause misuse.1 Along with diazepam and lorazepam, Xanax has been shown to have euphoric effects compared to placebo.2 Inducing euphoria can change the brain’s reward circuit by initiating more frequent releases of dopamine. This can lead to dependence and addiction.

Who is at Risk of a Xanax Addiction?

Anyone who misuses Xanax is at risk of developing an addiction. However; risk factors can increase a person’s likelihood. Risk factors for people to develop Xanax addiction have been well documented and studied. Having the following traits increases your risk of developing Xanax addiction and poor health outcomes:1, 10, 11, 12, 13, 14, 15, 16, 17

  • Greater age
  • History or presence of pulmonary diseases
  • Alcohol dependence
  • Use of antidepressants
  • Co-occurrence of other substance use disorders
  • Using Xanax for extended periods
  • Severe symptoms of depression
  • Belief that Xanax treatment is necessary
  • Concern about potential harmful consequences of Xanax use
  • Diagnosis of insomnia
  • Indications of current and past psychiatric illness
  • Low income
  • Low level of education
  • Current unemployment
  • Obsessive-compulsive personality disorder

Additionally, studies have shown that women are at higher risk of developing addictions to benzodiazepines such as Xanax.13

How to Treat Xanax Addiction

There exist several treatment modalities for substance use disorders, including Xanax addiction. Nearly all programs begin with detoxification, also known as medically managed withdrawal. This is intended to manage your withdrawal symptoms when you stop using the substance. Your Xanax withdrawal symptoms can be severe, physically harmful, or even life-threatening depending on the longevity of misuse and the amount you misused.9

A professional physician administers treatment during the detox phase in an inpatient setting. Outpatient care may be done depending on several factors, which will be assessed before you enter the program. Such care is medically supervised as well. You may qualify for entry into a partial hospitalization program (PHP). This is done if you need regular visits to an inpatient setting but do not need to stay for overnight supervision.9

Inpatient and Outpatient Addiction Treatment

While detox is a necessary and vital first step, it is only the beginning of your path on the continuum of care towards recovery. You will likely begin in an inpatient setting and gradually step down to outpatient care. Once this is completed, your program may offer you referrals to support groups, sober living programs, or various therapies.

Cognitive Behavioral Therapy for Xanax Addiction

One of the most common evidence-based therapies for combatting drug relapse is cognitive behavioral therapy (CBT). CBT was intended to help users prevent relapse into alcohol misuse. Gradually, it was expanded to address a host of substance use disorders.19

In CBT, you will examine how your thoughts, feelings, and behaviors influence each other. Your therapist helps you to change any unhelpful thoughts you may have into ones that can reduce emotional distress, encouraging healthy behaviors. You will enhance your self-control and develop a variety of coping strategies that are effective at maintaining sobriety.19

If you are struggling with Xanax addiction and need assistance, call 800-662-4357. You will speak with a treatment specialist who can inform and direct you towards the appropriate treatment program.

Resources

  1. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of addiction medicine, 12(1), 4–10.
  2. Orzack, M. H., Friedman, L., Dessain, E., Bird, M., Beake, B., McEachern, J., & Cole, J. O. (1988). Comparative Study of the Abuse Liability of Alprazolam, Lorazepam, Diazepam, Methaqualone, and Placebo. International Journal of the Addictions, 23(5), 449-467.
  3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  4. Hood, S. D., Norman, A., Hince, D. A., Melichar, J. K., & Hulse, G. K. (2012). Benzodiazepine dependence and its treatment with low dose flumazenil. British Journal of Clinical Pharmacology, 77(2), 285-294.
  5. Schweizer, E., Rickels, K. (2007). Benzodiazepine dependence and withdrawal: a review of the syndrome and its clinical management. Acta Psychiatrica Scandinavica, 98(s393), 95-101.
  6. Jonas, J. M. & Cohon, M. S. (1993). A comparison of the safety and efficacy of alprazolam versus other agents in the treatment of anxiety, panic, and depression: a review of the literature. Journal of Clinical Psychiatry, Suppl:25-45; discussion 46-8.
  7. Rush, C. R., Higgins, S. T., Bickel, W. K., & Hughes, J. R. (1993). Abuse liability of alprazolam relative to other commonly used benzodiazepines: A review. Neuroscience & Biobehavioral Reviews, 17(3), 277-285.
  8. Moylan, S., Staples, J., Ward, S. A., Rogerson, J., Stein, D. J., & Berk, M. (2011). The Efficacy and Safety of Alprazolam Versus Other Benzodiazepines in the Treatment of Panic Disorder. Journal of Clinical Psychopharmacology, 31(5), 647-652.
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
  10. Klein, E., Colin, V., Stolk, J., & Lenox, R. H. (1994). Alprazolam withdrawal in patients with panic disorder and generalized anxiety disorder: vulnerability and effect of carbamazepine. American Journal of Psychiatry, 151(12), 1760-6.
  11. Chen, T., Ko, C., Chen, S., Yen, C., Su, P., Hwang, T., Lin, J., & Yen, C. (2015). Severity of alprazolam dependence and associated features among long-term alprazolam users from psychiatric outpatient clinics in Taiwan. Journal of the Formosan Medical Association, 114(11), 1097-1104.
  12. Andersen, A. B. T., & Frydenberg, M. (2011). Long-term use of zopiclone, zolpidem and zaleplon among Danish elderly and the association with sociodemographic factors and use of other drugs. Pharmacoepidemiology and Drug Safety, 20(4), 378-385.
  13. Johnell, K., & Fastbom, J. (2011). Gender and use of hypnotics or sedatives in old age: a nationwide register-based study. International Journal of Clinical Pharmacy, 33(788).
  14. Manthey, L., Lohbeck, M., Giltay, E. J., van Veena, T., Zitman, F. G., & Penninx, B. W. J. H. (2012). Correlates of benzodiazepine dependence in the Netherlands Study of Depression and Anxiety. Addiction, 107(12), 2173-2182.
  15. Tvete, I. F., Bjørner, T., & Skomedal, T. (2015). Risk factors for excessive benzodiazepine use in a working age population: a nationwide 5-year survey in Norway. Scandinavian Journal of Primary Health Care, 33(4), 252-259.
  16. Romach, M., Busto, U., Somer, G., Kaplan, H. L., & Sellers, E. (1995). Clinical aspects of chronic use of alprazolam and lorazepam. American Journal of Psychiatry, 152(8), 1161-7.
  17. Kroll, D. S., Nieva, H. R., Barsky, A. J., & Linder, J. A. (2016). Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care. Journal of General Internal Medicine, 31(9), 1027-1034.

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