Finding a Rehab with a Xanax Addiction Treatment Plan

Last updated on November 4th, 2019

For people diagnosed with anxiety or panic disorder, Xanax, a prescription benzodiazepine medication, can help reduce distressing symptoms.1,2 However, like many other medications, Xanax can cause serious problems when misused, and it has significant addictive potential.1,3,4

Xanax addiction carries some serious health risks. However, with the right treatment, recovery is possible. It is important to note that you must take caution when attempting to quit Xanax, as hazardous withdrawal symptoms may arise that may require immediate medical attention.5


Xanax and Its Intended Uses

xanax pills spilling out of prescription bottleXanax is a brand name for alprazolam, a prescription medication indicated for use in managing anxiety disorders such as generalized anxiety disorder (GAD) and panic disorder or otherwise for the short-term management of symptoms of anxiety.1,2 Nearly 50 million prescriptions for alprazolam were filled in 2011.1

Xanax is available in scored, capsule-shaped oral tablets in 4 strengths that are stamped with “XANAX” and the strength.2 These pills are sometimes called a Xanax bar or “Zanbars” due to their appearance.6 Pill color varies according to the dose:2

  • 25 mg – white
  • 5 mg – orange
  • 1 mg – blue
  • 2 mg – white*

*While 2 doses are found in white pills, you can differentiate them by looking for the dose imprinted into the pill. The 2mg pill will have “XANAX” on one side and “2” on the other.

Xanax fits into several broad categories of medications. It may be referred to as a sedative-hypnotic, a tranquilizer, or as a central nervous system (CNS) depressant.1,7 Xanax is a benzodiazepine, belonging to a group of depressant medications that share similar chemical properties and actions in the body. Other frequently used benzodiazepines include:1,7

  • Ativan.
  • Klonopin.
  • Valium.

When taken, Xanax is carried through the blood to the brain where it interacts with a protein complex (known as a GABA receptor) on the surface of certain brain cells. This interaction serves to increase the activity of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA).7 By triggering this increase of GABA activity, Xanax and other benzodiazepine drugs effectively slow down normal brain functioning and communication.7 The stronger the GABA effect, the slower and more depressed certain types of brain activity become.7 By interacting with the GABA system in this manner, Xanax effects are similar to the those of alcohol on the brain.8

Potential Side Effects

When taken as prescribed for troublesome anxiety, the increase in GABA activity produces a comforting, calming, and drowsy effect that offers symptom management and relief.7,8 In sufficient doses, Xanax may also produce a euphoric high, and the combination of these pleasurable effects may reinforce compulsive abuse of the drug.1,8

Despite the positive feelings Xanax can induce, the medication is associated with numerous negative side effects. Xanax side effects include:2,5

  • Headaches.
  • Joint pain.
  • Drowsiness.
  • Lightheadedness.
  • Poor coordination.
  • Dizziness.
  • Confusion.
  • Memory problems.
  • Unusual thoughts or behaviors.
  • Hallucinations – seeing or hearing things that are not present.
  • Dry mouth.
  • Nausea.
  • Constipation.
  • Problems urinating.
  • Trouble falling asleep.
  • Weight changes.
  • Trouble breathing.

Using Xanax can meaningfully impact your mental health. People using the substance may report higher levels of depression and anxiety with increased worry.2,5 This risk may be higher among those misusing the drug and/or taking it without any medical need.

These mental health changes can significantly impair the individual’s life and well-being. Taking Xanax may even lead to thoughts of death and suicide attempts.5 If you’re abusing Xanax, your physical and mental health are both at risk, and because Xanax is addictive, you may also develop a debilitating sedative use disorder.7

Addictive Potential

Xanax is a DEA-controlled substance because, while it is legal and has medical use, it has the potential to be abused and to cause dependence.1,2 Xanax can cause physical dependence in users who take the drug as prescribed. A certain amount of physiological dependence may develop even in those who take the drug within prescribed parameters—it doesn’t necessarily mean you are on a path to addiction. However, among those who consistently abuse the drug, the risk of eventually developing an addiction is high.

If you’re taking a prescription drug, you might not even realize you’re abusing it. Misusing or abusing Xanax could entail:7

Man holding xanax pill bottle with glass of alcohol on table in front of him
  • Using this medication in ways other than prescribed by:
    • Taking higher doses than prescribed.
    • Using it more frequently than directed.
    • Consuming it for longer durations than advised.
    • Mixing it with other substances to modify the effects.
    • Changing the method of administration, like crushing it up and snorting it.
  • Taking the drug with the intention of getting high.
  • Using someone else’s prescription.

Xanax not only affects GABA to produce a sense of calm and sleepiness but it can also influence the release of dopamine in certain areas of the brain, increasing pleasurable feelings and sending signals of reward that motivate the user to take Xanax again and again.9 Artificial increases in dopamine activity are known to be contributors to addiction development. Essentially, when your brain cells release dopamine, you feel good. Over time, your brain adjusts to the consistent elevation in dopamine activity, at which point taking Xanax may become the only thing that gets you close to feeling good or normal. This is a dangerous place to be and is an indicator that significant physiological dependence has developed.

The Xanax high may feel good but as your body starts to become tolerant to the drug, which can happen quickly, the pleasure you used to feel soon becomes out of reach unless you up the dose.10 When you continue to take increasing amounts, you subject yourself to a significantly higher risk of overdose.

Tolerance often goes hand in hand with physical dependence. With the brain’s adaptation to the higher levels of Xanax in the system, it begins to rely on the substance, and you only feel well when you have Xanax in your system.10 Physical dependence is not the same as addiction but it is tied to it. For example, if your body is dependent on Xanax, you may feel really bad (suffer withdrawal) when you don’t have it. In an effort to avoid the extreme discomfort associated with withdrawal, you might compulsively seek out Xanax and take it even if using Xanax is continually causing you harm. Compulsive drug-seeking in light of the negative consequences is the main characteristic of addiction.4

Dependence and addiction often develop in tandem, but not always. For instance, someone prescribed Xanax for an extended period can develop some level of tolerance and dependence to the drug without progressing to the compulsive drug use behavior that accompanies an addiction.

Signs You Might Have a Problem

People who are or who love someone suffering from an addiction—in the case of Xanax, a condition diagnosed as a sedative use disorder—may not immediately recognize that there’s a problem.

To determine if you or someone you care about needs help, it can be useful to go through the diagnostic criteria for a sedative use disorder. You might need treatment for addiction if you are:11 

  • Taking larger doses of Xanax over a longer period of time than you meant to.
  • Still using Xanax despite your attempts to stop.
  • Spending a lot of time and energy getting, using, and recovering from Xanax.
  • Experiencing cravings or strong urges to use Xanax.
  • Failing in your responsibilities at work, school, or home.
  • Continuing to use Xanax even when it negatively impacts your social life, relationships, or physical health.
  • Spending less time engaging in pleasurable activities you used to enjoy with people you care about.
  • Experiencing symptoms of tolerance and physical dependence. 

Another sign of a problem is attempting to gain prescriptions under false pretenses, for example by visiting multiple doctors or forging prescriptions.1

Overdose

As mentioned, the misuse of Xanax can lead to serious harm or overdose. The signs and symptoms of a Xanax overdose may include:2,5,8 

  • Very shallow or stopped breathing.
  • Extreme drowsiness.
  • Weakened or absent tendon reflexes (e.g., knee jerk, etc.).
  • Severe confusion.
  • Significantly impaired coordination and risk of injury.
  • Coma.

Woman passed out on floor with pills next to her portraying an overdoseUnfortunately, benzodiazepine overdose is not a particularly rare occurrence. According to the DEA, there were nearly 125,000 emergency room visits caused by Xanax in 2010 alone.1 Poison control centers received about 81,500 calls related to benzodiazepines in that same year.1

Xanax overdose can end in death. In 2015, Xanax and other benzodiazepines caused 8,700 overdose deaths in the U.S., according to the National Institute on Drug Abuse.7 

Benzodiazepines such as Xanax are implicated in 30% of all overdose deaths related to prescription medications.7

If you or someone you know could be experiencing symptoms of a Xanax overdose, it is critical to receive medical care as quickly as possible to avoid serious health complications.2 Medical professionals will offer supportive care while ensuring that breathing and heart functioning are stable.8 A medication called flumazenil may be able to treat some instances of Xanax overdose by helping to reverse the sedating effects and restore normal respiration.2,8

Xanax and Other Depressants: A Deadly Combo

The risk of fatal overdose from Xanax is relatively low but grows significantly when the drug is combined with other central nervous system depressants like opioids or alcohol.1,2 It is extremely risky to mix these substances, as the combination may lethally compound already dangerous effects such as respiratory depression.1

Despite these potentially fatal risks, the practice of mixing the substances is common. For example, benzos like Xanax have been shown to increase the pleasurable and rewarding high from opioid drugs like heroin and methadone.1,12 About 1/3 of emergency room visits linked to Xanax involved opioid pain medications. 13 Benzodiazepine use is also common among heroin and buprenorphine users, with benzodiazepines being linked to more than 80% of buprenorphine overdose deaths.13

Effects of Long-Term Abuse

Consistent misuse of Xanax can culminate in long-term health problems, including the emergence or worsening of symptoms like:14

  • Problems with thinking and decision-making.
  • Poor memory.
  • Regularly feeling confused.
  • Difficulty speaking/slurring words.
  • Weakness.
  • Poor coordination.

As with addiction to any substance, many aspects of a person’s life will start to unravel as compulsive drug-seeking becomes the sole focus. Xanax abuse has the potential to take a toll on a person’s mental health, as well. People that were previously healthy might experience new symptoms of depression and anxiety.8 People with preexisting mental health issues might see their conditions deteriorate as time goes on.14

Finally, as with addiction to any substance, many aspects of a person’s life will start to unravel as compulsive drug-seeking becomes the sole focus. Someone with a Xanax addiction may experience problems with their:4,8

  • Social life and relationships.
  • Financial status.
  • School or work.
  • Legal record (e.g., arrests for driving while impaired, buying or selling drugs illicitly, stealing, etc.)

The Risks of Ending Xanax Use

It can feel like a no-win situation to be addicted to Xanax. Continuing to abuse it carries a multitude of risks, but quitting can feel awful and may even bring about dangerous, life-threatening symptoms.2,3,11 However, as much as the situation might feel hopeless, it isn’t. If you seek professional treatment, you can get through the process of quitting safely with relative comfort as medical providers manage your symptoms.3

Xanax withdrawal symptoms develop when you cut down or stop using the drug.10 The pleasurable feelings of sedation and calm associated with Xanax intoxication will be replaced by symptoms that, in many cases, mirror the discomfort and agitation of alcohol withdrawal.8 Symptoms of Xanax withdrawal may include:2,3,11

Silhouette of woman with head down experiencing symptoms of quitting xanax
  • Increased anxiety levels.
  • Dysphoria.
  • Insomnia.
  • Tachycardia (elevated heart rate).
  • Tachypnea (quicker respiration rate).
  • Hypertension (raised blood pressure).
  • Increased body temperature.
  • Sweating.
  • Muscle cramps.
  • Abdominal cramps.
  • Nausea and vomiting.
  • Hallucinations.
  • Shaking hands.
  • Jerky or erratic movements.
  • Grand mal seizures.

The timing and severity of these symptoms will be dictated by a number of factors, including:2,3,11

  • The dose and frequency of use.
  • The duration of use.
  • If it was combined with other substances.
  • The presence of mental health or physical health issues.

Typically, someone who has been using high doses for many years will have more intense withdrawal symptoms; however, people that have been using as little as 0.75 mg per day for a relatively short durations have exhibited withdrawal symptoms.2

With benzodiazepines, the onset of withdrawal symptoms depends, in part, on the drug’s duration of action.14 Xanax is a short-acting drug, which means it is processed through the body faster. Because of this, withdrawal symptoms will typically begin anywhere from a few hours to 2 days after the last dose.11, 15 The full duration of the acute withdrawal syndrome may last between 2 and 4 weeks, but some Xanax withdrawal symptoms may last even longer.15

The Xanax withdrawal process is unpredictable. Some people in withdrawal will have symptoms that emerge quickly, peak during the second day, and slowly alleviate over the next 4 or 5 days.11 Other people’s symptoms will fluctuate greatly without a steady decline.15 Because you can’t necessarily predict how your withdrawal will go or whether you’ll suffer dangerous symptoms like seizures, it is essential to detox under medical supervision or be cleared by a medical professional to proceed without it.

The Importance of Medical Detox

Up to 30% of people that do not receive professional medical treatment for Xanax withdrawal will have grand mal seizures.11 Due to this and other health risks, medical detox is the safest option for Xanax withdrawal.3

Detoxification is a set of strategies and medical interventions used to safely and effectively allow the body to rid itself of toxins.3 Medical detox includes observation from medical professionals and administration of medications as needed to relieve symptoms.3 

There are several methods by which Xanax may be safely cleared from the body:3,8,15 

  • Ending all Xanax use and treating withdrawal symptoms with anticonvulsants (carbamazepine, valproate) and sedating antidepressants (trazodone).
  • Gradually tapering the current dose of Xanax over time.
  • Switching to a longer-acting benzodiazepine like diazepam (Valium) or a barbiturate like phenobarbital and then gradually weaning the dose.

Where Should I Get Treatment?

Your first step in getting clean from Xanax will ideally be a 24-hour medical detox.3 We say this is your first step because, while it is an essential aspect of treatment, as a standalone treatment it is rarely enough to maintain a drug-free lifestyle; it does not address the psychological and behavioral elements of drug use.4

The spectrum of professional addiction treatment is easily separated into 2 categories: inpatient and outpatient. However, there are varying degrees of intensity within both of these categories.

Inpatient/Residential Treatments

If the provider requires you to leave your home and live at the facility during treatment, it is an inpatient/residential treatment. These options offer an intensive focus on your recovery, and many offer 24-hour medical staffing. Inpatient treatments will provide a range of therapy and medication services. Settings include:3,4

Female portraying doctor speaking with male patient about treatment for xanax addiction
  • Inpatient hospital. These are secured units in hospitals or standalone facilities that offer the highest intensity of services for physical and mental stability. These tend to be shorter in duration, with treatment lasting a few days or weeks.
  • Long-term residential. This setting will more closely resemble a home than a hospital. One type of long-term residential treatment is the therapeutic community (TC) that can last up to a year, with a highly structured environment wherein staff and other residents help you adjust maladaptive beliefs and behaviors.
  • Short-term residential. These programs share many similarities with long-term programs but don’t last quite as long—most last between 3 and 6 weeks. Short-term residential programs focus on preventing relapse before transitioning to ongoing, outpatient care.

Outpatient Treatments

If a treatment allows you to return home after treatment hours and attend therapy during the day, it is an outpatient program. Like inpatient options, these treatments offer a spectrum of intensities and durations, including:3,4

  • Partial hospitalization programs (PHP). PHPs may involve roughly 30 hours of treatment each week with a mixture of individual and group therapy services.
  • Intensive outpatient programs (IOP). IOPs are a step-down from PHPs, offering an average of 6-9 hours of treatment per week.
  • Standard outpatient. You’ll attend hour-long individual, group, or family sessions, the frequency of which will be based on your needs at the time.

When deciding which option is the best for you, you can meet with a treatment professional to come up with a plan that will give you the best chance of success. Asking yourself certain questions (including but not limited to the following) will help you be honest with yourself about the kind of care you should seek:

  • How long have I been addicted to Xanax?
  • Can I realistically stay sober in my current environment?
  • Do I need the 24-hour support of an inpatient environment?
  • Have I tried to quit before and relapsed?
  • Do I have transportation to and from outpatient appointments?
  • Can I line up childcare if I leave home to attend residential treatment?
  • Will I lose my job if I miss work?
  • What treatments worked and did not work for me in the past?

You can tailor your treatment plan and choose multiple types of care. For example, as you progress through treatment, you could move from an inpatient detox program to a residential rehab and then continue in an outpatient program so that you stay focused on your recovery.

For those who began using Xanax as a way to treat an anxiety disorder but then began abusing it, recovery can be even more complicated.

Treating a Co-Occurring Mental Disorder

For those who began using Xanax as a way to treat an anxiety disorder but then began abusing it, recovery can be even more complicated.

Man with co-occurring mental disorder on couch with head in hands talking to therapistWhen Xanax use ends, the previously experienced anxiety symptoms may reemerge and may, in fact, be worse.16 Now, the individual will have severe symptoms but will be left without the primary coping mechanism, Xanax. Treatment must focus on learning new skills and experimenting with non-addictive, psychiatric medication options to manage symptoms.3

Protracted withdrawal—sometimes called post-acute withdrawal syndrome (PAWS)—adds another layer of complexity to Xanax treatment. These symptoms that begin after the initial withdrawal period ends can bring about troubling, persistent mental health symptoms, such as:16 

  • Depression.
  • New anxiety and panic.
  • Obsessive thoughts and compulsive behaviors.

If these symptoms become problematic, they will need to be addressed by mental health professionals. Having an anxiety disorder increases the need for a complete treatment plan with a multifaceted approach that addresses not only the addiction but the mental health issues that complicate recovery.4 A dual diagnosis treatment program is a great way to ensure that both conditions are addressed at the same time, which increases the chances of successful recovery from each.

You Can Get Help Today

No matter who you are, or what stage of addiction you are in, you can get the help you need. People that choose to seek professional addiction treatment may have a better chance of achieving long-term abstinence. Professional treatment can also aid in your safety and wellness during different stages of recovery. Don’t wait to begin a healthy sober life.


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References

  1. Drug Enforcement Administration. (2013). Benzodiazepines.
  2. U.S. National Library of Medicine: DailyMed. (2017). Xanax.
  3. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  4. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  5. U.S. National Library of Medicine: MedlinePlus. (2017). Xanax.
  6. Connecticut Department of Consumer Protection. (2013). Alprazolam.
  7. National Institute on Drug Abuse for Teens. (2016). Prescription Depressants.
  8. Weaver, M. F. (2015). Prescription Sedative Misuse and Abuse. The Yale Journal of Biology and Medicine88(3), 247–256.
  9. National Institute on Drug Abuse. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
  10. Medscape. (2016). Withdrawal Syndromes.
  11. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  12. Jones, J. D., Mogali, S., & Comer, S. D. (2012). Polydrug Abuse: A Review of Opioid and Benzodiazepine Combination Use. Drug and Alcohol Dependence125(1-2), 8–18.
  13. University of Maryland. (n.d.). Lethal Mixtures – Benzodiazepines and Opioids, including Buprenorphine.
  14. Center for Substance Abuse Research. (2013). Benzodiazepines.
  15. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
  16. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
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