Overview

Alprazolam, also known as “Xanax” is one of the most common drugs available today, with clinical use in treating anxiety and panic disorders. Xanax is classified as a benzodiazepine, a class of drugs that is notable for its sedating and calming effects, as well as its strong potency and potential for addiction. While benzodiazepines have accepted and effective medical uses, they are often abused for their high and lead to a large number of deaths worldwide. Benzodiazepines are a common threat in the U.S that is steadily and rapidly growing; with nearly 9,000 deaths being reported in the United States from benzodiazepines.¹ Xanax is both effective and dangerous due to its effect on GABA receptors in the brain, which control a wide variety of neurological functioning. The primary danger behind Xanax is how easy it is to build a tolerance to it, as well as withdrawals that come from overuse of the drug, which can lead to seizures. Xanax exhibits short-term effects similar to other benzodiazepines including drowsiness, relaxation, heavy limbs, and loss of coordination. Long term abuse of Xanax can lead to a variety of physiological and mental ailments including depression, amnesia, anxiety, and neurological decay. Recovery from Xanax can be effective through the use of various medications to minimize the intense withdrawal symptoms and seizures, as well as therapeutic options. Rehabilitation facilities also offer extensive resources for recovering from Xanax addiction in a safe, stable, and comfortable manner.

What is Xanax?

Alprazolam, a drug often known by its brand name “Xanax” is a legal prescription benzodiazepine drug that is used for a wide variety of uses, but primarily in treating anxiety and panic disorders. Xanax is one of the most commonly abused benzodiazepines due to its commonality and notably potent effects. Xanax is notable for its commonality; being the most commonly prescribed benzodiazepine in the United States as of 2010.² Alprazolam is similar to many other prescription benzodiazepines in their similar physical and mental effects, as well as their chemical classification. Benzodiazepines are a diverse class of drugs that have found common usage in medicine for their use as potent GABA enhancers, which makes them effective at treating psychological conditions such as anxiety and insomnia, and physical conditions such as nausea, seizures, and muscle spasms. However, benzodiazepines are notoriously dangerous drugs with a high potential for dependency and abuse, as well as a great deal of potential fatal and nonfatal side effects that are still being discovered today. The death toll of benzodiazepine usage has been steadily increasing every year, with nearly 9,000 deaths being deported in the United States in 2015, with a 4.3-fold increase from 2002 to 2015. With over 5.2% of U.S. citizens using benzodiazepines in 2008, this presents a serious risk.³ Xanax is classified as a Schedule IV drug Controlled Substances Act (CSA), meaning that Xanax is classified as having a low potential for abuse as well as accepted medicinal usage in the U.S.

How Does Xanax Addiction Work?

Xanax’s effectiveness as a relaxant and sedative can primarily be attributed to its interaction with GABA, a common inhibitory neurotransmitter that is responsible for a large amount of various neurological functioning. Xanax, like all benzodiazepines, enhances the effects of GABA in the brain. GABA is one of the most common neurotransmitters found in the brain, and is key in controlling essential neurological behavior and functioning such as muscle control, as well as facilitating neurological connections between the brain and spinal column.  Because GABA is an inhibitory neurotransmitter, benzodiazepines are able to effectively utilize the slowing and sedating effects of GABA, which is what makes them so effective at treating illnesses such as anxiety and insomnia. However, because benzodiazepines are not selective GABA medicines like other GABA-enhancing drug classes such as nonbenzodiazepines, they are active at a much lower dosage with stronger effects and a stronger capability of addiction. Xanax is particular among benzodiazepines for its popularity, being considered the most popular selling drug in the United States for many years. Xanax is notable among benzodiazepines for its shorter but potent half-life, as well as its particular effectiveness at treating anxiety.

Short and Long Term Effects

Xanax is most commonly taken in the form of compressed tablets, often colloquially called “bars”. Onset generally takes up to half an hour, with effects lasting for around 11 hours.

When taken at psychoactive doses, users report short-term mental effects such as feelings of:

• Euphoria
• Drowsiness
• Relaxation
• Memory impairment
• Reduced anxiety
• Relaxation

And physical effects such as:

• Loss of coordination
• Heaviness of limbs

Repeated long-term use of Xanax leads to physical side effects such as:

• Neurological damage – Frequent abuse of nonbenzodiazepines as well as other GABAeffecting drugs such as benzodiazepines through Xanax can lead to distinct cognitive impairment when abused. This can manifest in effects such as memory loss, sleep disturbances, anhedonia, and disorientation.
• Amnesia – Amnesia and otherwise severe memory impairment are potential side effects of long-term Xanax usage. These symptoms are considered dose-dependent and thus more likely to occur and with increased severity the higher the dosage is. Because tolerance is easily built on benzodiazepines, this can quickly become a serious risk.
• Muscle problems – Because Xanax functions as a sedative, prolonged use of Xanax can result in coordination and muscular difficulties. This can include a general loss of motor coordination, muscle cramping and pain, and chronic muscle fatigue.
• Insomnia – Due to frequent interruptions in ordinary circadian activity and damage done to GABA receptors with repeated abuse, Xanax users often experience worsening sleeping problems, developing into insomnia even in those who originally took Xanax to treat insomnia.

Long-term use of Xanax also carries several mental side effects including:

• Addiction – Xanax along with all other benzodiazepines is notable for both its physical and psychological addictiveness and its potential for dependency. Because withdrawal symptoms are generally exaggerated problems that led to Xanax usage in the first place (such as anxiety), many will continue to abuse Xanax to avoid worsened symptoms.
• Depression – Due to overstimulation of GABA receptors, Xanax frequently leads to depression due to the brain’s inability to properly manage its circadian rhythm and GABA receptors.
• Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in Xanax abuse due to external factors such as family or friends finding out about becoming dependent on the drug, and internal factors from the chemistry of the drug itself. This can compound and develop into chronic paranoia.

Other risks posed by Xanax abuse include:

• Allergic reaction – Allergic reactions to Xanax are not uncommon, and can result in a variety of different side effects that can become fatal in the cases of severe allergic reaction. Symptoms of allergic reaction to Xanax include difficulty breathing, chest pain, skin rash, and hives.
• Risk of overdose – Xanax holds a potential for overdose for a variety of reasons. The most common cause of overdose is the tolerance that can build with frequent Xanax use. Even when taken as prescribed for insomnia or anxiety, Xanax can still lose its effectiveness over time and no longer prove beneficial, which may lead some people to increase their dosage until it is effective again, which can often result in accidental overdose. Death by respiratory failure is common and predicated by signs of extreme disorientation and drowsiness, and survivors are at risk of permanent neurological damage.
• Tolerance – Xanax as well as other benzodiazepines are notorious for their quick ability to quickly build a physical tolerance in individuals with frequent usage. This can result in the drug no longer functioning as well as it did before, leading some users to either increase their dosage or develop a dependency on the drug from frequent usage.

Xanax withdrawal is a difficult process to go through, and includes withdrawal symptoms such as:

• Anxiety
• Uncontrollable shaking and shivering
• Fatigue
• Nausea and vomiting
• Sweating
• Elevated heart rate
• Depression
• Muscle aches and cramps
• Insomnia

Methods of Treatment

Pharmacological:

Treatment for addiction to benzodiazepines is particularly important to be done under careful supervision and with the right environment, as withdrawal from chronic usage faces the risk of seizures. As such, pharmaceutical treatment first begins with a tapered detoxification, usually under the supervision of a physician, so as to allow the body to safely rid itself of the drug. Only once the body has fully detoxified itself can treatment be safely administered. While there are currently no drugs available specifically for Xanax addiction, there are many drugs that are used for general benzodiazepine addiction depending on both the severity of the addiction and the personal need of the individual. Some drugs such as clonazepam, another type of benzodiazepine, can be used to wean the patient off of addiction while also decreasing their withdrawal symptoms. Others, such as the barbiturate drug phenobarbital are used more specifically for withdrawal symptoms and minimizing the risk of seizures, while drugs such as carbamazepine can be used to treat anxiety symptoms directly.

Therapeutic:

Other forms of treatment for Xanax addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as Xanax addiction as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings. The twelve-step program, which is utilized by Alcoholic Anonymous, is a long-established method of treating drug and alcohol addiction. The twelve-step program works as a gradual method of guiding principles and pragmatic steps that can be taken to go from the depths of addiction and unhealthy habits to sobriety. These twelve steps are aimed at effectively recovering from compulsive and addictive behaviors, and addressing mental and behavioral problems that led to addiction in the first place. These twelve steps include both internal and external actions aimed at making amends for past mistakes, accepting responsibility for the actions that led to addiction, and moving forward to establish healthy habits and a positive mindset.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting Xanax addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

References

1. “Overdose Death Rates.” NIDA, National Institute on Drug Abuse, 6 Jan. 2017, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
2. Langreth, Robert; Herper, Matthew (11 May 2010). “In Pictures: The Most Popular Prescription Drugs”. Forbes.
3. Olfson, M, et al. “Benzodiazepine Use in the United States.” JAMA Psychiatry., U.S. National Library of Medicine, Feb. 2015, www.ncbi.nlm.nih.gov/pubmed/25517224.