During the dark throes of addiction, there comes a point of no return wherein an individual develops a severe drug or substance dependency. They may continue to use, even though they are aware of the harm the drug causes. The acute cravings make it very difficult to quit using drugs, especially if the root causes aren’t fully addressed.
As is the case with many drugs, if you stop using abruptly after a period of regular use, or go “cold turkey”, you may experience unpleasant and even fatal withdrawal effects. Sadly, this can also become the reason for continued-use (or even overdose) amongst addicts, as the physical and mental burden of withdrawal becomes too much to bear.
One drug with a pronounced rebound and withdrawal syndrome is Xanax; a commonly prescribed anti-anxiety medication.
Xanax 101 f
Alprazolam – available under the trade name Xanax – is a potent, intermediate-onset benzodiazepine. It is commonly used for the treatment of generalized anxiety disorder and panic disorder (Ait-Daoud, Hamby, Sharma & Blevins, 2018).
Xanax works like any other benzodiazepine; by enhancing the effects of Gamma-Aminobutryric Acid (GABA), a chief inhibitory neurotransmitter in the brain. It plays a principal role in reducing neuronal excitability throughout the central nervous system via inhibition of postsynaptic neurons. GABA produces a calming effect on the brain, thereby decreasing anxiety (Longo & Johnson, 2000).
Alprazolam is the most commonly prescribed benzodiazepine and the most commonly prescribed psychiatric medication within the United States (Grohol, 2016). However, this does not mean that this is a safe medication. In fact, statistics show that alprazolam is the most common benzodiazepine responsible for drug-related emergency department visits (SAMHSA, 2013). Studies suggest that alprazolam causes a more severe withdrawal syndrome than other benzodiazepine (Browne & Hauge, 1986).
Short-Term Effects of Xanax
When taken properly and as prescribed by a doctor, the short-term effects of Xanax are highly beneficial to those whose everyday lives are negatively affected by anxiety. A multicenter trial showed efficacy in short-term treatment, whereby the following symptoms showed significant improvement whilst on alprazolam (Ballenger et. al, 1988):
- Panic attacks
- Avoidance behavior
Xanax can, however, cause adverse effects even in a short period of time. O’Sullivan et. al (1994) demonstrated that, by 8 weeks, patients using alpeazolam developed depression, bed-wetting, aggression, sedation, slurred speech, irritability and impaired memory.
The great dichotomy with Xanax is that, although it is effective in the short-term, it has a high misuse potential. All benzodiazepines, in susceptible patients, are liable to misuse but Xanax is of particular importance due to its rapid absorption and short half-life. These pharmacokinetics increase its abuse liability (Ait-Daoud, Hamby, Sharma & Blevins, 2018). It isn’t unusual for those under the effects of Xanax to have slurred speech and appear almost intoxicated.
When Xanax is taken in larger doses, the effects become even more dramatic. Confusion, memory impairments, cognitive impairments and respiratory depression or coma may be induced at these high doses (Longo & Johnson, 2000).
Dangers of Xanax Withdrawal
There is no way of supposedly sugar-coating the pill or this following issue; going “cold turkey” or discontinuing the use of Xanax abruptly can cause severe withdrawal symptoms (Browne & Hauge, 1986). Any sustained-use of a benzodiazepine requires medical supervision for withdrawal. It is recommended that, if you have been using a benzodiazepine for a week or longer (especially at a higher dose), that you are adequately weaned off of the medication by a doctor (Ait-Daoud, Hamby, Sharma & Blevins, 2018).
Xanax or alprazolam withdrawal syndrome causes rebound anxiety, insomnia, homicidal or suicidal ideation. It may even cause delirium and psychosis, and this is not a common occurrence with other benzodiazepine withdrawals. Seizures have also been reported on discontinuation (Ait-Daoud, Hamby, Sharma & Blevins, 2018).
The symptoms of withdrawal are secondary to the body’s response to sudden changes in chemicals in the brain. When a patient abuses Xanax, the body becomes accustomed to the effect it causes (tolerance), and without the drug, the body goes into overdrive trying to compensate for the loss of GABA activity (Longo & Johnson, 2000).
How to Quit Safely
There is only one recommended method for coming off Xanax and that is to gradually reduce the dose under medical supervision; a process called weaning or tapering. In a medical setting, the withdrawal process is managed by slowly reducing the dose and transferring the patient to a longer acting form of the drug. This can take as long as 6 months (or even longer).
Severe withdrawal symptoms previously mentioned can importantly occur even if the dose is tapered or weaned (Ait-Daoud, Hamby, Sharma & Blevins, 2018). The chance of them occurring is lower, but not altogether eliminated. That means that tapering the dose without the supervision of a medical professional is foolhardy at best. Always detox safely under the encouragement and supervision of trained professionals.
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.
Ballenger, J.C., Burrows, G.D., DuPont, R.L., Lesser, I.M., Noyes, R., Pecknold, J.C., . . . Swinson, R.P (1988). Alprazolam in panic disorder and agoraphobia: Results from a multicenter trial: I. Efficacy in short-term treatment. Arch Gen Psychiatry, 45:413–422.
Browne J. & Hauge, K. (1986). A review of alprazolam withdrawal. Drug Intelligence Clin Pharm, 20:837–841.
Grohol J. (2016). Top 25 Psychiatric Medication Prescriptions for 2013. Retrieved March 17, 2019 from https://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013/
Longo, L.P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects Abuse Risk and Alternatives. American Academy of Family Physicians, 61: 2121-8.
O’Sullivan, G.H., Noshirvani, H., Başoğlu, M., Marks, I.M., Swinson, R., Kuch, K., . . . Kirby, M. (1994). Safety and side-effects of alprazolam. Controlled study in agoraphobia with panic disorder. Br J Psychiatry, 165(1):79-86.
SAMHSA. (2013. Drug Abuse Warning Network, (2011): National Estimates of Drug-Related Emergency Department Visits. Subst Abuse Mental Health Serv Administr. 13:4760.