Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Xanax (alprazolam) is a benzodiazepine drug widely prescribed to treat anxiety disorder. Benzodiazepine addiction is a growing concern in the United States, with around 30% of opiate overdose deaths also involving drugs like Xanax.
Addiction is now classified as a substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5). Benzodiazepine use can be apparent if someone appears intoxicated or there is drug-seeking behavior, but the problem can also be well concealed.
Treatment may involve a combination of strategies, including detoxification and various psychotherapeutic and psychosocial approaches.
Other commonly prescribed benzodiazepines that pose a risk of dependence include Valium (diazepam) and Ativan (lorazepam).
Theresa Chiechi / Verywell
Benzodiazepines (also known as “benzos”) are commonly referred to as sedatives, hypnotics, or minor tranquilizers. They work by increasing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. This reduces the excitability of neurons (nerve cells), resulting in decreased feelings of anxiety.
Xanax, one of the most commonly prescribed benzodiazepines, is generally considered safe for short-term use, but it can cause side effects like sleepiness, headaches, lethargy, dry mouth, and memory problems.
Among older adults, long-term use of Xanax can also lead to cognitive issues that may resemble dementia. However, the impairment may resolve after the drug is stopped.
While Xanax is sometimes prescribed for longer than a few weeks to manage certain anxiety disorders, prolonged use can lead to a rebound of anxiety symptoms when the drug is eventually stopped. Prolonged use also increases the risk of withdrawal syndrome.
Withdrawal from Xanax is characterized by physical effects and emotional symptoms. Symptoms of withdrawal include:
Moreover, some people using Xanax can develop drug tolerance. If you develop tolerance to Xanax, you may need to use higher doses to maintain a therapeutic effect. This can lead to excessively high dosing, intoxication, and, in some cases, drug-seeking behaviors.
Signs of Xanax addiction include:
The potential for addiction is higher with Xanax than with lower-potency benzodiazepines like Librium (chlordiazepoxide).
The use of Xanax and other sedatives and hypnotics has some association with an increased risk of death. The exact reason for this is unclear, but it may relate to a potential increase in depression, infections, respiratory issues, and accidents. Furthermore, there is some association of Xanax with an increased risk of suicide.
Another concern with Xanax addiction is the risk of overdose, which can result in acute benzodiazepine toxicity. Overdose can occur with Xanax alone, but the majority of deaths occur when Xanax is combined with other drugs such as opioids, including heroin. Polydrug use (using multiple drugs) is common among people with benzodiazepine addiction, with 54.2% abusing opioids and 24.7% abusing alcohol.
Due to these risks, the FDA issued a black box warning in 2016 against the concomitant use of benzodiazepines and opioids.
Signs and symptoms of Xanax overdose can include:
Signs of overdose usually develop within four hours of a dose, which is the time when the drug concentration is highest in the body. The symptoms of an overdose may persist for 12 to 36 hours.
However, even after the symptoms of a Xanax overdose wear off, the consequences to the body may persist, potentially with lasting effects. For example, pulmonary aspiration during a lethargic state can lead to aspiration pneumonia or permanent lung damage.
Xanax overdose causes central nervous system (CNS) depression, which is a direct result of the drug's effect on reduced neuronal excitability. CNS depression leads to impaired respiration and bradycardia (slow heart rate), which can cause coma or cardiac arrest (interruption of the heartbeat).
If you suspect that you or someone else may be experiencing Xanax overdose, contact Poison Control (800-222-1222) or call 911 immediately.
Like opioids or stimulants, addiction to Xanax can initially be associated with pleasurable effects or a sense of feeling “high” or euphoric. Addiction can develop in the context of "self-medication" for anxiety, and can be complicated by efforts to avoid withdrawal symptoms, which tend to be more severe the longer you take the drug.
Even at relatively low doses, Xanax addiction can develop—in part because the drug has a relatively short half-life of 11 hours, which means that its effects wear off quickly.
And, as you develop tolerance to the drug (this can happen with any dose), the duration of its therapeutic effects becomes shorter, while the feeling of “comedown” leading to the withdrawal comes quicker.
Even if a person tries to stop taking Xanax, the fear of withdrawal and rebound can be so strong that the adverse consequences of stopping seem to outweigh the benefits. Xanax addiction is specifically part of a subcategory of substance use disorder known as sedative, hypnotic, or anxiolytic use disorder.
Benzodiazepine addiction can happen to anyone, but certain groups are at greater risk. Risk factors for developing Xanax addiction include:
There are several proposed explanations for why these groups may be at risk. Research shows that young adults who use Xanax tend to use it along with illegal drugs and are also more likely to have psychiatric conditions, which might be undiagnosed or untreated.
Additionally, some people are predisposed to substance addiction, possibly due to genetic factors and altered activity of neurotransmitters in the brain.
A substance use disorder is a condition in which there is a cluster of cognitive, behavioral, and physiological symptoms leading to an individual continuing to use the substance despite significant adverse health or emotional effects or problems at work, school, or home.
Like many drugs, the presence of Xanax can be detected with laboratory tests. This drug can be detected in urine, saliva, and hair follicles, although the reliability of these tests is not consistent.
And while the drug can be identified in the body, there are no blood or lab tests that can diagnose Xanax addiction. The diagnosis of Xanax addiction is based on whether a person meets certain diagnostic criteria outlined in the DSM-5.
For a person to be diagnosed with substance use disorder, they must meet at least two of 11 criteria within a 12-month period:
The severity of the disorder can be classified as “mild” if two to three criteria are met, “moderate” if four to five are met, and “severe” if six or more are met. These classifications may help direct the most appropriate course of treatment.
Your healthcare provider cannot know the answers to these questions unless you are willing to participate in your diagnostic process—this means that you have to be interested in being diagnosed and treated. Sometimes family and friends can help in encouraging you to seek help and in pointing out these issues to you.
In the treatment of Xanax addiction, abstinence is often a goal. This means discontinuing the drug. The process of reaching abstinence may involve detoxification (often referred to as “detox”) and behavioral therapies.
In some situations, an alternative approach—harm-reduction strategies—may be considered, particularly for people in whom abstinence is difficult.
Treatment can sometimes be delivered on an outpatient basis, but it often requires a period of inpatient care in a treatment center. Because Xanax addiction is usually associated with abuse of other substances, rehabilitation for opioid or alcohol addiction may also be needed.
Detox is a process during which a person stops taking a harmful drug. The process can be rapid or gradual, depending on the drug.
With Xanax, the effects of drug withdrawal can be severe and even dangerous, so detox is often a gradual process, especially if it had been used in high doses and/or for a prolonged period of time. For example, to reduce the risk of seizures, the Xanax dose is gradually tapered over weeks under medical supervision.
During Xanax detox, you would be monitored for signs of withdrawal, and you might need to receive treatment to alleviate and prevent harmful complications.
Behavioral therapy is an important component of recovery from drug addiction. While detox medications are focused on avoiding adverse effects of withdrawal, behavioral therapy is a process that is focused on maintaining recovery.
You might need to continue to meet with a therapist for months after your detox is complete, or even for longer. The purpose of therapy is for you to understand your addiction and to gain control so you can avoid misusing Xanax or another drug in the future.
A number of different types of therapy are used in the treatment of substance abuse disorders.
You may benefit from one or more of these types of behavioral therapy. Upon leaving the treatment center, many people will pursue a 12-step recovery program to maintain abstinence or stabilization and maintenance.
The long-term abstinence rates after recovering from Xanax addiction vary significantly. About 80% of older adults achieve abstinence, while about 25% of those with complicated addiction with polydrug use achieve abstinence.
If you or a loved one is struggling with substance abuse or addiction, you can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357. SAMHSA also provides an online treatment center location.
If you or someone you know is having suicidal thoughts, contact the National Suicide Prevention Hotline at 800-273-8255 (800-273-TALK).
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