Xanax Addiction: Signs, Effects, and Treatment

What is Xanax?

Xanax, the brand name for alprazolam, is a central nervous system (CNS) depressant that, like other benzodiazepines, works to calm an otherwise overexcited nervous system.^1,3

Xanax is federally classified as a Schedule IV drug under the Controlled Substances Act, which means there is a recognized risk for misuse and dependence.¹

It is legally distributed with a prescription from a licensed healthcare professional as oral tablets, imprinted with “Xanax”, which come in different colors and strengths.³ Unfortunately, Xanax is also one of the top three prescriptions diverted and sold on the street, as well as appearing as counterfeit pills that aren’t necessarily even alprazolam, according to the Drug Enforcement Administration (DEA).¹

What is Xanax Used For?

The Food and Drug Administration (FDA) approved Xanax for the short-term treatment of generalized anxiety disorders and panic disorder.³ Off label, Xanax may be prescribed to treat insomnia and depression.⁴

It is the most commonly prescribed benzodiazepine. In fact, in 2019, U.S. outpatient pharmacies dispensed approximately 92 million prescriptions for benzodiazepines, 38% of those were prescriptions for alprazolam.⁵ In 2020, more than 3.4 million individuals aged 12 and older misused alprazolam. ⁶

Misuse of Xanax includes taking it in higher doses or in a manner other than that which was prescribed, taking someone else’s Xanax prescription, or taking it for the effects it produces—such as lowered inhibitions, euphoria, or to modulate the effects of other substances.^1,7

Is Xanax Addictive?

As previously mentioned, Xanax carries the potential for misuse and dependence. Xanax also has the potential to become addictive, especially for individuals with a personal or family history of substance misuse or substance use disorder.^2,3

In 2020, an estimated 1.2 million Americans aged 12 and older met the criteria for a sedative, hypnotic or anxiolytic use disorder, the clinical term used to describe an addiction to benzodiazepines like Xanax.⁸

Xanax Addiction Symptoms

When a person experiences problems with daily functioning as a result of compulsive use of Xanax or other benzodiazepines, it’s clinically referred to as a sedative, hypnotic, or anxiolytic use disorder in the Diagnostic and Statistical Manual of Mental Disorders (5^th edition) (DSM-5).⁹ To diagnose a sedative, hypnotic, or anxiolytic disorder, there are 11 criteria that clinicians use which are outlined in the DSM-5:⁹

• Taking more of a sedative, hypnotic, or anxiolytic drug, like Xanax or other benzodiazepine, than intended, or for longer periods than intended.
• Having a persistent desire to cut back or stop using Xanax but being unable to do so.
• Spending an increasing amount of time obtaining, using, or recovering from Xanax use.
• Experiencing cravings or intense urges to use Xanax.
• Failing to fulfill responsibilities at home, school, or work due to recurrent Xanax use.
• Continuing to use Xanax despite having persistent social or relational problems that are caused by or worsened by use.
• Giving up previously important or meaningful activities or commitments due to Xanax use.
• Repeatedly using Xanax in physically dangerous situations.
• Continuing to use Xanax despite knowing that it causes or worsens ongoing physical or psychological problems.
• Developing tolerance to Xanax, which means needing more of the drug to achieve the desired effect or the effect is greatly reduced when using the same dose.
• Experiencing withdrawal symptoms when cutting back or trying to quit Xanax.

An individual who experiences 2 or more of these symptoms in a 12-month period meets the diagnostic criteria for a sedative, hypnotic, or anxiolytic use disorder.⁹

Xanax Withdrawal

Regular Xanax use can cause a person to develop a physiological dependence to it, wherein the body becomes so used to having the substance present that if use suddenly stops or drastically reduces, withdrawal symptoms can surface.^3,10

Quitting Xanax can prove difficult—even dangerous—and avoiding these unpleasant withdrawal symptoms may contribute to an individual’s continued, compulsive use of Xanax.^7,9

Xanax withdrawal symptoms can include:³

• Heightened sensory perception.
• Impaired concentration.
• Changes to the sense of smell.
• Inability to think clearly.
• Tingling, burning, or prickling sensation in the hands, arms, legs, or feet.
• Muscle cramps.
• Muscle twitching.
• Diarrhea.
• Blurred vision.
• Loss of appetite.
• Weight loss.
• Anxiety.
• Insomnia.
• Seizures.

Xanax dependence generally results in experiencing acute withdrawal symptoms within 6 to 8 hours of discontinuing use, peak at day 2, and last for 4-5 days.⁹ Certain symptoms of withdrawal, such as depression, anxiety, and insomnia, may persist beyond acute withdrawal for several weeks or months after discontinuing Xanax.

Xanax Overdose

Overdose on benzodiazepines alone, including Xanax, is rare but not impossible.¹² Xanax overdose generally results in symptoms of oversedation and CNS depression, including:¹²

• Slurred speech.
• Loss of coordination.
• Confusion or other changes in mental state.

Most benzodiazepine overdoses are not fatal. However, overdoses involving benzodiazepines taken concurrently or alongside other substances, particularly opioids, alcohol, and other CNS depressants, can result in severe respiratory depression that can lead to brain damage, coma, and death.¹³ In fact, according to data collected from 38 states and the District of Columbia by the Centers for Disease Control and Prevention (CDC) from January 2020-June 2020, 92.7% of deaths involving benzodiazepines also involved opioids.¹⁴

Individuals who buy Xanax illicitly run the risk of unintentionally combining benzodiazepines and opioids since fake and adulterated Xanax have been increasingly found. In fact, the DEA found that 6 out of every 10 fake prescription pills contained fentanyl, a potent opioid, in 2022. An individual who purchases Xanax on the street, may take a pill they think is legitimate Xanax but is, in reality, laced with fentanyl, which can significantly increase the likelihood of a fatal overdose.¹⁵

An overdose is a medical emergency. If you suspect an overdose, call 911 immediately. If available, naloxone (Narcan) should be administered as soon as possible. Naloxone won’t reverse the effects of Xanax or other benzodiazepines, but it can reverse the respiratory depressing effects of opioids and won’t harm an individual who has not taken opioids.¹⁴

Xanax Treatment and Relapse Prevention

Effective Xanax addiction treatment typically involves a variety of interventions, and may include education, medications, counseling, and behavioral therapies. While treatment is tailored to the unique needs of the individual, components of treatment may include:^11,16

• Medically managed detox. As previously mentioned, due to the possibility of experiencing life-threatening withdrawal symptoms, you should never abruptly stop or significantly reduce your Xanax intake without medical guidance. A supervised medically managed detox can allow your body to rid itself of Xanax and other substances safely and comfortably under the watchful eyes of trained professionals. With supervised detox, medications may be used to taper off Xanax and help minimize withdrawal symptoms. It should be noted, however, that detox alone is rarely sufficient to sustain long-term recovery from substances in someone with a substance use disorder. Instead, detox is often considered a first step in a more comprehensive treatment plan that addresses the thoughts, emotions, and behaviors behind addiction, and arms people with skills and techniques to avoid triggers that might result in a return to drug use or a relapse of the disease.
• Inpatient treatment. Inpatient or residential treatment consists of 24/7 care in a hospital or residential facility. You usually participate in educational sessions, as well as individual and group counseling that uses behavioral therapies to help you get to the root of your addiction and learn coping strategies to assist you in identifying triggers, managing stressors, and preventing relapse.
• Outpatient treatment. Outpatient programs vary in intensity and time commitment. Treatment is generally similar to what’s experienced in inpatient treatment but allows you to return home or to a sober living environment at the end of treatment each day.
• Continued care. Sometimes referred to as aftercare, continued care can include continued counseling, group support (e.g., mutual-help groups), monitoring, and accountability to help you stay substance free after formal inpatient or outpatient treatment ends.

If you or a loved one struggle with Xanax use, help is available. Often, insurance companies provide partial or full coverage for mental health and substance use disorder services.

Call American Addiction Centers (AAC) at our confidential helpline

We can answer questions about insurance coverage, explain the admissions process, and help you understand your treatment options so you can stop the cycle of Xanax misuse and start your path to recovery.