Xanax Abuse: Short- and Long-Term Effects of Xanax

While alprazolam (al-PRA-zuh-lam) can be helpful when used as directed, it can also be misused, which further increases the likelihood of a host of adverse effects, including addiction, overdose, and on rare occasions death.¹ In fact, according to the 2020 National Survey on Drug Use and Health, 4.7 million people aged 12 or older misused prescription benzodiazepines, and 3.4 million of those people misused alprazolam in the past year.²

If you or someone you know uses Xanax, it’s important to familiarize yourself with the short- and long-term effects of alprazolam, the dangers of overdose and drug mixing, and various treatment options.

What is Xanax?

In the U.S., Xanax is the most commonly prescribed psychotropic (i.e., a medication that affects a person’s mental state). Aside from its FDA-approved treatment uses, alprazolam is misused recreationally, as it can decrease inhibitions, reduce anxiety, and create feelings of euphoria.³

Misuse of benzodiazepines typically involves a larger than recommended dose and the use of other medications, illicit substances, and/or alcohol.¹ For example, Xanax is sometimes used in combination with methadone to increase the latter’s euphoric effects. (Similarly, benzodiazepines may be used to relieve adverse effects of cocaine binges and to augment the effects of alcohol.⁴

Xanax Effects

When taken orally, Xanax is rapidly absorbed. Thus, effects can be experienced within 30 minutes and can last up to roughly 6 hours.³ The most common adverse effects of alprazolam include impaired coordination, low blood pressure, difficulty speaking, and increased libido.⁵

Additional adverse effects of Xanax include:^1,3

• Decreased mental alertness.
• Confusion.
• Trouble concentrating.
• Memory impairment.
• Drowsiness, fatigue.
• Light-headedness.
• Dizziness.
• Muscle weakness.
• Poor balance/coordination.
• Slurred speech.
• Blurred vision.
• Nausea, vomiting, upset stomach.
• Worsening depression.

Long-Term Effects of Xanax Use

Those who regularly take Xanax, even when under a healthcare provider’s supervision, run the risk of developing physical dependence.¹ Along these same lines, alprazolam use can lead to tolerance, meaning a higher dose is needed to produce the same effect.⁵

Xanax withdrawal symptoms can include:⁶

• Increased heart rate, blood pressure, temperature, and sweating.
• Anxiety.
• Insomnia.
• Hallucinations.
• Severe cravings.
• Overactive reflexes.
• Agitation.
• Shakiness.
• Seizures.

Rapid dose reduction or abrupt discontinuation of alprazolam can lead to unpleasant acute withdrawal symptoms and, more rarely, potentially life-threatening withdrawal complications such as seizures.³

Severe acute Xanax withdrawal symptoms can be life-threatening and can include:⁵

• Mania.
• Psychosis.
• Catatonia.
• Depression with suicidal ideation.
• Hallucinations.
• Delirium tremens.
• Seizures and convulsions.

Xanax Overdose

When used as directed, alprazolam is generally considered safe. However, misuse increases the risk of adverse effects, including overdose. Though many cases of overdose toxicity involve the concurrent use of other substances, benzodiazepine overdose is a risk with high dose misuse.⁸

Overdose symptoms for benzodiazepines include:⁸

• Altered mental status.
• Slurred speech.
• Poor muscle control (i.e., ataxia).

Mixing benzos with certain other drugs or medications can increase the risk for more significant respiratory depression, which can lead to dangerously slowed breathing, respiratory arrest, and death. Many benzo-related overdoses involve other substances, including opioids, alcohol, or other sedative drugs.⁸

Signs of overdose related to mixing benzodiazepines with opioids, alcohol, or other depressants include:⁹

• Slow breathing.
• Weak pulse.
• Altered mental status/confusion.
• Passing out.

Counterfeit pills typically look like prescription medications such as Xanax, Valium, Adderall, etc. According to the U.S. Drug Enforcement Administration, these fake pills often contain methamphetamine or fentanyl, which can be deadly. In fact, testing showed that 2 out of every 5 counterfeit pills with fentanyl contain a potentially lethal dose.¹⁰

What Can Happen When You Mix Xanax with Other Drugs?

Mixing Xanax with other drugs, especially alcohol or opioids, significantly increases the risk of overdose and may cause respiratory depression, a type of suppressed breathing that can lead to coma and death.⁹

According to the Centers for Disease Control and Prevention (CDC), data gathered from January to June 2020 indicates that more than 92% of all fatal benzodiazepine overdoses involved an opioid (e.g., OxyContin, codeine, fentanyl, Percocet, etc.).¹²

Combining benzodiazepines such as alprazolam with other respiratory depressant substances (e.g., other benzos and/or opioids such as morphine, heroin, oxycodone, fentanyl, etc.), can indirectly or directly increase the risk of:⁹

• Overdose toxicity.
• Damage to the brain or other organs (as a result of respiratory arrest).
• Death.

Additionally, mixing alprazolam with stimulants (e.g., ecstasy, cocaine, methamphetamines, etc.) can mask or modify the effects of one or both substances. This may deceive you into believing the drugs aren’t affecting you, potentially leading to overdose.⁹

Also keep in mind that the dangers of drug mixing apply to prescription drugs. So always inform your healthcare provider of the prescriptions you’re taking and substances you’re using, and never take medications prescribed for someone else.⁹

Xanax Addiction and Treatment

Withdrawal from any type of benzodiazepine is potentially dangerous, and serious complications, such as seizures and delirium, can occur without warning. As such, management of benzodiazepine withdrawal without medical supervision is not recommended.¹³

Plus, to minimize the risk of severe withdrawal symptoms, the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that medical withdrawal management may involve first substituting another relatively long-acting benzo (e.g., chlordiazepoxide or clonazepam) before gradually reducing its dosage.¹³

When necessary, detox is an early treatment component comprising interventions that manage acute intoxication and withdrawal. Available via inpatient and outpatient settings, detox can not only help prevent potentially life-threatening complications of benzodiazepine withdrawal but also provide palliative care to reduce symptom intensity.¹³

Due to the risk of experiencing dangerous, sometimes potentially fatal withdrawal symptoms, medically equipped inpatient detox or hospitalization may be helpful for people who have chronically used high doses of benzodiazepines and other sedatives. For those with less severe use of benzodiazepines, who are not dependent on other substances, and who have supportive friends or family to help them through the process, outpatient detox can be an option.¹³

Detox alone, however, may not fully address the underlying issues associated with chronic substance misuse or addiction. Thus, following detox, people may benefit from transitioning to inpatient rehab or outpatient treatment to focus on these underlying issues.6

To be most effective, treatment plans should be tailored to your individual needs. However, most programs offer interventions that can include:^14,15

• Inpatient treatment. Provided within a hospital or residential setting, inpatient rehab comprises 24/7 care. Depending on your treatment needs, this care can be offered short term or long term for up to 12 months or more.
• Outpatient treatment. Varying widely in intensity and based on your needs, outpatient programs allow you to live at home or in a sober living environment during treatment. Some involve multiple hours of treatment each day, most days of the week; others may require a couple of hours a day a few days each week.
• Behavioral therapy. Behavioral therapies, such as motivational interviewing or cognitive-behavioral therapy (CBT), occur in individual or group settings. These interventions address the underlying issues of substance misuse, teach you coping skills to help prevent relapse, and provide psychoeducation about addiction and substance use.
• Also known as continuing care, aftercare starts after formal treatment ends and aids in long-term recovery. Programs may include participation in a 12-step or other mutual-help group, ongoing counseling, or assistance in securing sober living.

Offering the ability to treat alprazolam addiction, polysubstance addiction, and other co-occurring mental health disorders, American Addiction Centers (AAC) include accredited treatment facilities across the United States. To learn more about treatment options, contact our Admissions Navigators.