Xanax (also known as Alprazolam) is a benzodiazepine drug that is used to treat anxiety, however, it is not currently available on prescription through the NHS in the UK although it is possible to obtain the drug through appointments with private doctors.
Xanax falls into the anxiolytic category of benzodiazepine drug rather than the hypnotic category as it is primarily used to treat anxiety and panic disorders. (1)
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In the UK the most common medication prescribed by doctors for anxiety is Valium, Xanax has been scientifically proven to be 10 times stronger than Valium.
It also has a shorter half-life of 6-20 hours meaning that it is processed by the body and eliminated very quickly unlike diazepam which has a half-life of up to 50 hours.
Xanax, therefore, has a moderately quick onset of action and people taking the drug can begin to feel its effects within 1 hour (if on a dose prescribed by doctors). (1,15)
Like all Benzodiazepine drugs Xanax should only be used for 2-4 weeks because if its use is continued beyond this period the risk of physical dependence drastically increases.
This is because the effects of the drug start to weaken as patients’ bodies quickly become tolerant to the drug. The consequence of this is that they will need to take a higher dose of Xanax in -order to alleviate their anxiety-related symptoms. (12,16)
Recreational drug users are keen to obtain Xanax as it takes effect quickly and is much stronger than other benzodiazepine drugs.
Xanax begins to act several minutes after being ingested and leads to feelings of pleasure and euphoria at levels that cannot be achieved naturally and these effects can last for several hours.
It also has the potential to enhance the positive effects of alcohol, meaning it is commonly used in social situations and the party scene. It can also lead to experiencing light-headedness and a feeling of detachment and numb our ability to experience emotions.
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In America, Xanax is widely used and is the most commonly prescribed psychotropic (any medication that alters human behaviour and functioning) medication in America let alone the most commonly prescribed benzodiazepine.
Over the last 10 years around 50 million prescriptions have been written out each year such to the prevalence of anxiety in the USA and the strong belief in the effectiveness of the drug for treating anxiety. (15)
As well as posing a higher risk for physical dependence, scientific research has revealed that Xanax is significantly more toxic than most other drugs from the benzodiazepine category.
Studies have revealed that patients who overdose on Xanax tend to be in hospital for a longer period compared to those patients who abused other benzodiazepines.
More patients tend to require intensive care support if they become hospitalised due to the severe physical effects associated with Xanax abuse when compared with other benzodiazepines. (15)
Because of its high level of toxicity, people who become physically dependent on Xanax will experience intense withdrawal symptoms if they try to give up the drug as it is the toxic chemicals in the bloodstream that influence the severity of withdrawal symptoms.
The quickest way to alleviate such strong withdrawal symptoms is to take more Xanax which will only strengthen the possibility of becoming addicted.
Xanax is unavailable on prescription in the UK and because of this there is a real danger that many Xanax products that people can obtain on the illicit market are of poor quality, or the strength of the Xanax doses are unknown.
This can have potentially disastrous consequences regardless of whether the people taking it are seeking its medicinal or recreational benefits.
There is also the added danger that any counterfeit Xanax products that are available online on the “dark web” may contain other dangerous chemicals which could also be highly toxic leading to life-threatening physical problems.
This means there is a strong likelihood that there could be a lot of people needing hospital treatment to help overcome their physical dependence on Xanax, or worse still require treatment to deal with the negative physical effects associated with highly toxic drugs.
These effects include serious brain, cardiac and respiratory problems. (1,15)
Anyone taking the drug recreationally should be aware that it can be difficult to assess the strength of the Xanax dose if it is obtained illicitly so they may experience the effects quicker, depending on the dose strength they take.
This makes Xanax a very dangerous drug to take if the source of the drug is uncertain as anyone taking Xanax from an unregulated source is likely to become sedated within minutes, potentially placing themselves and others around them in danger. (2,15)
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Xanax works by attaching to a neurotransmitter in the brain called GABA and triggering it into action.
The role of GABA is to inhibit the activity of most of the internal biological systems as GABA will lower physical activity in all these mechanisms which leads to a state of calmness and relaxation as any activity has been inhibited.
Xanax is a drug that produces highly powerful effects and there are several negative consequences that can occur if the people who have been prescribed the drug do not adhere to its instructions.
Some of these consequences include:
Both recreational users of Xanax and patients who require the drug to help with their anxiety are at risk of becoming addicted to Xanax.
The following signs indicate the presence of Xanax addiction:
Xanax is a fast-acting drug medical and recreational users can build up a tolerance to it quickly. The body automatically strives to adapt to the presence of all substances that are ingested so that they can be processed and safely removed from the body.
As it does this the effects of the drug weaken over time (tolerance) meaning greater amounts are required to achieve the same effects.
If after building a tolerance towards Xanax a person stops taking Xanax or increases the time gap in between using the drug they will experience withdrawal symptoms.
This is because their body has become used to functioning with Xanax present and is thrown into a confused state when it is not consumed, which results in withdrawal symptoms.
This is a sign that the Xanax user is now physically dependent on the drug. (4,10)
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Many medical researchers have reported that patients who become physically dependent on Xanax find it very difficult to give up the drug.
One of the main reasons for this is that the withdrawal symptoms people experience when they try to give up the drug are extremely strong when compared with other benzodiazepine drugs.
These symptoms can only be alleviated in the short term by taking more Xanax which only seeks to strengthen the addiction. (1)
The common withdrawal symptoms experienced by patients stopping their Xanax intake after a period of sustained use include:
There are a range of biological, psychological and social factors that can make people more vulnerable to becoming dependent on Xanax if they are currently taking the substance, these include:
When treating Xanax addiction there are three areas that need to be considered:
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Due to the highly toxic nature of Xanax and the threat of cardiac complications and brain seizures if detox is not carefully monitored by medical professionals it is highly recommended that patients spend the early phase of their treatment in a residential setting.
Or at least be monitored carefully by community-based addiction specialists if residential treatment is not possible.
This gives rehab medical teams the chance to fully assess each patient’s physical and mental state and accurately set their detox schedule and also be close at hand in case of any medical emergencies.
The detox process for treating Xanax dependence is similar to the approach used for withdrawing from most benzodiazepine drugs. This involves setting up a detox schedule and using a process known as drug tapering.
Detox treatment is needed to reduce the level of toxicity in the bloodstream and throughout the body which has occurred as a result of the patient’s prolonged Xanax use which has resulted in the patient experiencing withdrawal symptoms when they try to stop taking the drug.
It is imperative to offer full support and constant supervision to patients detoxing from Xanax as it is a drug in the benzodiazepine class and withdrawing from any drug in this category can be very precarious. (4,10)
Tapering involves gradually reducing the amount of a drug a person consumes over a period of time (3-6 months) to help them eliminate the toxic chemicals present in their body.
The amount of the drug each patient is given when their treatment commences needs to be sufficient to prevent withdrawal symptoms. (3)
All patients will be given an individual tapering plan which doctors base on:
The tapering schedule can differ in timescale between patients, with some schedules lasting 12 weeks whereas others may have a schedule lasting 40 weeks.
Each patient will be given their own tapering schedule which will gradually reduce the dose size of the benzodiazepine the patient will consume daily every 2-3 weeks to help lower the toxic particles of Xanax from their bodies. (3,16)
To help patients overcome their dependence it is necessary for medical practitioners to use a longer-acting benzodiazepine which shares similar chemical characteristics to Xanax.
This will help keep any unpleasant withdrawal symptoms at bay for a longer period than Xanax can, as Xanax is a shorter-acting drug.
Diazepam only needs to be taken once every 24-48 which helps to gradually lower the toxic chemicals in the body which trigger withdrawal symptoms.
Xanax has a short half-life so people taking the drug for a few weeks will, within 2-4 weeks need to take the drug more often (every 6-8 hours) or in stronger doses to feel its effects as their body has developed a tolerance to it.
Patients going through detox will be able to extend this to over 24 hours by switching to diazepam as the time gap between experiencing withdrawal symptoms will be extended (14,16)
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Any patient or recreational user who is addicted to Xanax and tries to stop taking the drug suddenly without consulting with medical professionals is placing themselves in grave danger.
This is because the sudden act of stopping their intake of Xanax (cold turkey) can cause erratic physical reactions which can cause brain seizures and sudden changes in blood pressure. (3)
Any patient going through detox treatment will engage in their own psychological therapies programme which is important for two reasons.
Firstly, these sessions provide patients with emotional support when going through detox as research has indicated that patients who receive counselling whilst going through detox have a much higher chance of adhering to the detox treatment schedule. (5)
Secondly, psychotherapy and addiction counselling helps patients understand the psychological, emotional and social factors that contributed to their addiction.
By addressing these factors the patient can make key decisions to turn their life around and leave their Xanax use behind them. (8)
CBT is an effective therapy for many mental health conditions and is based on the premise that inaccurate and negative thought patterns can influence our emotional state and our subsequent behaviour.
For example, many recreational users take Xanax to improve their mood.
By challenging clients’ negative thought patterns therapists can change the clients’ perception of themselves and the way they view the world around them which can decrease their emotional distress.
CBT usually plays a key role in relapse prevention where the patient learns psychological techniques to deal with anxiety-provoking and stressful situations that usually precede their Xanax use. (8,13)
DBT helps clients gain control over their responses to stressful situations and difficult emotions that arise throughout the day.
Research has shown that strong emotions play a huge role in addictive behaviour so by working with a DBT therapist patients can acquire key mental skills that they can implement when they face challenging situations.
As the sessions progress clients will become more confident and successful in implementing these key skills so they learn to deal with their emotions rather than engage in substance use. (8)
MI is an intervention carried out by specialist drug practitioners designed to keep patients focused on their treatment programmes and ensure that their motivation to change remains high.
Quite often over the course of a treatment journey, some clients have doubts about their suitability for treatment and experience a drop in their enthusiasm towards treatment.
MI sessions help clients identify their personal psychological barriers to treatment and help them gain valuable insight into why they are experiencing a drop in motivation.
By taking their concerns through with an empathic therapist who listens to the concerns of the client, the client can rediscover their motivation to change and re-engage with their treatment plan. (9)
Groups such as Narcotics Anonymous offer a strong support base for anyone attempting to overcome substance addiction of any kind.
Xanax is a difficult drug to withdraw from and research has found that emotional support from peers going through similar experiences can make a huge difference to anyone going through the challenges of detox treatment.
Support groups are based on the Alcoholics Anonymous principle of fellowship and mutual support and creating an environment where all attendees and meetings can draw strength from each other which helps to strengthen each member’s motivation for recovery. (5,8)
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All patients going through rehabilitation for Xanax addiction need to be fully prepared to give them the best chance of continuing to abstain from the drug.
Many patients can commit to treatment and show discipline during the early phase of treatment when they are surrounded by expert support and receiving detox treatment and psychological therapies. (9)
However, once the treatment is over they need to show resilience and motivation to maintain their abstinence and not slip back into taking Xanax again.
Part of the patient’s treatment plan will involve helping them acquire vital cognitive strategies which they can utilise to prevent them from relapsing back into Xanax use when they find themselves in high-risk situations.
Trained therapists will help patients reflect on which circumstances in their life make them vulnerable to taking Xanax again.
This may include social events, being in a certain location with specific people or even when they are in a low mood or feel lonely and angry. Negative physical states have been found for many people in recovery to be high-risk situations for triggering relapses. (10,13)
By working with therapists clients going through rehab will learn new techniques to help them withstand the emotional and psychological pressure that can occur in high-risk situations.
Techniques include drug refusal skills, improving assertiveness and learning to deal with strong emotions.
At Rehab 4 Addiction, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
For more information, simply reach out to our 24/7, confidential hotline on 0800 140 4690.
Rehab centres also help to devise an aftercare plan for patients with Xanax addiction so they know specifically what they need to carry on doing to maintain their recovery.
Without a detailed aftercare plan, patients are vulnerable to slipping back into substance use. (4)
An aftercare plan tends to include:
(1) Ait-Daoud, N. et al (2018) A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine. Jan-Feb 12(1). Available@A Review of Alprazolam Use, Misuse, and Withdrawal – PMC (nih.gov)
(2) Black, D., Grant, J. (2013) DSM5 Guidebook: The Essential Companion to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. APP. London.
(3) Cambridgeshire and Peterborough Clinical Commissioning Group NHS (2021) Coming off Benzodiazepines and “Z” drugs: A guide for patients. available @ getresource.axd (cambridgeshireandpeterboroughccg.nhs.uk)
(4) Ghodse, H. (2002) Drugs and Addictive Behaviour: A guide to treatment Cambridge University Press.
(5) Herie, M. & Skinner, W. (ed) (2014) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada
(6) Isbister, G. et al (2004) Alprazolam is relatively more toxic than other benzodiazepines in overdose. British Journal of Clinical Pharmacology. Jul 58(1) available@ Alprazolam is relatively more toxic than other benzodiazepines in overdose – PMC (nih.gov)
(7) Konopka, A. et al (2013) Psychosocial characteristics of benzodiazepine addicts compared to not addicted benzodiazepine users. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 40, 10 January. available@Psychosocial characteristics of benzodiazepine addicts compared to not addicted benzodiazepine users – ScienceDirect
(8) Lewis, J, Dana, R., Blevins, G.(2002) Substance abuse counselling. Brooks Cole, London.
(9) Miller, W. & Rollnick, S. (1991) Motivational Interviewing: Preparing to Change Addictive Behaviour. Guilford Press. New York.
(10) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York
(11) National Institute for Health and Care Excellence (2019) Benzodiazepine and Z drug Withdrawal Available onlineBenzodiazepine and z-drug withdrawal | Health topics A to Z | CKS | NICE
(12) Newton, D.E. (2016) Prescription Drug Abuse. ABC-CLIO California
(13) Rassool, G.H. (2011) Understanding Addictive Behaviours. Palgrave MacMillan. New
(14) Semel Institute for neuroscience and human behaviour (2022) Benzodiazepine Addiction. available@ Benzodiazepine Addiction | Semel Institute for Neuroscience and Human Behavior (ucla.edu)
(15) UK Health Security Agency (2018) Alprazolam (Xanax): What are the facts? available@Alprazolam (Xanax): What are the facts? – UK Health Security Agency (blog.gov.uk)
(16) Wirral NHS (2021) Benzodiazepine WithdrawalAvailable online@BenzoWithdrawalGuidance.pdf (wirral.nhs.uk)
