Xanax (Alprazolam) Withdrawal and Treatment

What is Xanax?

Xanax is a prescription benzodiazepine medication used to manage anxiety and panic disorder.¹ Even if used properly, you can become addicted via physical dependence through prolonged use of the drug. Once physical dependence on Xanax develops, potentially severe withdrawal symptoms may occur to people who try to quit “cold turkey” or abruptly cut off their use.¹ Anyone can become dependent upon Xanax after prolonged use. Whether under the direction of their physician or for recreational use, Xanax’s negative side effects do not discriminate.

Some people abuse Xanax for recreational purposes for its sedating high.³ Others may use it in order to self-medicate their anxiety or their insomnia. Xanax is also commonly sought out by people looking to alleviate the side effects or soften the comedown of a stimulant high (such as from cocaine, meth, or Adderall).⁴

Xanax Withdrawal and Addiction

Regardless of how you came to be physically dependent on Xanax, you may require professional help to quit, in order to safely manage a withdrawal syndrome that can be both physically and psychologically severe (and sometimes life-threatening, in the case of seizures).¹

Xanax binds to certain receptors in your central nervous system and, in doing so, increases the activity of an inhibitory neurotransmitter known as GABA. The resulting increase in GABA activity creates a temporary calming and sedating effect. While benzodiazepines can be effective anxiolytic medications, their misuse can quickly lead to physical dependence.

Physical dependence is often an indication of addiction. Though people who are not addicted and also use Xanax as prescribed may experience some degree of withdrawal upon stopping.

Addiction encompasses much more than simply going through withdrawal upon substance cessation; it involves compulsively seeking and using a substance even when it has a multitude of negative effects on your life, such as:⁴

• Job loss.
• Problems at school.
• Family conflict/strained relationships.
• Legal charges.
• Damage to physical or mental health.

Some people using Xanax on a prescription basis may not feel that they need any help when they decide to quit. However, for anyone who has developed a significant severe physical dependence on a benzodiazepine, there is a high level of risk associated with abruptly quitting. Medical detox provides a safe environment for withdrawal and minimizes the chances of relapse or serious medical complications.²

How Long Does Xanax Withdrawal Last?

There is no set timeline for Xanax withdrawal. Due to the nature of the substance, the time it takes one to detox from Xanax can range depending on how long they used Xanax, the doses used, the frequency of the dosage, and if any other benzodiazepines or substances were used concurrently.

What Happens During Xanax Withdrawal?

When you first quit, you’ll experience the more medically threatening, acute symptoms. A rapid reduction or complete cessation of Xanax may trigger the most severe and dangerous adverse effects, such as seizures.² A medical detox approach will help you to taper off Xanax and will reduce the risks of dangerous complications.

Longer-term treatment avenues and engagement with aftercare can help with the more drawn-out, protracted symptoms—keeping people on track and perhaps making relapse in response to persisting symptoms less likely.

Xanax Withdrawal Symptoms

Xanax withdrawal symptoms may vary in severity from person to person, and not everyone experiences all of them. Xanax withdrawal symptoms include:^2,5

• Anxiety.
• Insomnia.
• Restlessness.
• Unintentional and purposeless movements.
• Hand tremors.
• Muscle spasms.
• Excessive sweating.
• Rapid pulse.
• Nausea/dry heaving.
• Vomiting.
• Weight loss.
• Muscle pain.
• Headaches.
• Hallucinations
• Delirium.

The biggest physical risk of withdrawal from Xanax is that of seizures. Seizures can be life-threatening if not treated properly. Another risk of Xanax withdrawal that can be extremely distressing to the individual is rebound anxiety, a condition in which anxiety symptoms recur or even escalate to a level higher than a person experienced before taking Xanax.^4,6

Post Acute Withdrawal Syndrome (PAWS)

Additionally, some people experience a condition known as post-acute withdrawal syndrome (PAWS), in which people experience changes in mood and cognitive functioning lasting for many weeks or even months after withdrawal from a drug. Researchers believe that PAWS arises as a result of physiologic changes to the brain that result from repeated drug use. The symptoms of PAWS, as well as their severity and how often they occur, vary from person to person. We have listed the most common symptoms below:⁷

• Cognitive problems, including issues with learning and memory.
• Anxiety.
• Depression.
• Irritable mood.
• Obsessive-compulsive behaviors.
• Loss of interest in most things.
• Problems interacting with others.
• Greater sensitivity to stress.
• Cravings for drugs.

Should I Quit Xanax?

You may wonder if Xanax is a dangerous drug, especially if you are taking it with a doctor’s approval. For many people, a short-term course of Xanax can be safe and effective. However, Xanax is associated with a number of risks that extend beyond that of physical dependence such as irritability, hypotension, slowed pulse, respiratory depressions, loss of libido, and long-lasting cognitive impairments. There’s also a chance you may experience memory loss and suicidal thoughts as well. ^1,4,8

Additionally, overdoses are a high risk when it comes to Xanax, as well. This risk is heightened when the drug is consumed simultaneously with certain other substances. The greatest danger for overdose occurs when people mix Xanax with opioid painkillers or alcohol, as all of these substances are central nervous system depressants, and the compounding effects of mixing these substances can significantly repress breathing and may lead to a coma or death.¹ It is also important to note that the elderly are more sensitive to the effects of Xanax and may accidentally overdose more easily than younger people.¹

How to Stop Taking Xanax

Treating an addiction to Xanax involves much more than just undergoing detox to remove the drug from your body. After detox, a follow-up addiction treatment program, either on an inpatient or outpatient basis, is necessary to help you deal with the addiction itself and learn improved coping skills that don’t involve turning to Xanax or any other substances when you’re feeling triggered or overwhelmed by cravings.

However, several non-pharmacologic therapies can help a person to cope with anxiety without benzodiazepines. These include: ¹⁰

• Cognitive-behavioral therapy, or CBT. Studies have shown that CBT is effective for many people who have various forms of anxiety, such as panic attacks, generalized anxiety disorder, and social anxiety.
• Eye movement desensitization processing (EMDR). This is another practice found to be effective with post-traumatic stress disorder (PTSD), as well as panic disorders and phobias.
• Dialectical behavioral therapy (DBT). This therapy type involves learning skills such as mindfulness to cope with dysregulated feelings and emotions. DBT has been helpful to many people who have anxiety disorders.

Xanax Detox and Withdrawal Treatment

Withdrawal symptoms can persist for a long period of time, but the symptoms will differ according to the phase of recovery: ⁸ Detox treatment plans will vary for each individual and will be influenced by many factors, including any polysubstance dependence, as well as the individual’s overall mental and physical health. In some cases, the doctor will first order a slow taper off Xanax to give the body time to safely adjust to lower doses. Reducing the dose helps alleviate, and may even prevent, many common symptoms experienced during withdrawal.

Some people can undergo a Xanax taper under a doctor’s supervision on an outpatient basis. However, this option is only appropriate when the person’s doctor has thoroughly evaluated the risks and determined whether it is safe. ²  Additionally, while some people may prefer the idea of detoxing on an outpatient basis, many reported that inpatient treatment worked best for them.³

Can I Ever Take Xanax Again?

You may be scared that you can’t handle your anxiety without Xanax. It is not likely that your doctor will want to prescribe Xanax after you have developed an addiction to it. In addition to therapy to help with anxiety, there are non-addictive medications, known as selective serotonin reuptake inhibitors (SSRI) and selective noradrenaline reuptake inhibitors (SNRI) that can provide relief to many people who have anxiety. Commonly prescribed SSRIs include sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa). Some of the popular SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).¹² You may be able to work with your doctor on developing a treatment regimen that utilizes medications with much lower addictive potential.

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