Benzodiazepines are a class of medications designed to replace barbiturates, which were originally used in the treatment of anxiety disorders and seizures. Xanax (alprazolam) is the most commonly prescribed benzodiazepine.
It is typically prescribed:
- To offer acute relief of anxiety
- To induce sleep or relaxation
- As a preanesthetic drug
- For the control of seizures
- To address withdrawal from alcohol
While Xanax is often associated with anxiety relief, it is only prescribed for clinically significant dysfunctional anxiety in individuals with anxiety disorders or other psychiatric disorders. It is not used for normal nervousness or anxiousness that people experience as a result of daily living.
Prior to the use of benzodiazepines like Xanax, barbiturates were prescribed for many of the above purposes; however, barbiturate abuse became a major issue in the United States. Benzodiazepines are shorter-acting in most cases and were believed to have less of a potential for abuse than barbiturates; however, benzodiazepine abuse is a significant issue in itself.
Benzodiazepines have good medical uses as depicted above, but the United States Drug Enforcement Administration (DEA) also recognizes that they are potential substances of abuse that can produce physical dependence. Benzodiazepines are typically classified as controlled substances under the Schedule IV categorization. This means that any legal use of Xanax can only occur when a person has a prescription from a physician for the drug.
- The development of tolerance
- The potential development of a withdrawal syndrome (physical dependence)
- Slowing down of the functioning of the central and peripheral nervous system while on the drug
Xanax is a very potent medication, meaning that its effects occur with small doses of the drug. It also has a relatively fast (intermediate) onset of action and a short half-life, meaning that it typically works quickly and the effects of the medication are not long-lasting as it does not remain in the system very long.
Xanax was developed as an alternative to Valium (diazepam), another benzodiazepine that was primarily prescribed to treat anxiety. Valium became a significant drug of abuse. It was believed that Xanax’s relatively fast onset of action and its quick elimination from the system would prevent it from being a significant drug of abuse; this did not prove true.
Abuse of Xanax
The Substance Abuse and Mental Health Services Administration (SAMHSA) releases yearly estimates of the use and misuse of numerous illicit drugs and prescription medications. The data is released for the previous year, such that the data released at the end of 2017 covers the use and misuse figures for 2016. Misuse of any drug does not necessarily imply abuse, but continued misuse of a drug could qualify for abuse.
Misuse of a drug implies that the individual took the drug for reasons other than as prescribed or in amounts greater than or more often than its prescribed purposes. SAMHSA compiles estimates on the individuals who say they have misused a particular drug or medication at least once within the past month or year prior to their survey. According to the data from 2016, estimates for the number of individuals who reported any use of Xanax was 18.4 million. The number of individuals reporting at least one misuse of Xanax during the same year was 4.3 million (or about 24% of the individuals reporting any use of the drug).
The number of individuals formally diagnosed with a substance use disorder as a result of Xanax is hard to reliably estimate, but it would be significantly lower than the number of individuals reporting at least one misuse of the drug.
Major organizations such as the National Institute on Drug Abuse (NIDA) and SAMHSA have reported that when benzodiazepines like Xanax are abused, they are often not the primary drug of abuse. Benzodiazepines like Xanax are most commonly abused in conjunction with narcotic pain medications, alcohol, and other benzodiazepines.
Individuals abusing Xanax will most often be abusing some other drug as well. This can lead to significant complications and an increased potential for toxic or overdose effects. Polydrug abuse is a significantly complicated issue and very often much harder to treat than the substance abuse issues that occur in people who abuse one type of drug or medication.
Signs of Xanax Abuse
An individual who is diagnosed with a substance use disorder as a result of abusing Xanax would receive a formal diagnosis of a sedative, hypnotic, or anxiolytic use disorder according to the diagnostic criteria provided by the American Psychiatric Association (APA). Very often, these individuals will have some co-occurring diagnosis that will include some other substance use disorder, and they are at an increased risk to also be diagnosed with some other mental health disorder, such as depression or an anxiety disorder. The diagnosis of any substance use disorder can only be made by a licensed mental health professional.
The types of indicators that are used to diagnose substance use disorders include:
- Frequent nonmedicinal use of a drug/medication that leads to significant distress or functional impairments in the person
- Numerous indicators that the individual is unable to control their use of the drug
- Continued use of the drug even though its use is resulting in significant damage or harm
- Nonmedicinal use that leads to significant tolerance to the drug
- Nonmedicinal use that leads to the development of withdrawal symptoms
There are no formal diagnostic signs of a substance use disorder as a result of Xanax abuse that can differentiate abuse of Xanax from abuse of other benzodiazepines. The specific benzodiazepine being abused would have to be reported by the individual with the abuse issue or by some other person close to that individual. Clinicians may be able to estimate whether or not the benzodiazepine in question is a long-acting or short-acting one, but determining the exact benzodiazepine being abused is not a function of the diagnostic criteria for substance use disorders.
Moreover, benzodiazepine abuse often resembles abuse of alcohol, and clinicians would need to differentiate this issue based on the reports of the person with the abuse problem or someone close to that person. Laboratory tests such as blood tests could confirm the presence of the specific substance being abused (e.g., Xanax, alcohol, or some other benzodiazepine); however, laboratory tests alone cannot formally be used to diagnose any substance use disorder.
The formal diagnosis of any substance use disorder is made by a careful evaluation and assessment performed by a trained and licensed clinician. The assessment is based on behavioral signs and symptoms that the person exhibits associated with their use of the drug. People without formal training and certification in mental health diagnoses cannot make a formal diagnosis, but they can recognize some of the signs that should be a cause for concern. Some of these signs, both mental and physical, include the following:
- Frequently using Xanax without a prescription
- Frequently using the drug in a way that is contrary to its prescribed instructions
- Attempts to get numerous prescriptions from different doctors for Xanax
- Frequently using Xanax along with other drugs or alcohol
- Using Xanax for nonmedical reasons and needing to use more and more Xanax to get the effects once achieved at lower amounts of the drug (tolerance)
- Issues when use of Xanax is stopped (possible withdrawal symptoms)
- Numerous empty prescription bottles for Xanax in the person’s possession or in their room, car, or clothes
- Giving up important activities or failing to fulfill important commitments due to use of Xanax
- Frequently appearing intoxicated without the smell of alcohol
- Strong urges to use Xanax to cope with everyday stressors
- Being unable to cut down on use of Xanax
- Becoming extremely defensive, reactive, or aggressive when confronted about Xanax use
- Using Xanax alone or attempting to hide Xanax use
- Uncharacteristic problems with memory, irritability, or emotional outbursts
- Problems at work, in personal relationships, or in other areas of life
- Legal difficulties as a result of Xanax use
Any person demonstrating two or more of these possible indicators should be considered for formal evaluation for a potential substance use disorder.
Moreover, Xanax is a central nervous system depressant drug that slows down functioning of the nervous system. Chronic abuse of the drug can lead to numerous issues that represent chronic problems.
Some of these include:
- Cognitive problems, such as issues with attention, memory, and problem-solving abilities
- Respiratory issues that can include increased susceptibility to infections or even cancer
- Cardiovascular issues
- Significant passiveness that can display itself as neglect of responsibilities, self-care, and/or personal hygiene
- Rebound effects that occur when one stops using the drug, such as an increase in anxious behavior, pain, irritability, or restlessness
- Increased potential to become the victim of a crime or abuse
- Increased potential to be diagnosed with some other type of mental health disorder
The appearance of any of these above issues related to Xanax abuse would suggest a chronic and serious problem with abuse of the drug. Cognitive problems indicate significant changes in the brain pathways that are more likely to occur with chronic abuse of the drug than with long-term medicinal use. Other health issues, such as cardiovascular issues or respiratory issues associated with Xanax use, should also be considered the result of chronic abuse of the drug. In addition, because Xanax is most commonly abused with other drugs, there can be significant complications due to the interaction of Xanax and other drugs of abuse that accelerate these detrimental effects.
Because there is a significant potential for abusers of Xanax to develop physical dependence on the drug, telltale signs of Xanax abuse are the appearance of withdrawal symptoms in an individual who does not use the drug medicinally or in an individual with a prescription for the drug who often uses too much of the drug and runs out before its renewal time.
Individuals who use Xanax under the supervision of their physician according to the prescribed instructions may develop some level of physical dependence on the drug, but this would not be considered a potential sign of abuse or addiction. By definition, a substance use disorder (addiction) is associated with frequent nonmedicinal use of the drug that leads to significant problems in functioning. Because Xanax is commonly abused in conjunction with other drugs of abuse, any individual who uses Xanax along with other drugs that are not prescribed to them should be suspected of abusing the drug.