What is Xanax?
Xanax is the brand name for a benzodiazepinesedative medication, alprazolam. This calming prescription drug is used to treat generalized anxiety disorder (GAD), panic disorder and panic attacks, and anxiety associated with depression. It is an important drug for many people who struggle with intense anxiety in specific situations, panic attacks, social anxiety, and other immediate struggles with high levels of panic.
Because Xanax is a short-acting benzodiazepine, it binds to receptor cells in the brain very quickly, creating almost immediate relief that lasts for hours. Because Xanax works very quickly, doctors typically do not prescribe this medication for regular use. All benzodiazepines can rapidly lead to physical dependence and tolerance, so they are almost never prescribed for more than two weeks of daily use.
A report found that there were 32 million people over the age of 12 with benzodiazepine prescriptions in 2015. About 20% reported misusing the medication at least once. These sedatives were also reported to be the second-most misused and abused drug among people age 65 and older in 2011, leading to thousands of emergency room admissions.
Xanax Withdrawal Occurs After Physical Dependence
Since benzodiazepines like Xanax can lead to feeling intoxicated and relaxed, many people who take these substances begin to feel like they need this drug to feel normal, or they seek out the intoxication associated with it. They may begin to take larger or more frequent doses of Xanax without consulting their physician. This is prescription misuse and can lead to addiction and dependence.
Once a person develops physical dependence on Xanax, they may experience withdrawal symptoms when they try to quit. For people who take Xanax as prescribed, their doctor will work with them to taper off the medication and avoid discomfort during detox. However, people who struggle with Xanax addiction need to find medical oversight from an addiction specialist, so they can taper off alprazolam abuse.
There are several factors that influence how long Xanax withdrawal can last, including:
- The amount of the drug taken
- How often doses were taken
- How long the person misused or abused the drug
- Weight or body mass
- Metabolism speed
- Liver function
Although Xanax is a controlled substance, it is widely prescribed. This means that many people have access to this medication, and struggle with abuse or dependence. This can lead to various side effects, including addiction, which the National Institute on Drug Abuse (NIDA) defines as a chronic disease that changes the brain, leading to compulsive behaviors, drug cravings, and relapse.
Often, people who struggle with addiction attempt to quit “cold turkey.” They try to suddenly stop taking the drug without any support from medical professionals. Quitting a drug suddenly can lead to uncomfortable withdrawal symptoms, which may lead to relapse back into abuse and then overdose. Because Xanax and other benzodiazepines are so potent, some withdrawal symptoms may be life-threatening.
The Xanax Hangover
Without help from an addiction specialist, withdrawal symptoms from Xanax can include mild symptoms like:
- Trouble falling asleep
- Higher pulse and breathing rate
- Slightly higher blood pressure
- Increased body temperature, like a fever
- Excessive sweating
- Blurry vision
- Reduced appetite
- Stomach cramps
- Physical tremors
- Muscle tension or aches
These symptoms can appear when a person stops taking Xanax, even after one dose, and they are sometimes called the Xanax hangover. These symptoms can feel like a hangover from alcohol, but the emotional symptoms after Xanax can be more intense and may lead to taking another dose of the drug and eventually feeling reliant on it.
Emotional and mental symptoms from a Xanax hangover can include:
- Trouble concentrating
- Difficulty thinking clearly
- Trouble remembering things
- Lack of motivation
- Heightened sensitivity to stimuli like light or sound
- Agitation or irritation
- Increased anxiety
- Thoughts of suicide
Xanax’s half-life is about 11 hours, but some people process the drug within six hours, and others with slower metabolisms take over a full day to completely process the medication. Withdrawal or hangover symptoms begin once the drug is metabolized out of the body, and the brain’s gamma-aminobutyric acid (GABA) levels lower. Because the brain is used to Xanax binding to the GABA receptors, there are lower levels of the naturally produced neurotransmitter after one dose, so the brain needs time to recover. This can take a day or two for the Xanax hangover. Withdrawal after misuse or abuse of Xanax can take longer.
Acute Withdrawal Symptoms
Typically, withdrawal symptoms are associated with physical dependence. While there may be discomfort the next day after taking too much Xanax, true withdrawal symptoms may take 1–3 days to begin, and they usually last for about a week.
Acute withdrawal symptoms, like hangover symptoms, begin after the last dose of the benzodiazepine has metabolized out of the body, but for people who have taken Xanax consistently or misused the drug for a long time, it may take longer for the medication to metabolize out completely.
These are more intense hangover symptoms in many cases. They can also include symptoms like:
- Nightmares and other sleep disturbances
- Rebound anxiety and panic attacks
- Agoraphobia or social phobia
- Changes in visual perception
- Paranoid thoughts
- Intense depression
- Rage or aggression
- Intrusive memories
- Cravings for the drug
- Pain or stiffness throughout the body
- Weakness like “jelly legs”
- Gastrointestinal cramping or pain
- Double vision or blurred vision
- Tinnitus, or ringing in the ears
- Changes to appetite and weight
- Flushing or feeling hot or feverish
- Difficulty with balance
While these may not seem like serious issues, intense acute withdrawal symptoms can include:
- Strong cravings
- Hallucinations or delusions
- Increased panic, leading to a racing heart and chest pain
Medical supervision during detox reduces the risk of these serious health risks. It can also reduce the likelihood that withdrawal may become protracted.
Benzodiazepine Withdrawal Syndrome or Protracted Withdrawal
Sometimes, people who abuse Xanax for a long time or in large doses develop benzodiazepine withdrawal syndrome (BWS), a condition that can cause long-lasting withdrawal symptoms. Withdrawing from Xanax typically takes seven days, but BWS can extend the experience of psychological discomfort and cravings for a month or more.
Working with an addiction specialist to safely detox from Xanax greatly reduces the risk of developing BWS. This condition is more likely to occur in people who try to quit cold turkey after abusing Xanax for a long time.
BWS symptoms include:
- Ongoing tinnitus
- Chronic insomnia
- Cognitive difficulties
- Muscle pain and weakness
- Involuntary twitching or tremors
- Tingling sensations
Tapering Off Xanax Dependence
The goal of medically supervised detox from Xanax and other benzodiazepines is to avoid progression of withdrawal symptoms into severe, intense, or life-threatening territory. Mild symptoms can be managed without drugs, but people who experience very uncomfortable symptoms need help to taper their dose of Xanax, or they may need a replacement drug that can then be tapered.
Replacing Xanax with a long-acting benzodiazepine—most often, Valium—can help the person stop compulsively taking several doses of the drug because they do not crave benzodiazepines as often. Once they are medically stabilized, the overseeing physician can taper them slowly, at a rate that will vary by individual, until the person no longer physically depends on the benzodiazepine to feel normal. This means their brain chemistry can balance itself.
The National Center for PTSD, which is part of the Veterans Administration (VA), recommends that once a patient has been chemically stabilized, clinicians start by reducing the benzodiazepine dose by 25%–30%, then monitoring withdrawal symptoms for a week. If that is effective, reducing the dose by 5%–10% per day or week is the best process. The speed can depend on the individual’s experience of cravings and other symptoms. The focus must be avoiding relapse back into substance abuse, so tapering schedules must be individually tailored.
Detox is only the first step in the longer process of recovering from addiction. It is important to follow detox with an evidence-based rehabilitation program that focuses on behavioral changes.