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HOW OUR HELP LINE WORKS
For those seeking addiction treatment for themselves or a loved one, the AddictionBlog.org helpline is a private and convenient solution. Caring advisors are standing by 24/7 to discuss your treatment options.
Calls to any general helpline (non-facility specific 1-8XX numbers) for your visit (IP: 73.111.49.103) will be answered by American Addiction Centers (AAC) or a paid sponsor.
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Dependence on Xanax


CONTENT OVERVIEW: Dependence is an expected outcome of long term benzodiazepine use but can cause cognitive decline. Management involves gradual drug reduction (tapering) or maintenance treatment. Additionally, dependent users also benefit from substitution therapy, psychotherapies, and pharmacotherapies.


TABLE OF CONTENTS


Defining Dependence

The term “dependence” is sometimes used for both addiction and physical dependence on a drug. Medically speaking,  physical drug dependence refers to a state that develops during chronic drug use in which discontinuation is accompanied by withdrawal symptoms.

Simply put, dependence on Xanax is just what it sounds like. If you take Xanax for more than a week or two, your brain and body become dependent on Xanax in order to function normally. And if you stop taking Xanax or drastically reduce dosage, you will go through withdrawal symptoms. So, dependence is not a matter of how long Xanax lasts, but how it builds up in your system over time.

Indicators of a Problem

The new DSM-5 criteria have categorized a drug problem under a new term called “Substance Use Disorder (SUD)“. This term was created to avoid the stigma and labels people were given attached to dependence, abuse, and addiction; and to reduce the stigma to patients given these labels. The DSM-5 criteria combine cognitive, behavioral and physiological symptoms into a complex condition called SUD.

There are 11 main symptoms of a drug problem according to the DSM-5 criteria:

  1. Taking Xanax in larger amounts, or over longer period than directed.
  2. Struggling with persistent desire to use Xanax, or unsuccessful efforts to reduce or control your use.
  3. Spending large amount of time dedicated to obtaining, using, or recovering from Xanax effects.
  4. Experiencing craving or strong desire for to use Xanax.
  5. The repeated use of Xanax affects your ability to fulfill obligations at work, school or home.
  6. Continuing to take Xanax despite recurrent social problems.
  7. Drastic reduction of important social, occupational or recreational activities due to Xanax use.
  8. Taking Xanax in physically hazardous situations.
  9. Continued use despite persistent or recurrent physical or psychological problems caused by Xanax.
  10. Diminished effects with continued use of the same amount of Xanax (tolerance).
  11. Experiencing withdrawal symptoms when you cut down your use, or completely stop taking Xanax.

IMPORTANT: Severe withdrawal reactions and adverse consequences come with long term use of Xanax and require medical supervision if and when you decide to get Xanax out of your system.

Time to Develop

The FDA label for Xanax states:

Even after relatively short-term use at the doses recommended for the treatment of transient anxiety and anxiety disorder (ie, 0.75 to 4.0 mg per day), there is some risk of dependence. Spontaneous reporting system data suggest that the risk of dependence and its severity appear to be greater in patients treated with doses greater than 4 mg/day and for long periods (more than 12 weeks).

The main ingredient in Xanax, alprazolam, is known to be habit forming. This is why Xanax is not usually prescribed for long periods of time unless there’s not a good alternative available. In fact, Xanax dependence can develop after only 1-2 weeks of taking the drug regularly. Plus, the longer you take Xanax and the higher the dose, the more likely you are to develop a dependence.

Withdrawal Symptoms

According to the Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence, Xanax withdrawal symptoms are unpleasant and can occasionally be dangerous, including:

  • anxiety
  • diarrhea
  • insomnia
  • muscle cramps
  • poor concentration and memory
  • restlessness
  • seizures

The only way to effectively treat Xanax withdrawal safely is to SEEK MEDICAL ADVICE. Your prescribing doctor will most likely gradually decrease the dose until you can safely go off the medication. Because of the risk of seizure, it’s not safe to simply “wait out” or go cold turkey through Xanax withdrawals. Still, be sure that you know what symptoms to expect when, and consult a Xanax withdrawal timeline chart.


The safest way to stop taking Xanax is under medical supervision.


Stopping Safely

The safest way to quit Xanax safely is under medical supervision using a tapering protocol that is custom-made for you. Tapering is a medical process that involves slowly reducing drug dosage over the period of days or months. According to the XANAX FDA-approved label, in a controlled study, subjects who were taking Xanax from 3-6 months were able to taper to zero dose. In contrast, patients treated with doses of Xanax greater than 4 mg/day had more difficulty tapering to zero dose than those treated with less than 4 mg/day.

NOTE HERE: Always seek medical supervision from a prescribing doctor when coming off Xanax. Tapering guidelines from the VA’s National Center for PTSD outline benzodiazepine equivalent dose tapering protocols…that require medical advice and feedback! Never try to reduce doses on your own, as you can experience seizures or serious symptoms of withdrawal.

Treatment

The treatment of Xanax dependence involves a variety of tools and treatment approaches. Depending on your individual case, doctors recommend various approaches ,or a combination of therapeutic practices. These are the most common protocols involved in the treatment of Xanax dependence:

1. Assessment

The assessment determines the severity of Xanax dependence and also provides information and insight about the user’s risk of relapse and of harm. During the assessment as a starting point in any substance use disorder treatments, doctors gather information about:

  • amounts of Xanax you take
  • duration of use
  • history of psychiatric or medical disorders (if there are any)
  • your age
  • your family history

Additionally, expect your doctor to discuss your readiness for change, as well as the reasons why you want to quit taking Xanax.

2. Management

If you are not truly ready to change, or is just considering change, then motivational interviewing techniques are recommended. If you are ready for change, there are usually two approaches to the management of dependence:

A) Benzodiazepine withdrawal with the aim of abstinence
B) Benzodiazepine maintenance therapy

The approach depends on how your doctor estimates your personal risk of harm and relapse. Low-risk users can be usually benefit from attempting withdrawal. High-risk users are best managed with initial stabilization and maintenance therapy in residential or outpatient addiction services.

3. Substitution Therapy

A common approach in the treatment of benzodiazepine dependence is substituting shorter half-life benzos such as Xanax with longer half-life drugs, such as diazepam. Conversion tables are available to guide conversion to diazepam equivalents.

4. Monitoring

When your start a medically guided therapy, your doctor has tools that assure her/him that you are not doctor shopping to obtain more prescriptions. There is an online directory which provides a limited telephone report called Medicare’s Prescription Shopping Information Service. This way doctors stay informed about people who attempt to get a prescription from multiple resources.

5. Tapering

There are no standard tapering regimens for Xanax, or any other benzodiazepine. The duration of dose reduction depends on your:

  • duration of therapy
  • risk of relapse
  • starting dose
  • success rates of tapering
  • tolerance levels

Most medical studies have found that gradual withdrawal over at least 10 weeks is successful in achieving long-term abstinence. For additional information about tapering you can visit Helping Patients Taper from Benzodiazepines

6. Pharmacotherapy

Anticonvulsants have been proven effective during Xanax withdrawal for users who are not dependent on other drugs. Doctors also prescribe Flumazenil, to help people who rapidly withdraw from Xanax to a lower dose or to abstinence without severe and intense withdrawal symptoms.

7. Psychotherapy

The latest studies about the effectiveness of benzodiazepine withdrawal discovered that gradual dose reduction combined with psychological treatment are very effective for achieving long term abstinence. Incorporating cognitive behavioral therapy during tapering helps people achieve greater results. Working on the psychological issues behind your dependency will help you easily cope with the withdrawal symptoms.  Interventions that could reduce Xanax use include standardized interviews and relaxation techniques.

8. Stabilization and maintenance therapy

Some users do not want to consider tapering off Xanax and are at high risk of relapse or harm. Harm reduction strategy can be very helpful for people who have a high risk dependency. This treatment approach involves using a long half-life substitute to prevent intoxication and withdrawal.

People who are best candidates for maintenance therapy are those who are on a high Xanax equivalent dose, have a variety of drug-related behaviors, and those who have an unstable psychiatric diagnose. The treatment for these people is done in a specialized treatment center.  It is possible to reach a period of stability and eventually quit Xanax completely if you are persistent during your maintenance therapy.

Am I an Addict?

No, not necessarily.

Dependence on Xanax happens when the drug is taken in high doses or for long periods of time. Xanax dependence mostly means you can’t stop taking the drug abruptly without withdrawals. However, during the detoxification or withdrawal period from Xanax, symptoms of abuse or psychological dependence may emerge.

A Xanax addict cannot live without Xanax and uses it to avoid emotional or psychological pain.

Xanax addiction is mainly characterized by psychological symptoms on top of physical need.You might be an addict if you use Xanax to get high, or if you’re mixing Xanax with other substances for euphoric effect. Xanax addiction is more likely if you’re not taking Xanax as directed. Plus, snorting or smoking Xanax increases your addiction risk, as does taking large amounts of Xanax.

What Next?

If you think you have a problem with Xanax, you probably do.

What can you do about it?

  1. Admit the problem.
  2. Seek help.
  3. Get treatment.

There is no longer shame in facing a drug problem. Organizations like Facing Addiction and NCADD are advocates for identifying and treating the 22 million addicts in the U.S. You are not alone!

If you face any of the following red flags of addiction, please give us a call. Or, see your prescribing physician. You can also call an addictions counselors, pyschotherapist, psychiatrist, addiction treatment center, or a clinical social worker. Each of these behavioral health professionals can help refer you to assessment and treatment!

Red flags to beware of:

  • Active addiction to another substance.
  • Deteriorating function despite increasing dose.
  • Doctor shopping.
  • Quick escalation of drug use.
  • Routine early refill requests.
  • Selling Xanax to fund your own use.
  • Using Xanax in manners other than prescribed, especially non-oral.

Questions

Do you still have questions about Xanax dependence and addiction? We welcome all questions in the comments below.

Reference Sources:DailyMed: Clinical Toolkit: Benzo Use and Taper
Xanax XR
PubMed Health: Alprazolam
ToxNet: Alprazolam
PubMed: Alprazolam use and dependence. A retrospective analysis of 30 cases of withdrawal.
NCBI: DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale
NCBI: Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings
SA Health: Benzodiazepine equivalents

 

Leave a reply

Gio
Wednesday, November 21st, 2012

You mentioned that Xanax dependence can develop after only 1-2 weeks of taking the drug "regularly". Please define regularly. One or twice a week is regularly or is everyday use considered regularly? Thanks
Addiction Blog
Sunday, November 25th, 2012

Hi Gio. My (unprofessional) understanding, is that regular use = daily. But for benzodiazepines with a long half life, I wonder if even every-other-day dosing can cause the dependence effect. I'd suggest that you call a pharmacist or consult with your prescribing doctor for clarification. And please share what you learn!
Gio
Monday, December 3rd, 2012

Hello, My doctor basically said that I can get hooked with only 10-15 days of everyday administration of the drug. He said that i could be taking xanax daily for ten days and everyday I will wake up in the morning feeling great but sooner or later I will wake up one day and feel like all hell broke loose and that is when the problem starts. He also said that due to the high levels of relief that the drug is offering, even with 2-3 times per week administration a rebound anxiety may occur that will drive someone to take more. That is what he said more or less.
Gene
Sunday, January 26th, 2014

I had a operation Jan 6 2014 and was prescribed Norco 7.5 and oxycodone 5mg and stop taking them because my pain can now be controlled by Tylenol. I am having minor withdrawels. My surgeon wrote me a prescription for Xanax only twelve 1 every 12 hrs can I develope a dependence on that amount if taken as directed.
Addiction Blog
Friday, January 31st, 2014

Hello Gene. Dependence on Xanax occurs after regular dosing over a period of 1-2 weeks. How long is the prescription written for? Also, have you consulted (even on the phone) with a pharmacist? I'd suggest you seek a professional opinion and make a decision based on your findings.
Chichi
Thursday, March 24th, 2016

If i have had xanax withdrawl seizures in the past, would one mg of xanax hurt me if i havent taken any in years? (Im flying and would like to take 1 mg for the flight if it is safe) its been over 2 years since ive taken any sort of benzo
Lydia @ Addiction Blog
Thursday, March 31st, 2016

Hi Chichi. I suggest you speak with your doctor who knows your medical history and can give you the best advice.
Anup
Sunday, February 19th, 2017

My grandma is taking the alprazolam tablet 0.25 since 28 yrs period twice a day seeking some clinic without following up consultant, as she passed from some sort of anxiety disorder and depression. Now, i got to know about the tablet, and its dosage with its function. Can my grandma get rid off from this drug addiction and reduce its use so as to get normal?
Rita
Monday, August 14th, 2017

If you have been taking 2mg Xanax 4 times a day for yrs now and you are cut to 2 2mgs a day how will this affect you? Concerned! Thanks¡
Ivana @ Addiction Blog
Monday, August 14th, 2017

Hi Rita. This might be an abrupt decrease. Do you have enough Xanax to do a more gradual taper? You will experience withdrawal symptoms either way, but they will be far more manageable and less intense if you do it more slowly. You can talk with your doctor and ask him/her to help create a custom tapering schedule for you. Still, some general Xanax tapering guidelines include: - A Xanax taper is recommended to occur over a period of eight weeks. - Doses of Xanax should be lowered no more the .5mg every three to four days. - You should let people know what’s going on, so they can support you during your withdrawal process. Read more on what you can expect during Xanax withdrawal and ways to address symptoms, here: http://prescription-drug.addictionblog.org/xanax-withdrawal-treatment-how-to-treat-xanax-withdrawal/
Queen
Wednesday, September 6th, 2017

How do I deal with the withdrawal at home cold turkey ...what will help me?
Lydia @ Addiction Blog
Thursday, September 7th, 2017

Hi Queen. Benzodiazepine withdrawal is one of the most severe and harsh to overcome. First, I suggest you speak with a pharmacist who can recommend some over-the-counter medication, home remedies, teas and hot baths to ease withdrawal symptoms. Moreover, you may look into the Ashton Manual: http://www.benzo.org.uk/manual/
Alan
Monday, December 11th, 2017

If I took .5 a week ago. Took .25 last night and a few nights before ( opiate withdrawal ) am I at risk for seizures?