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
- Time to Develop
- Withdrawal Symptoms
- Stopping Safely
- Am I an Addict?
- Signs of a Problem
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:
- Taking Xanax in larger amounts, or over longer period than directed.
- Struggling with persistent desire to use Xanax, or unsuccessful efforts to reduce or control your use.
- Spending large amount of time dedicated to obtaining, using, or recovering from Xanax effects.
- Experiencing craving or strong desire for to use Xanax.
- The repeated use of Xanax affects your ability to fulfill obligations at work, school or home.
- Continuing to take Xanax despite recurrent social problems.
- Drastic reduction of important social, occupational or recreational activities due to Xanax use.
- Taking Xanax in physically hazardous situations.
- Continued use despite persistent or recurrent physical or psychological problems caused by Xanax.
- Diminished effects with continued use of the same amount of Xanax (tolerance).
- 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.
According to the Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence, Xanax withdrawal symptoms are unpleasant and can occasionally be dangerous, including:
- muscle cramps
- poor concentration and memory
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.
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.
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:
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.
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.
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.
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
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.
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.
If you think you have a problem with Xanax, you probably do.
What can you do about it?
- Admit the problem.
- Seek help.
- 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.
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
PubMed Health: 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