The Xanax High: Alprazolam Abuse, Addiction & Treatment Options

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Xanax, the leading brand name for the drug alprazolam and used for treating anxiety and panic disorders, has become one of the most commonly abused prescription medications in the U.S., as recreational users take high doses of the drug seeking a “Xanax High,” a rapidly induced, yet long-lasting euphoric state.
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Between 2005 and 2013, Xanax was the most widely prescribed psychiatric medication in the U.S., and enabled many people suffering with anxiety disorders to control their symptoms and enjoy their lives once again.

However, the medication, from the class of drugs known as benzodiazepines, which also includes Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam), is designed only for short-term use. This is due to its highly addictive nature, and its recreational use, often prompted by other abusers describing the high from Xanax, has led to high rates of abuse and addiction.

What is a “Xanax High”?

Since Xanax is a legal medication, although only available by prescription, most recreational users don’t understand the very real dangers and risks of attempting to achieve a high from the drug. However, recreational users expose themselves again and again to the same stark dangers – like a fatal overdose – just to experience another euphoric Xanax high, one of the reasons that many of them quickly become addicted to the drug.

However, overdose is just one of the risks involved in seeking a Xanax high. The long-term abuse of Xanax can contribute to chronic medical conditions, such as substance use disorder (SUD) and major depressive disorder. Xanax is often used in conjunction with other substances, known as “polydrug use,“ particularly alcohol and opioids, as each substance enhances the effects of the other. However, this only makes an overdose more likely.

So what is it about a Xanax high that prompts recreational users to repeatedly put themselves in real danger just to experience it again?

Xanax High: Short-Term Effects of Xanax Abuse

Xanax is a central nervous system depressant, and when people abuse the drug for recreational reasons, they do so in high doses because of the euphoric high it provides them. In addition to this feeling of euphoria, the drug releases a flood of dopamine into the brain, creating the calming state that anxiety sufferers need.

All of this happens relatively rapidly – within 20 minutes or so of the drug entering the user’s bloodstream. The state of euphoria peaks after around 4 hours. This timeline is another reason why it is easy to become addicted to Xanax if it is used recreationally.

Furthermore, its side effects also include other pleasurable feelings, such as lightheadedness, a detachment from reality (including hallucinations), emotional numbness, and a higher sexual urge. Some Xanax abusers will even chew, inject, or snort the drug to achieve a high more rapidly.

When using Xanax in high doses, many people will fall asleep and some will experience blackouts (periods of lost time) for several hours. Other effects can include:

  • Memory and concentration issues
  • Respiratory difficulty
  • Nausea and vomiting
  • Joint pain
  • Increased energy or extreme fatigue
  • Erectile dysfunction
  • Depression
  • Suicidal ideation (thoughts of committing suicide)
  • Agitation
  • Unpredictable and aggressive behavior
  • Tremors
  • Hallucinations
  • Convulsions (seizures)

What is Xanax (Alprazolam)?

Xanax, a popular brand name for the drug alprazolam, is a prescription anti-anxiety medication from the family of drugs called benzodiazepines, and it is used for the treatment of anxiety disorders, panic disorder, and anxiety associated with depression. When used as directed, it is effective in balancing the brain’s chemicals, making anxiety sufferers feel normal.

However, because of this psychoactive calming effect, it has become one of the most commonly abused prescription drugs.

How Does Xanax Work?

Developed in the late 1960s as an anti-anxiety drug, Xanax works rapidly upon entering the patient’s bloodstream (within 20 minutes), and peaks within hours. It works by binding to GABA receptors in the brain, producing feelings of calmness. Because it is so fast-acting, quickly providing recreational users with a euphoric and pleasurable high, and is highly addictive, both physically and mentally, Xanax dependency can happen relatively quickly, too.

Xanax as a medication has an interesting history of development. Developed by Upjohn Laboratories in Michigan in the late 1960s as an antidepressant, it was originally a superior sleep aid with muscle relaxant qualities. However, during ongoing research, Upjohn believed it to be effective for anxiety, panic and mood disorders, too.

Other antidepressants on the market at that time were considered to be harsher and more toxic. In response, Upjohn repositioned its new benzodiazepine as a medication for “panic disorder.” They presented a new drug application to the FDA called Xanax, as an antidepressant, and it was eventually released in 1981.

Because of this unusual pathway to authorization, The FDA never requested Xanax be compared in research studies to placebos or other anti-anxiety medications such as Valium and Librium.

However, the FDA did insist that Upjohn could only launch Xanax as an anti-anxiety medication that “does not produce depression.” By the early 1990s, Xanax had become one of the most prescribed drugs in psychiatric medication, and it is currently the most prescribed benzodiazepine in the U.S.

Even using Xanax as prescribed and directed can be risky, which is why it is only meant for limited, short-term exposure. Over time, users develop a tolerance to the drug, meaning that it takes more and more of the drug to produce the desired result. Therefore, if you have ever had a problem with substance abuse or addiction, it is important you discuss this with your doctor.

Due to its reputation as a popular “party drug,” Xanax is illicitly bought and sold on the streets of the U.S. On the street, it goes by the following street-names:

  • Bars
  • Ladders / Ludes
  • Bennies
  • Phennies
  • Xs
  • Peanuts
  • Footballs / Goofballs
  • Downers
  • Christmas Trees
  • Zannies

Xanax Addiction in the U.S.: Facts & Statistics

Sadly, overdose deaths involving Xanax and other “benzos” (benzodiazepines) have risen steadily over the past 30 years. Here are some of the more concerning facts and statistics about Xanax and other benzodiazepine abuse in the U.S.:

  • According to the National Institute on Drug Abuse (NIDA), a rise in the number of overdose deaths coincided with an increased number of benzodiazepine prescriptions being written by physicians
  • Between 2002-2015, fatalities from benzodiazepine overdose quadrupled – however, Xanax and other benzodiazepine prescriptions kept being written
  • In 2017, 1 in 20 U.S. citizens was filling a benzodiazepine prescription
  • It is estimated that every year in the U.S., there are nearly 200,000 people, new to this family of medications, who begin abusing benzodiazepines
  • Additionally, according to the Centers for Disease Control and Prevention (CDC), during the years 2010 and 2014, more than 30% of opioid overdose fatalities involved benzodiazepines like Xanax
  • The NIDA reports that you are 10 times more likely to die from an overdose when taking benzodiazepines with opioid painkillers

The Signs & Symptoms of Xanax Abuse / Addiction

Long-term use of any benzodiazepine, such as Xanax, is certainly not recommended, as the drug carries serious mental and physical health risks. Here are a few of the more common negative effects you can expect to experience:

  • Cognitive difficulties: Impaired memory, attention span, verbal learning, motor skills, and spatial reasoning
  • Sleep disturbance: Shortened sleep time, delayed/decreased REM sleep, increased alpha/beta activity, and impaired “deep sleep”
  • Mental health disorders: Depression, anxiety, PTSD, agoraphobia, panic attacks, hallucinations, delusions, and suicidal ideation
  • Suppression of the immune system
  • Increased risk of cancer: Specifically, bladder, breast, bowel, lung, and brain
  • Substance use disorder (SUD): increased risk of addiction, with life-threatening withdrawal symptoms

Xanax Polydrug Use: Benzodiazepines + Opioids or Alcohol

Mixing drugs for recreational purposes is known as “polydrug use.” It is never advisable to mix prescription medications together unless advised by your doctor that it is safe to do so, and it is simply dangerous to mix a drug like Xanax with either opioid or other benzodiazepine  medications, illicit opioids or alcohol, as this will seriously increase any chance of overdose.

Benzodiazepines, such as Xanax, depress central nervous system (CNS) activity, which provides the Xanax high. They are safe and effective when taken as prescribed and directed. However, when combined with other drugs that also depress CNS activity, such as alcohol or opioid medications, such as OxyContin (oxycodone), Vicodin (hydrocodone), Dilaudid (hydromorphone), or morphine, benzodiazepines can present serious or even life-threatening problems.

A fatal overdose occurs when the combined effect of these drugs causes severe respiratory suppression to the point where the user is simply unable to breathe.

Similarly, the use of alcohol when taking benzodiazepine medications is not recommended. However, recreational users who abuse Xanax and other benzodiazepines drink alcohol to increase the effects of both the drug and the alcohol.

According to a 2014 Substance Abuse and Mental Health Services Administration (SAMHSA) DAWN Report on benzodiazepines and polydrug use, between the years from 2005 to 2011, almost a million emergency department (ED) visits involved benzodiazepines alone or in combination with opioid pain relievers or alcohol – and no other substances.

The abuse of benzodiazepines alone resulted in an 20% increased risk of a serious outcome, including death, and the polydrug use of benzodiazepines with opioid painkillers or alcohol meant a 24-55% increase in the predicted risk of a more serious outcome, when compared with abusing benzodiazepines alone.

Xanax Polydrug Use in the U.S.: Facts & Statistics

Additional facts and statistics about poly drug use in the U.S., which has Xanax as one of the primary drugs abused, includes:

  • Almost 75% of heroin users have used benzodiazepines like Xanax during the past year
  • One-third of heroin users have filled a benzodiazepine prescription within the last 30 days
  • 80% of deaths involving heroin, methadone, or buprenorphine also involve benzodiazepines
  • 40% of patients in opioid replacement therapy (ORT), such as suboxone or methadone, have filled a benzodiazepine prescription within the last year; this rate is 8 times the rate for the U.S. population as a whole
  • 40-60% of chronic pain patients use benzodiazepines like Xanax on a regular basis.
  • 1 in every 6 patients in opioid use disorder (OUD) treatment also tests positive for benzodiazepines

What is a Xanax Overdose?

A Xanax overdose is normally most likely when polydrug use is involved, as it can react negatively with many substances, especially other CNS depressants, eg. opioids and alcohol. Additionally, even if Xanax has been abused for a long time, taking a higher dose than prescribed can still be extremely dangerous. Here are the clear signs of a Xanax overdose:

  • Extreme or sudden lethargy
  • Confusion
  • Poor coordination and reflexes
  • Slow or irregular breathing
  • Vital organ failure
  • Coma

If you or someone with you experiences any of these symptoms, please seek emergency medical treatment and call 911 immediately.

Lastly, recreational use overdoses can be even more dangerous due to the illicit availability of counterfeit “Xanax.” Buying the drug illegally is dangerous because you cannot verify the ingredients. Many fake Xanax tablets can be mixed with fentanyl, other opioids, and other lethal substances.

Xanax Withdrawal: Symptoms & Dangers

Benzodiazepine withdrawal syndrome, which includes seizures and psychotic reactions, is a potentially fatal medical condition that occurs when Xanax or other benzos are reduced or discontinued abruptly. Withdrawal symptoms begin less than 24 hours after the last dose.

Dosage reduction can result in a host of withdrawal symptoms, which can include:

  • Accelerated heart rate
  • High or low blood pressure
  • Nausea, vomiting and diarrhea
  • Anxiety
  • Depression
  • Akathisia (mental distress and restlessness)
  • Agitation
  • Insomnia
  • Paranoia
  • Fatigue
  • Poor concentration and memory
  • Loss of appetite
  • Mood swings
  • Muscular aches and cramps
  • Hypnagogic hallucinations during waking or falling asleep
  • Panic attacks
  • Suicidal thoughts / ideation
  • Tremors

However, when Xanax use (either prescribed or recreational) is discontinued abruptly, it can lead to benzodiazepine withdrawal syndrome, and some of these withdrawal symptoms can be fatal:

  • Confusion
  • Delusions / Hallucinations / Psychosis
  • Homicidal thoughts/Violent urges
  • Organic brain syndrome (delirium)
  • Suicide
  • Autonomic imbalance –
    potentially fatal condition
  • Convulsions –
    potentially fatal condition
  • Coma
  • Hyperthermia (elevated body temperature)
  • Mania (abnormal activity level)
  • Post-Traumatic Stress Disorder (PTSD)
  • Catatonia (rigid immobility and stupor) –
    potentially fatal condition
  • Delirium tremens –
    potentially fatal condition

Xanax Addiction: Treatment Options & Recovery

Because of the addictive and brain-altering nature of the drug, recovery from Xanax addiction is not easy, and the difficulties begin with the detox. As described above, any person with Xanax addiction requires a medically-assisted and supervised detoxification, due to the problematic and potentially fatal withdrawal symptoms that can occur, including benzodiazepine withdrawal syndrome.

Following the detox process, patients should participate in a professional evidence-based addiction treatment program run by an an accredited drug and alcohol rehab center or other recognized facility; this program can either be as an inpatient or an outpatient, depending on the level of addiction and the patient’s needs, eg. work and family responsibilities.

It is important to remember that Xanax and other benzodiazepine withdrawal symptoms can take months to disappear completely, such as depression and anxiety, and any choice regarding the type of treatment program chosen should reflect the patient’s healthcare needs, too.

After the drug addiction treatment program is completed, whether it is as an inpatient or an outpatient, it is recommended that individuals continue their recovery by attending support groups, such as a 12-Step program or other mutual aid group, and therapy sessions, if required.

Inpatient Program (IP) for the Treatment of Xanax Addiction

An inpatient treatment program (IP), otherwise known as a residential drug rehab, allows the patient to focus fully on their treatment and their recovery, without any outside influences or disruptions. Additionally, it removes any potential relapse triggers normally present in the patient’s home environment, and the patient can access constant care – 24/7 if required.

Inpatient drug rehabs can vary widely in the type of accommodation available, from a 5-star hotel-type setting, with luxury facilities and amenities, to the typically sterile surroundings of a hospital ward. The vast majority of drug rehabs are somewhere in between these extremes, providing a comfortable and friendly environment, so patients are as relaxed as possible while receiving their treatment.

IPs offer a high chance at a sustainable and long-term recovery, as it allows the patient to fully engage with both their treatment and their improving health. Furthermore, patients can learn how to spend their free time in a way that is substance-free.

Outpatient Program (OP) for the Treatment of Xanax Addiction

Outpatient treatment programs can be undertaken at varying levels of intensity, allowing the patient to balance their Xanax addiction treatment with any other important obligations, such as attending work, caring for family, and carer responsibilities. The levels of treatment and care follow these guidelines:

  • Partial hospitalization programs (PHPs)
  • Intensive outpatient programs (IOPs), and
  • Outpatient programs (OPs)

These different levels of care are determined by a combination of the patient’s clinical assessment, and the choice preferred by the patient, specifically based upon the number of hours per week someone can commit to their treatment.

In general, OPs take place several days a week, and for a few hours each day. Depending on the treatment facility, timetables and appointments are reasonably flexible, enabling a patient to either continue working, attend school, or care for family while still receiving treatment.

Outpatient programs are at their most effective when they form part of an overall drug addiction treatment plan that provides a “continuum of care” for a recovering individual that begins with an inpatient drug rehab program or another more intensive level of care.

Life After Xanax Addiction Treatment

After the Xanax addiction treatment program is completed, it becomes the responsibility of the newly-sober patient to maintain their recovery. There are a number of options available, such as:

  • Sober Living Homes: Providing a direct link between a patient’s residency in an IP and a direct return to life in their own home and usual environment, sober living homes provide a safe, structured, and sober environment for those who need additional time adjusting to their new Xanax-free way of life.
  • Mutual Aid Support Groups: Support groups and programs, such as the 12-Step fellowship, eg. Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), and SMART Recovery (Self-Management And Recovery Training).

External Sources:

  1. U.S. National Library of Medicine: “Benzodiazepine Interactions with GABA Receptors.” March, 2018. Available at NCBI.NLM.NIH.gov.
  2. U.S. National Library of Medicine: “A Review of Alprazolam Use, Misuse, and Withdrawal.” June, 1984. Available at NCBI.NLM.NIH.gov.
  3. FDA Approves Pharmacia and UpJohn’s Xanax. October, 1981. Available at WorldHistoryproject.org.
  4. National Institute on Drug Abuse (NIDA): Benzodiazepines and Opioids. February, 2021. Available at DrugAbuse.gov.
  5. Substance Abuse and Mental Health Services Administration (SAMHSA): “2014 DAWN Report on Benzodiazepines and Poly Use.” Available at SAMHSA.gov.
  6. U.S. National Library of Medicine: “The Benzodiazepine Withdrawal Syndrome.” November, 1994. Available at NCBI.NLM.NIH.gov.
  7. Narcotics Anonymous. 2021. Available at NA.org.
  8. SMART Recovery (Self-Management And Recovery Training). 2021. Available at SMARTRecovery.org.

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