Xanax is the brand name for alprazolam, a benzodiazepine medication that treats generalized anxiety disorder, panic disorder, and anxiety associated with depression. Like other benzodiazepine medications, Xanax binds to the gamma-aminobutyric acid (GABA) receptors in the brain to slow down firing between neurons. This can help to reduce seizures in the most serious cases, and it eases anxiety and insomnia in more common instances.
As a short-term treatment for anxiety conditions, Xanax is very important; however, any benzodiazepine including Xanax can quickly cause physical tolerance, meaning the person needs a higher dose to feel the original effects, and dependence, meaning the brain requires the presence of the drug to manage neurotransmitters. Because benzodiazepines can lead to dependence and tolerance, most psychiatrists and physicians will only prescribe them for two weeks of consistent use, and they usually only recommend them for “as-needed” treatment. Any psychiatric medicine, including Xanax, should only be used in concert with talk therapy.
Unfortunately, many people who receive a prescription for Xanax become dependent on and eventually addicted to the drug. One of the reasons many people struggle with Xanax abuse is due to concern about experiencing panic attacks or other anxiety symptoms in the future; most benzodiazepine withdrawal symptoms mimic the symptoms of the underlying condition. These often include anxiety, panic, and insomnia. Rather than experience these symptoms, many people begin taking too much Xanax, get multiple Xanax prescriptions, mix Xanax with other sedatives like alcohol or opioids, or abuse the drug in other ways.
Since withdrawing from a psychiatric medication like Xanax can be uncomfortable, it is important to work with a medical professional. Many psychiatrists and physicians have protocols to ease their patients off Xanax; however, if a person misuses their prescription or abuses the drug without a prescription, they likely need help from an addiction specialist.
What Is Detox?
The National Institute on Drug Abuse (NIDA) defines detox as a medically supervised process of managing withdrawal symptoms that occur when easing the body off dependence on a drug. The main focus of the detox process is to manage physical symptoms, like pain or nausea, until they subside. This process typically takes up to two weeks, depending on the substance.
Sometimes, medications are used to ease these physical symptoms. For example, opioid withdrawal can be addressed with buprenorphine, a partial opioid agonist. In other cases, there are no specific medications that can treat withdrawal, although over-the-counter pain treatments, anti-nausea drugs, and moderate exercise can alleviate withdrawal symptoms.
The Xanax Detox Process
There are three basic stages of benzodiazepine withdrawal.
Initial: Alprazolam has a half-life of about 11 hours, on average, so withdrawal symptoms are likely to begin about one day after the last dose is taken. Withdrawal symptoms begin as the body metabolizes the remnants of Xanax out, and the brain does not receive a replacement dose. These symptoms may be cravings, anxiety, restlessness, and trouble falling asleep. These may feel especially intense if Xanax was prescribed to treat an anxiety, panic, or insomnia disorder. The person may also develop headaches, sweating, and heart palpitations from blood pressure and pulse changes.
Peak: After 2-3 days, withdrawal symptoms will become physical aches and pains, and psychological symptoms will intensify. The individual may develop nausea, vomiting, diarrhea, muscle aches, joint pain, cognitive problems, lethargy, and ongoing anxiety, depression, insomnia, and mood swings. People who have abused large doses of Xanax for a long time are at risk of developing seizures, so working with a physician or addiction specialist is extremely important. Delirium and hallucinations can also result in severe cases of withdrawal.
Final: After 3-7 days, physical and psychological symptoms will become less intense. While some psychological effects, like insomnia, anxiety, and cravings may not go away, the body is no longer dependent on Xanax to feel normal.
Those most at risk of benzodiazepine withdrawal syndrome (BWS) or intense withdrawal symptoms are people who:
- Quit benzodiazepines “cold turkey” without medical supervision
- Abuse a lot of short-acting drugs like Xanax
- Have tried to quit before and relapsed
Physicians who prescribe benzodiazepines will work with their patients to taper off the dose slowly. Those who struggle with Xanax addiction or abuse, however, will need to work with an addiction specialist. Rather than tapering their dose of Xanax, a medical professional will evaluate withdrawal in the person and replace Xanax with a long-acting benzodiazepine like Valium. The doctor will then taper Valium doses.
Valium functions much like buprenorphine does in opioid detox. Valium binds to the GABA receptors, like Xanax, but remains active for much longer than Xanax does. This reduces cravings over time and is the first step for the person to stop compulsively taking doses of benzodiazepines. Physical and psychological withdrawal symptoms can be managed with a slow reduction in Valium until the person is no longer physically dependent on the presence of any benzodiazepine to feel normal or functional.
Some individuals may not need to replace Xanax with Valium and can instead stop taking Xanax with a doctor managing any symptoms that appear with different drugs or non-pharmaceutical approaches. Regardless, working with a medical professional to safely detox from Xanax is essential, and it is the first step in long-term addiction treatment.