Key takeaways:

  • Xanax is a regulated schedule IV controlled substance, meaning it has a high potential for abuse and addiction. In large doses, it is possible to overdose on Xanax, especially when taking the drug with alcohol or other substances
  • The treatment for a Xanax overdose will depend on how much of the drug was taken, by what means, how long ago it was taken, and if any poly-drug use occurred (taking with other drugs or alcohol)
  • Rebound anxiety can occur when someone who has been prescribed Xanax to treat GAD, insomnia, or panic attacks stops taking the drug

Xanax is the brand name for alprazolam, a powerful prescription benzodiazepine used to treat generalized anxiety disorder (GAD), as well as panic attacks and insomnia. Xanax is the most prescribed psychiatric medication in the United States and unfortunately, one of the most commonly abused prescription drugs. For this reason, Xanax is classified as a controlled substance, meaning it has a high risk for abuse and addiction.

Understanding Xanax (Alprazolam)

Xanax affects the brain's central nervous system (CNS) by helping the brain produce more GABA, a natural brain chemical that helps to deactivate the nervous system and reduce stress and anxiety. Xanax is often prescribed to help people struggling with high anxiety or a panic disorder and results in an immediate calm and relaxed feeling. As it is a CNS depressant, it can cause a lack of coordination, slurred speech, and drowsiness. [1, 2] 

Alprazolam or Xanax pills are dispensed in 0.25 mg, 0.5 mg, 1 mg and 2 mg strengths. The pills come in different shapes and colors depending on strength. The 2 mg tablets are white, green, or yellow in color and rectangular in shape. The rest are oval-shaped and colored white (0.25 mg), orange (0.5 mg), or blue (1 mg). Xanax will typically stay in the system for 12 to 15 hours. [1] 

Xanax is a regulated schedule IV controlled substance, meaning it has a high potential for abuse and addiction. In large doses, it is possible to overdose on Xanax pills, especially when taking the drug with alcohol or other substances. Many people abuse Xanax (take it when not prescribed or take it in higher doses or more often than prescribed), and some develop an addiction to the medication. [2, 3]

Even those who are prescribed Xanax can become addicted to the medication when taking it long-term, even when taking it as prescribed. Once addicted, it is dangerous to withdraw from Xanax without medically supervised detox, as many people experience serious and even fatal withdrawals, including seizures. [2, 3]

Common street names for Xanax include Xannies (zan-knees), Handlebars, Bars, Blue footballs, Benzos, French fries, sticks, and ladders.

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Side effects of Alprazolam abuse

Alprazolam is commonly abused because of its relaxing and pleasurable effects. Taking Xanax without a prescription, taking it with other substances, or taking it more often, in higher doses or for ‘off-label’ reasons is considered abuse. Xanax is highly addictive and even those who take the recommended amount can eventually become addicted. [2, 3]

Alprazolam can be taken in multiple ways, most commonly though it is taken in its xanax pill form. When more than the recommended dose is taken it elevates the calming effect of the drug.

Forms of Xanax abuse include:

  • Injecting it

  • Snorting it

  • Taking it via blotter paper

  • Taking it with other drugs or alcohol

Xanax is often combined with other substances, such as alcohol or stimulants, in order to elevate the effects of one another or to, in theory, cancel out any negative side effects or come down. 

If you are worried about someone's Xanax abuse then there are some warning signs to look out for:

  • Drowsiness
  • Light-headedness
  • Cognitive impairment
  • Sluggishness
  • Nausea or vomiting
  • Headache
  • Dry mouth
  • Delirium
  • Slurred speech
  • Vertigo
  • Impaired coordination

Because of the addictive potential, overdose risk, and risk of withdrawals, Xanax abuse is highly dangerous. Even those with anxiety disorders are not advised to use the medication long-term, as addiction can occur. [2, 3]

Xanax overdose

A Xanax overdose can be fatal, especially if taken in conjunction with other drugs. The risk of overdose also becomes greater if the person ingests the drugs by snorting, injecting, or chewing them as they remove the time-release delivery process of the drug, meaning the drug affects the brain faster. [3]

Some common symptoms of Xanax overdose include: [4]

  • Confusion

  • Slowed heart rate

  • Extreme drowsiness

  • Difficulty breathing

  • Fainting

  • Loss of balance

  • Muscle weakness

  • Coma

The treatment for a Xanax overdose will depend on how much of the drug was taken, by what means, how long ago it was taken, and if any poly-drug use occurred (taking with other drugs or alcohol). If you suspect that you or a loved one has overdosed on Xanax, seek emergency medical care. It’s vital to give the medical professionals any information you have on what has been taken, how much was taken, and when it was taken. Being accurate with this information could save someone's life. 

While emergency medical care can help to save a person’s life in the event of an overdose, subsequent treatment at an inpatient or outpatient addiction rehab is also needed to help the person overcome their addiction.

Addiction to Xanax

Someone who abuses Xanax can develop a tolerance quickly, meaning they need to increase their dose to get the desired effects. This can lead to a physical dependence forming, which if left unchecked can develop into an addiction. Someone with a severe Xanax addiction can need up to thirty pills a day and is at high risk of overdose. 

Still, a person addicted to Xanax cannot simply stop taking the medication on their own because of the risk of withdrawals and seizures. Often, detox and withdrawal need to be done in an inpatient facility under the close supervision of medical professionals, who can help to ensure the person is stable and detoxes safely.

Like most forms of addiction, a person with a Xanax use disorder will be diagnosed by a licensed professional using the 11 criteria of addiction, as outlined in the DSM-5. [1] Some of these criteria include:

  • Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.

  • Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.

  • Withdrawal: When you stop using the substance, you experience withdrawal symptoms.

  • Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.

  • Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.

  • Craving: You have experienced an intense craving for the substance.

Xanax withdrawal symptoms

Xanax addiction can form quickly, even after only a few weeks and even on the recommended dose, making it one of the most addictive forms of benzodiazepine. One of the warning signs of addiction is the onset of withdrawal symptoms when a person cuts down or misses a dose. 

For Xanax, withdrawal symptoms may be mild at first, but the severity increases with a longer duration of abuse, as well as the dose size being taken. Xanax withdrawal symptoms appear suddenly and can present themselves as little as three hours after the last dose. The most common and severe Xanax withdrawal symptoms include: [3, 4]

  • Seizures

  • Shakiness or trembling

  • “Rebound” anxiety, which can include panic attacks

  • Agitation and irritability

  • Insomnia or restlessness

  • Overactive reflexes or tics

  • increased heart rate and blood pressure

  • Hot and cold chills, sweating, or fever

  • Hallucinations

  • Severe cravings or urges to use

Rebound anxiety

Rebound anxiety can occur when someone who has been prescribed Xanax to treat GAD, insomnia, or panic attacks stops taking the drug. Many people who experience rebound anxiety find that when they cut back or stop using Xanax, their anxiety intensifies, sometimes even to a more severe level than what they experienced before. They may experience extreme nervousness, worry, insomnia, and panic attacks. 

Most of the time, these symptoms will fade on their own after about a week of stopping Xanax, but some people will experience residual anxiety for weeks or sometimes even months after stopping. Rebound anxiety makes it difficult for people with Xanax addiction to avoid relapse, especially because they know that taking a dose will help to alleviate their anxiety.

Xanax detox

Detoxing from Xanax can be a long and arduous process. The withdrawal symptoms can be very uncomfortable and quitting cold turkey is not recommended. Instead, tapering the use of the drug by having gradually smaller doses over time is the best way to detox from Xanax and reduce harsh withdrawal symptoms. This should only be done under the supervision and recommendation of a medical doctor, who can help to ensure you do not cut back on your dose too quickly. [3]

While it is possible to detox from Xanax alone, it is always advised that detox be overseen by a medical professional to ensure the process is handled comfortably and safely. For example, under a medically assisted treatment program, a doctor may prescribe a less potent benzodiazepine, such as Klonopin, to help with the tapering process and avoid withdrawal symptoms. Medically assisted detox is proven to be the most effective way of combating Xanax addiction and beginning the road to recovery.

Xanax addiction treatment

Xanax pills are incredibly addictive drug and overcoming an addiction can be difficult. With a safe and controlled medical detox and subsequent treatment program, conquering a Xanax addiction is possible and can pave the way to long-term sobriety. If you or someone you know is suffering from a Xanax addiction, contact a treatment provider today to see what help is available.