The drug Xanax (alprazolam) is a medication classified as a benzodiazepine. The benzodiazepines were developed as less addictive alternatives to another group of drugs known as barbiturates; however, benzodiazepines remain significant drugs of abuse, particularly as secondary drugs of abuse that are used with other central nervous system depressants, such as alcohol or narcotic drugs, or in conjunction with stimulants.
Xanax was actually developed as a less addictive alternative to its fellow benzodiazepine Valium (diazepam). Xanax has a relatively short onset of action and half-life, and therefore remains in the system for a shorter period of time than Valium does. Xanax is primarily prescribed for the treatment of anxiety, as a muscle relaxant, and to initiate sleep. In some cases, it can also used as a treatment for seizures; however, because of its short onset and duration of action, other more long-acting benzodiazepines are preferred for this use.
Xanax and all benzodiazepines are classified as central nervous system depressants (some sources may refer to benzodiazepines as sedatives). Central nervous system depressants primarily function by decreasing the actions of the neurons in the brain and spinal cord. They do this by working on a neurotransmitter known as gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the central nervous system. The function of GABA is to slow down the functioning of the central nervous system, keep things from getting overexcited, and modulate the activity of the brain and spinal cord. Without inhibitory neurotransmitters to balance the functioning of the central nervous system, the system would continue to fire at accelerated rates, and this could lead to damage. The therapeutic uses of benzodiazepines are based on their ability to increase the levels of GABA in the system.
These drugs are classified as controlled substances by the United States Drug Enforcement Administration (Schedule IV). While they do have significant medical uses, they are also drugs that can be abused and have the potential to cause psychological and physical dependence in people who use them for extended periods.
Xanax is a relatively quick-acting benzodiazepine. It has a high potency (meaning that small amounts are very effective), a quick onset of action (meaning that its effects are felt rather quickly after taking it), and a relatively short half-life of about 11 hours on average (meaning that it is eliminated from the system through normal metabolic processes relatively quickly). These three clinical aspects of the drug make it effective for certain medical issues, such as helping people go to sleep or relieving panic attacks.
Even individuals who take a significant amount of the pills will most likely not experience a serious overdose unless the amount is extremely excessive. The actual dosage level that will produce an overdose depends on the individual taking the drug, if they are mixing it with other drugs, and how they take it. People who use the drug in ways that are inconsistent with the prescribed uses, such as crushing pills and snorting them or mixing them with water and injecting the substance are far more susceptible to overdose issues.
Another complicating factor regarding abuse of Xanax is that it is often abused in conjunction with other drugs. When Xanax is mixed with other central nervous system depressants, such as alcohol, other benzodiazepines, or even narcotic medications, the risk of overdose becomes very significant. When an individual abuses and mixes different drugs with the same mechanism of action, these mixtures can enhance the potential dangers of either drug separately, and this can increase the risk that one can overdose on amounts that they may not perceive as excessive. Individuals abusing Xanax with stimulants will be desensitized to the effects of both drugs, and the potential to overdose on either drug can increase.
A third major issue with Xanax and other benzodiazepines is that these drugs induce tolerance in individuals very rapidly. Tolerance occurs when a person finds that they need more of the drug to achieve effects that they once got at lower doses. Individuals who repeatedly abuse Xanax may develop tolerance levels that are quite significant. When these people attempt to quit using Xanax and have not taken the drug for a while, their tolerance level sharply decreases. If they relapse during recovery, they may take more of the drug than their body can eliminate it. Their previously high tolerance levels left them with the impression that they can take significantly higher amounts of the drug than their body can handle. Thus, even though the immediate psychoactive effects of the drug may be perceived as diminishing, there still may be relatively high levels of the drug in the person’s system because the individual is taking amounts they can no longer tolerate, and the person is at risk for overdose.
Finally, elderly people or individuals who are emotionally unstable may overdose on Xanax by taking the drug in larger amounts than prescribed, more frequently than prescribed, or as a result of having multiple prescriptions to drugs that produce toxic interactions.
Anyone suspected of suffering an overdose on Xanax or another benzodiazepine is in extreme danger. Because of its central nervous system depressant effects, these drugs can shut down areas of the brain that control vital life-sustaining functions, such as respiration and heart rate.
Individuals suspected of overdosing on Xanax need immediate medical attention. Call 911, and keep the person in a position such that if they throw up, they will not choke. If one is trained in CPR and the person needs to be resuscitated, administer CPR. Do not attempt to administer drugs or fluids to the person unless one is trained to do so.
Signs of Abuse and Addiction
Individuals who meet the formal diagnostic criteria for a substance use disorder as a result of Xanax abuse would be diagnosed with an anxiolytic use disorder, according to the current diagnostic scheme used by the American Psychiatric Association. Because mental health clinicians have recognized that addiction occurs on a continuum of behaviors that encompass both the notions of substance abuse and formal addiction, the term substance use disorder covers both of these older designations under one heading. Only a licensed mental health clinician can diagnose a substance use disorder in anyone.
Long-term abuse of Xanax can lead to a number of social, physical, and cognitive issues as well. These include:
- Significant issues with thinking: Individuals with chronic and severe anxiolytic use disorders often experience changes in the structure of their brain that affect their ability to pay attention, recall recent events, and engage in problem-solving activities. Elderly individuals may be at an increased risk to develop dementia.
- Paradoxical effects: Some individuals who chronically abuse benzodiazepines may develop issues with seizures, anxiety disorders, and depression or other forms of mental health disorders. Others may develop psychotic behavior, such as hallucinations and delusions.
- Effects on physical health: The direct and indirect effects of chronic use of Xanax can affect physical health in a number of different capacities, including making a person more vulnerable to diseases, cardiovascular issues, infections (e.g., respiratory infections), or cancer in addition to direct effects on the liver and kidneys as a result of having to metabolize large amounts of the drug. Effects of poor decisions made as a result of having a substance use disorder can also lead to health issues.
- Personal relationships, career goals, and legal issues: Individuals with substance use disorders often experience damaging effects to their relationships with friends and significant others and their career. They may also become involved in financial and legal issues that can be life-altering.
- The development of physical dependence: Having significant physical dependence on a drug like Xanax leads to a number of detrimental issues, such as losing control over one’s functioning because they need to use the drug to feel “normal.” Potentially dangerous and even fatal issues during the withdrawal process can occur, such as the development of seizures.
Anyone who is diagnosed with, or suspected of having, a formal anxiolytic use disorder has a serious mental health condition that requires professional treatment. Such individuals are encouraged to consult with a licensed mental health clinician as soon as possible to mitigate serious effects and reduce the likelihood of an overdose.