Xanax (alprazolam) is a drug in the benzodiazepine class, the most commonly prescribed class of drugs in the United States.
There are more than 15 different types of benzodiazepines that have been developed to treat a number of different conditions, mostly psychological but also physical conditions. All benzodiazepines display at least one of the following therapeutic drug actions:
- Reduces anxiety
- Acts as a muscle relaxant
- Acts as an anticonvulsant medication
All benzodiazepines are classified by the United States Drug Enforcement Agency as Schedule IV drugs, meaning that they are believed to have a low potential for addiction and can only be purchased legally with a prescription from a physician. Benzodiazepines are typically taken orally in pill or capsule form. Occasionally, some benzodiazepines are administered intravenously and a few can be taken in tablet form, which allows them to be dissolved under the tongue.
Xanax was first released in 1981 by the Upjohn Company, which is now a division of the Pfizer Corporation. Xanax was developed for use as a less addictive alternative to Valium because it has a much shorter half-life; therefore, it has a much quicker course of action. Xanax has a half-life in the range of 9-20 hours, whereas the half-life range for Valium is between 30 to 200 hours.
The first approved indication for use of Xanax was for treatment of panic disorder, and then treatment for other conditions was approved. There was a huge marketing campaign to promote Xanax. It became the most prescribed benzodiazepine medication and one of the most prescribed medications in the United States.
- Anxiety and anxiety disorders: Xanax is used to treat several different anxiety disorders, including phobias, panic attacks, social anxiety, and general anxiety disorder. Research indicates that Xanax is more effective than other classes of medication, such as antipsychotic drugs, barbiturates, and antidepressants (particularly selective serotonin reuptake inhibitors) in the treatment of anxiety due to its rapid onset of action.
- Issues with sleep and sleep disorders: Xanax has been used as a sleep enhancer. Its primary use is to initiate sleep due to its rapid onset of action.
- Muscle relaxant: Xanax has also been used as a muscle relaxant and to treat muscle spasms.
- Epilepsy (Xanax can be described as an adjunctive medication for the treatment of seizures. It typically operates as an additive medication in these cases, especially in the treatment of emergencies.)
- Depression that results in irritability and restlessness
- Irritable bowel syndrome
- Symptoms of PMS (Xanax may be given in very extreme cases of PMS)
- Some types of cancer pain (in these cases, Xanax may be given with various narcotic medications to ease pain)
- Essential tremors
- Tinnitus (ringing sensation in the ears)
The majority of the peak effects of Xanax occur rapidly for most of its uses. For instance, 90 percent of the peak effects for the treatment of panic disorder are achieved within the first 60 minutes of administration, and typically, the full effects are achieved at around 90 minutes following administration. For more chronic anxiety conditions, the peak effects may take longer. The peak effects for treatment of generalized anxiety disorder may take up to seven days; however, this is still significantly quicker than what occurs with other forms of treatment.
How Xanax Affects the Mind and Brain
- A positive allosteric modulator is a substance that indirectly influences the effects of a neurotransmitter at a receptor site.
- GABA is the most common inhibitory neurotransmitter in the central nervous system and prevalent throughout the cerebral cortex and limbic system.
- An inhibitory neurotransmitter leads to a reduction in the firing of other neurons in the brain when it is released.
- Xanax is primarily a GABA agonist. This means that it mediates GABA neurotransmission in the brain and spinal cord by binding to the GABA receptor on the neuron and leading to the opening of the chloride channels of the neurons, which results in the influx of chloride.
- This action leads to a process known as hyperpolarization of the cell that results in release of GABA in the brain.
- This action decreases the excitability of the surrounding neurons (causing a reduction in their activity) producing sedation and a reduction in anxiety.
- Moreover, the particular GABA receptor that is affected by benzodiazepines like Xanax is found in high concentrates in the cortex, thalamus, and cerebellum of the brain so these affects are pervasive.
Xanax Use and Memory Loss
There are a number of potential adverse reactions or side effects that can occur with Xanax use and abuse. One particular potential effect of Xanax use (or use of any benzodiazepine) is memory loss:
The brain receptors affected by benzodiazepines are found in high concentrations throughout the brain. The process that occurs in the brain during learning and the formation of new memories occurs via the increased firing of neurons in specific brain areas like the hippocampus. Xanax administration results in decreased firing of neurons in all of these brain areas. Thus, the use of Xanax can result decrease neuronal activity and a particular type of memory loss known as anterograde amnesia, which is an inability to remember new information.
This memory loss will occur after the drug is taken effect and can result in interference with the formation of new memories at that time. Once the effects of the drugs are worn off and the drug is eliminated from the system, there is no reason to believe that additional new memories cannot form; however, when the effects of the drug are at its peak or large concentrations of the drug remain in the system, it may interfere with the formation of new memories. This property of Xanax and other benzodiazepines could actually be beneficial, such as for use during certain surgical procedures or to assist in reducing the effects of psychological trauma; however, it can also be misused (e.g., date rape) or result in difficulty with everyday functioning.
Other Potential Adverse Reactions
Adverse reactions affecting cognitive processes (the mind) include:
- Excessive drowsiness
- An increase in anxiety
Physical adverse effects can include:
- Abnormal coordination
- Changes in appetite (weight gain or weight loss)
- Nausea, vomiting, or abdominal cramps
- Dry mouth
- Slurred speech
- Urination problems
- Difficulty breathing
- Diarrhea or constipation
- Heart palpitations
- Blurred vision
- Sore breasts or milk secretion
- Irregular menstruation
Causes of Xanax Addiction
Certainly, individuals who use benzodiazepines like Xanax recreationally are prone to develop an addiction. At this time, the causes of any addiction are not well defined, but several factors can contribute to addiction, including heredity (genetic factors), environmental factors, and psychological factors. Drugs like Xanax that have a high potential for the development of tolerance can be drugs that individuals can easily become physically and psychologically addicted to because they need to use more and more of the drug to achieve the effect that the drug initially produced.
Moreover, addiction includes recruitment of the neurotransmitter dopamine in neurons in an area of the brain known as the nucleus accumbens. The nucleus accumbens is an important area associated with repeating a particular behavior. Thus, dopamine and the reward pathways of the brain are also associated with addictive behavior in addition to other neurotransmitters that may be specific to the drug of choice.
Features common to benzodiazepine abuse and Xanax use include the symptoms of tolerance and withdrawal, which can also be symptoms of addiction to a particular drug or medication. Tolerance to Xanax and other benzodiazepines, especially physical tolerance, develops rather quickly compared to many other types of drugs.
The potential of Xanax to be seriously physically addicting has been questioned and debated regarding the seriousness of physical withdrawal symptoms when one stops using Xanax (issues with tolerance are well established). However, if a person takes very high doses of Xanax regularly, or has taken Xanax for a long period of time, research indicates that the person will develop withdrawal symptoms if discontinuing use of the drug abruptly.
Moreover, research on the neurobiology of addiction has indicated that the brain adapts to repeated engagement of dopamine by altering or toning down the reward pathways. As a result, when a person who is a directed to a particular drug tries to abstain, the person feels that life is much less interesting, fun, and joyful than when the drug is used. Thus, the type of withdrawal that occurs with discontinuation of Xanax has sometimes been referred to as a protracted withdrawal that includes cravings and feeling the need to use the drug to keep life more enjoyable.
Physical withdrawal often occurs in individuals who cease use. Symptoms may include:
- Disturbances in sleep
- Increased irritability
- Increased feelings of tension and anxiety
- Sweating or trembling
- Panic attacks
- Seizures from physical withdrawal (seizures associated with physical withdrawal can be fatal)
In some people, the symptoms can be very serious and resemble serious psychiatric disorders, such as schizophrenia, or even seizure disorders.
Because people who abruptly stopped taking Xanax begin to feel symptoms associated with anxiety, its use becomes even more reinforcing. Since some of the withdrawal symptoms include anxiety-like symptoms, a person may believe that the best way to deal with anxiety-related withdrawal from Xanax is to take more Xanax.
Moreover, individuals who become addicted to Xanax are typically addicted to other drugs, such as alcohol or stimulant drugs like cocaine. This makes the need for treatment even more crucial and complicated.
A particularly serious potential side effect of withdrawal from benzodiazepines is potential suicide because of the complicated issues regarding multiple drug use, significant tolerance to the drug, and the potential withdrawal symptoms. As a result, medical detox is always recommended if one wishes to stop use of benzodiazepines.
Withdrawal symptoms from Xanax usually develop 3-4 days after the last use, although they can appear earlier. Anyone who stops taking Xanax and experiences withdrawal symptoms should be concerned that an addiction to the drug is present.
Treatment for Xanax Addiction
Because of the potential for significant withdrawal effects from Xanax when one is attempting to discontinue its use, medical detox is advisable, as mentioned above.
Medical professionals will then assist with the detox process and minimize the effects of withdrawal. This process can be done in an inpatient or outpatient program.
Research indicates that in general inpatient and outpatient programs for treating addictions are equivalent in terms of recovery rates and successes; however, there are several features to consider when choosing an inpatient or outpatient program. It is also important to note that just going through medical detox will not be sufficient to recover from an addiction to Xanax or any drug. Further therapeutic treatment is required.
The duration of inpatient treatment is typically limited (most often 30-90 days, although depending on the needs of the individual, treatment can be much longer). Outpatient programs can last any length of time.
Inpatient care is preferred for people who live in conditions that are unfavorable towards recovery. Some research suggests that there may be a lower probability of relapse in the first 30 days of recovery in an inpatient program due to the structure and supervision provided.
Often, the choice of beginning an inpatient program can be dictated by a physician who believes a person has a very severe addiction, individuals who feel more confident with the structure of an inpatient program, or the judicial system may require a person to seek treatment for addiction.
Outpatient programs can include individual therapy, group therapy, or both. It is often best to try to combine both individual and group therapy in one program in order to get specialized individual treatment and, at the same time, interact and learn from others in recovery.
Oftentimes, 12-Step programs, such as Narcotics Anonymous, are part of the recovery process. Individuals in structured treatment programs may attend 12-Step meetings as part of the larger program structure, and may continue with these meetings after their formal treatment has ended.