Why is Xanax so addictive?

Xanax is addictive because of how it works in the brain, its short duration of action, and the potent calming and anxiety-relieving effect of the medicine that some people may abuse.

It also can also cause withdrawal symptoms upon abrupt discontinuation, which may lead to a pattern of continued drug use and higher doses to help alleviate symptoms.

In general, potent benzodiazepines with shorter elimination half-lives may be more prone to causing problems with tolerance, dependence and addiction. For example, for triazolam (Halcion), alprazolam (Xanax) or lorazepam (Ativan) all have relatively shorter half-lives.

• The half-life is the time it takes for half of the drug to be broken down and excreted from the body.
• It usually takes 5 half-lives for a drug to be fully cleared from your body, but this can vary based on age, weight, genetics, your medical conditions, or other medicines you take.

A quick onset of action also appears to increase the chances for addiction of different benzodiazepines, although all benzodiazepines still have strong addiction potential, even when used at normal doses. The onset of action with alprazolam is about one hour, diazepam is 0.25 to 0.5 hours, and lorazepam is 0.5 to 1 hour.

Why does Xanax cause addiction?

Physical tolerance and addiction are multifactorial processes that involve drug pharmacology, patient factors such as past or current drug use, and social and environmental cues.

Pharmacologically, Xanax (alprazolam) belongs to the benzodiazepines class of drugs. This class works in the brain by binding to and enhancing the inhibitory effect of gamma-aminobutyric acid (GABA_A).

• GABA is a chemical messenger (neurotransmitter) found in the brain and central nervous system.
• The inhibitory effect on GABA helps to "slow" the brain down, lower anxiety and causes drowsiness and sedation. Benzodiazepines also exhibit anticonvulsant and muscle-relaxing properties as well.
• GABA receptors are a major target of drugs associated with sedation, abuse and addiction potential, such as alcohol, benzodiazepines, barbiturates, muscle relaxers and other sedatives.

Studies with alprazolam have also shown an increase in dopamine levels in the brain, which are linked to the brain’s reward system. Most drugs involved in misuse or addiction frequently lead to dopamine release.

Patient-specific factors can also contribute to misuse of benzodiazepines and the development of benzodiazepine use disorder. These include:

• people who have a personal history of substance use disorder
• people with long-term use of benzodiazepines or using higher doses
• people with a lower level of education

Studies have shown that individuals with a history of alcohol or opiate use prefer the rewarding effect of Xanax over other benzodiazepines, such as oxazepam or chlordiazepoxide. However, you can become addicted to Xanax even if you take it exactly as prescribed by your doctor.

What does Xanax treat?

Xanax (alprazolam) is approved by the FDA to treat:

• generalized anxiety disorder (GAD), which may include anxiety associated with depression
• panic disorders with or without agoraphobia (fear of places and situations that might cause panic, helplessness, feeling trapped or embarrassment).

In general benzodiazepines are used to treat a variety of other conditions, such as alcohol use disorder, short-term use in insomnia, as a muscle relaxant (short-term), procedural (conscious) sedation, and seizures.

Xanax is available as an oral tablet ranging in strengths of 0.25 mg to 2 mg. It also comes as an oral solution and an extended-release oral tablet (Xanax XR).

Regular use of Xanax can lead to tolerance, dependence, addiction, overdose and withdrawal side effects. It works quickly to relieve anxiety, but can become habit-forming if taken over a long period. Xanax is often only prescribed for a short period of time due to this potential.

For example, it might be used temporarily to relieve anxiety associated with depression or panic attacks, while an antidepressant (such as an SSRI or SNRI) takes effect.

Learn More: How does Xanax make you feel?

Does Xanax cause a withdrawal effect?

Yes, Xanax can cause physical dependence and withdrawal reactions. You may have serious or life-threatening withdrawal symptoms if you stop using this medicine suddenly. Do not stop using Xanax without talking to your doctor first., as you may need to slowly stop (taper) this medicine over a period of time.

After a period of regular use, it is best to slowly stop the medication under your doctor’s direction. Withdrawal symptoms can begin quickly in some people, even after just a week or two of benzodiazepine use.

Withdrawal symptoms with Xanax may include:

• anxiety or worsened anxiety
• trouble with memory or learning
• trouble concentrating
• depression
• panic
• hallucinations (seeing or hearing things that others do not see or hear)
• seizures
• trouble sleeping / rebound insomnia
• crawling sensation under your skin
• weakness
• mania (extreme increase in activity or talking)
• muscle twitching
• mental health or nervous system changes
• shaking or tremors
• losing touch with reality (psychosis)
• numbness, tingling or burning feeling in hands, arms, legs or feet
• ringing in your ears
• muscle twitching
• unusual movements
• suicidal thoughts or actions

Call your healthcare provider, go to the nearest hospital emergency room, or call for emergency medical help (call 911 in the US) right away if you get any of these symptoms.

Physical dependence is not the same as drug addiction. Ask your doctor more about the differences between physical dependence and drug addiction, and your risk factors when taking Xanax.

Related questions

• How long does Xanax last for / stay in your system?
• Valium vs Xanax: Which is better?
• Does Xanax help you sleep?

How long does Xanax withdrawal last?

The time frame needed to taper off of a benzodiazepine like Xanax is variable. It generally ranges from 4 weeks to 6 months, but can exceed one year in some circumstances.

The length of time required to complete a benzodiazepine withdrawal depends upon patient specifics, such as the type of benzodiazepine, length of use, ability to handle stress involved with withdrawal, and the original reason for benzodiazepine use.

Shorter-acting drugs like Xanax produce a brief and more intense withdrawal reaction that usually begins within 24 hours of discontinuation. Longer-acting benzodiazepines (for example, Valium) have a slower development of withdrawal symptoms that typically begin several days after discontinuation, but peak at about 7 days.

Can I overdose on Xanax?

Xanax, even at recommended doses, has a risk of overdose and death, especially when combined with opiates like heroin or oxycodone, alcohol, street drugs or other central nervous system depressants. This can lead to severe drowsiness, breathing problems (respiratory depression), coma and death.

Signs of a Xanax overdose may include:

• extreme sleepiness, somnolence, sedation
• shallow or slowed breathing; breathing stops or uneven breathing
• trouble with coordination, balance, walking
• confusion
• decreased use of reflexes
• coma

Flumazenil is a benzodiazepine antagonist that can be given intravenously (IV) as an antidote in the emergency setting to help reverse the effects of a benzodiazepine overdose.

Is Xanax a controlled substance?

Yes, Xanax (alprazolam) is a benzodiazepine prescription drug and is classified by the DEA as Schedule IV controlled substance.

As Schedule IV controlled substances, all benzodiazepines have the potential for abuse, addiction, withdrawal and diversion (illegal distribution). Schedule 4 drugs have a lower potential for abuse relative to other drugs in Schedule 3, but can still be abused. Abuse may lead to limited physical or psychological dependence. Keep this medicine in a safe place to prevent misuse and abuse.

Selling Xanax or giving it away may harm others, and is against the law. Before you start treatment with Xanax, tell your healthcare provider if you have abused or been dependent on alcohol, prescription medicines or street drugs.

Examples of Schedule IV benzodiazepines include:

• alprazolam (Xanax)
• chlordiazepoxide
• clonazepam (Klonopin)
• clorazepate (Tranxene)
• diazepam (Valium)
• lorazepam (Ativan)
• midazolam
• oxazepam
• temazepam (Restoril)
• triazolam (Halcion)

Related: What are the rules for controlled substance prescription refills?

Xanax can cause serious harm or death in other people. Do not share, sell or give away your Xanax to anyone else. Keep this medicine in a safe place and away from children and pets.

This is not all the information you need to know about Xanax (alprazolam) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.