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Is Xanax Addictive? 4 Questions, Answered

By Megan MacKay, Manjari Bansal
Misuse of Xanax (alprazolam) can result in addiction. Find out more about this common medication that should only be used under supervision.

Xanax is a prescription medicine used for treating anxiety and panic disorders. It's not normally prescribed for long-term use, and is known to produce significant withdrawal effects, even after it's used for a short time. Because of how it affects your body, the medication does come with certain risks. Read on for the answers to four key questions about the addictive potential of Xanax. 

1. Can you get addicted to Xanax?

“Xanax, also known as alprazolam in its generic form, is a prescription drug that belongs to the class of medications known as benzodiazepine,” Aaron Sternlicht, LMHC, CASAC, a therapist and co-founder of Family Addiction Specialist in New York, tells WebMD Connect to Care.

“Xanax is a central nervous system depressant that works on neurotransmitters in the brain to produce a calming effect and is subsequently often prescribed to help treat anxiety, stress, and panic. Although Xanax can be highly effective and beneficial in the treatment of anxiety disorders, it does have the propensity to be abused and lead to dependence, and in extreme cases can cause overdose or death,” Sternlicht says.

According to a 2018 study published by the Journal of Addiction Medicine, Xanax is one of the most commonly prescribed benzodiazepines to treat anxiety and panic disorders. However, many addiction specialists also consider the medication highly addictive.

“As a central nervous system depressant, Xanax slows key bodily functions such as heart rate, blood pressure, and body temperature regulation. Over time, the brain and body become physically dependent on Xanax and can result in adverse effects if stopped cold turkey. Xanax is also addictive because, in addition to producing a sedative effect, Xanax also releases dopamine and impacts the pleasure center of the brain, which is at the core of addiction,” Sternlicht adds.

Xanax’s Extended Release version, Xanax XR, carries the same risks as traditional Xanax since it acts on the same central nervous system receptors, according to the FDA. This version of Xanax releases small amounts over a longer period of time, providing a longer-lasting affect. Xanax XR is used to treat panic disorder, with or without Agoraphobia. The FDA warns of dependence and addiction for Xanax XR, citing withdrawal symptoms like seizures and dependence. The Drug Enforcement Agency (DEA) lists Xanax XR as a schedule IV drug, meaning it is addictive but has some therapeutic value.

“Benzodiazepines impact the brain in such a manner that any variation in dose could cause acute changes in physical and emotional wellness,” Leela R Magavi, MD, Hopkins-trained psychiatrist and Regional Medical Director for Community Psychiatry + MindPath Care Centers, tells WebMD Connect to Care.

Mayo Clinic reports that any reduction in the dose of Xanax, or suddenly stopping the drug, may cause withdrawal symptoms like:

  • Irritability
  • Sadness
  • Loss of appetite
  • Nausea or vomiting
  • Behavioral changes
  • Muscle cramps
  • Difficulty focusing
  • Sleep issues
  • Suicidal thoughts

According to Mayo Clinic, you should only take Xanax as directed by your prescribing doctor. If you take more than the prescribed dose, take it too often, or for too long, it may cause dependence or result in overdose.

“A Xanax overdose alone can have severe consequences, such as a loss of coordination, extreme sedation, and coma or death,” Kathryn Lee, EdM, MA, MHC, a psychotherapist at Intuitive Healing Psychotherapy Practice in New York, tells WebMD Connect to Care.

“To achieve a high, individuals who abuse Xanax may combine it with other substances, such as alcohol and/or opioids, which can potentially be lethal,” Lee adds.

2. How addictive is Xanax?

Pfizer, the manufacturer of Xanax, has a warning on its drug information pamphlet that Xanax exposes users to risks of abuse, misuse, and addiction; and can lead to overdose or death. It advises the prescribing medical professional to evaluate the patient for risk prior to dispensing the medication. Continued Xanax therapy forms physical dependence, withdrawal, and tolerance. Serious withdrawal symptoms include seizures, catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality.

The National Institute on Drug Abuse also acknowledged that Xanax is among the most commonly abused drugs, next to alcohol and marijuana, by individuals over 14. In the United States, at least 70% of teens with a Xanax addiction get access to the drug from their medicine cabinet at home. In 2011, a national emergency room department survey saw more than 150,000 emergency hospitalizations for Xanax misuse around the country,” Taylor Draughn, a Licensed Professional Counselor (LPC) at the National Drug Helpline in Upper Syracuse, NY, tells WebMD.

Highly efficacious in treating anxiety and panic symptoms, Xanax has become the most commonly prescribed psychotropic drug in the US, while also being the most abused medication. Due to its low threshold for tolerance, Xanax is highly addictive, with up to 44 percent of some population users developing a dependency,” notes addictions therapist Josiah Teng from Vivid World Psychology in NY. “Daily use can see tolerance manifest in days to weeks, with some research finding 4 out of every 10 users fully dependent after six weeks. Physical and psychological withdrawal effects can quickly set in, making any attempts at titration or quitting extremely formidable. Because Xanax is a fast acting drug, overdoses are a legitimate threat as well, contributing to almost 7,000 deaths from January 2019 to June 2020.

3. What's it like to be addicted to Xanax?

“Benzodiazepines impact the brain in such a manner that any variation in dose could cause acute changes in physical and emotional wellness,” Leela R Magavi, MD, Hopkins-trained psychiatrist and Regional Medical Director for Community Psychiatry + MindPath Care Centers, tells WebMD Connect to Care.

The DEA lists Xanax side effects include disinhibition, amnesia, episodic memory, vertigo, and mental confusion. Disinhibition may lead to irritability, hostility, and aggression. In rare cases, attacks of rage or violence, or other antisocial behaviors that are normally restrained by social norms, might occur. Vivid or disturbing dreams and worsened anxiety can occur when the user enters withdrawal. The state of awareness for those on Xanax is drastically decreased.

Because of this cognitive impairment, users are cautioned about taking Xanax and operating heavy machinery such as cars. Reaction time is especially slowed, which is the reason for the high number of automobile accidents people on Xanax who drive under its influence. People may use it with other drugs or alcohol, use it without a prescription, or use more than prescribed.

Benzodiazepine use is correlated with increased emergency room visitation, heroin use, HIV, and Hepatitis C infection, cites a 2018 journal Drug and Alcohol Dependence. Behavioral signs of Xanax addiction include an inability to fulfill daily obligations, denial and lying about use, isolation, and rapid emotional shifts. The affected user may appear out of it, confused, or become phobic. 

And what happens when you run out of Xanax? Mayo Clinic reports that any reduction in the dose of Xanax, or suddenly stopping the drug, may cause withdrawal symptoms like:

  • Irritability
  • Sadness
  • Loss of appetite
  • Nausea or vomiting
  • Behavioral changes
  • Muscle cramps
  • Difficulty focusing
  • Sleep issues
  • Suicidal thoughts
  • According to Mayo Clinic, you should only take Xanax as directed by your prescribing doctor. If you take more than the prescribed dose, take it too often, or for too long, it may cause dependence or result in overdose.

So, how much Xanax is a lot of Xanax?

“A Xanax overdose alone can have severe consequences, such as a loss of coordination, extreme sedation, and coma or death,” Kathryn Lee, EdM, MA, MHC, a psychotherapist at Intuitive Healing Psychotherapy Practice in New York, tells WebMD Connect to Care.

“To achieve a high, individuals who abuse Xanax may combine it with other substances, such as alcohol and/or opioids, which can potentially be lethal,” Lee adds.

Signs of dependency include exhibiting aggressive or irritable behavior that is out of the ordinary, hiding or lying about use, unreliability, taking Xanax with other addictive drugs such as alcohol or opioids, or putting oneself in dangerous situations. Driving under the influence, shoplifting, or buying counterfeit pills from a drug dealer are some events people reported to engage in while on Xanax. Any amount used beyond what is prescribed or out of the prescription instructions is too much. Short term use, even taking Xanax for just two weeks, has been linked to the development of dependence.

4. Is Xanax easy to get off of?

Getting off of Xanax is easier for people who lower the dosage in small steps prior to quitting. Abruptly stopping the medication or reducing the dosage drastically can be deadly; with potential seizures or death. There is still risk for dependence at doses from 0.75 mg to 4.0 mg, although people on 4.0 mg and higher doses per day exhibited significantly more withdrawal symptoms. Use over 12 weeks with dosages over 4 mg/day increases the risk and severity of dependence. Patient trials proved that there was no difference in difficulty for patients to decrease from 3.0 mg/day to zero over a period of 3 months when compared to a 6-month period.

The FDA discusses studies where participants experience rebound symptoms from Xanax discontinuance. Rebound symptoms are those that are as intense or worse for the user prior to starting Xanax treatment. Withdrawal symptoms pertain to those symptoms that were not present before active treatment.

If you believe you have developed a problem with Xanax, there is hope. Counseling teaches people with prescription drug problems to recognize destructive thinking, curb cravings, and manage difficult emotions and situations. Several levels of help exist to meet every person’s needs--such as inpatient, partial hospitalization, and outpatient treatment. 

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If you or a loved one are struggling with addiction, WebMD Connect to Care Advisors are standing by to help.