What Is Xanax Withdrawal?
Xanax (alprazolam) is a benzodiazepine drug commonly prescribed for anxiety and panic disorder. Xanax withdrawal occurs when a user stops taking the medication suddenly or rapidly decreases the dose. Withdrawal can include uncomfortable mental and physical health problems – some of which can be life-threatening.1
Xanax Withdrawal Symptoms
Xanax withdrawal is characterized by symptoms similar to withdrawal from other central nervous system depressants, such as alcohol and other sedatives or hypnotics.
Controlled studies have indicated the following symptoms to be characteristic of Xanax withdrawal:1,3
- Mild dysphoria
- Irritability and tension
- Difficulty concentrating
- Muscle twitching and cramps
- Muscle stiffness
- Blurred vision
- Dry retching
- Stomach cramps
- Appetite loss
- Weight loss
- Heart palpitations
- Psychotic reactions (rarely reported and typically associated with high doses)
- Rebound anxiety, panic attacks, or insomnia (may be the return of symptoms of the initial illness and not necessarily from Xanax withdrawal alone)
Withdrawal can come on quickly and is typically more apparent after abrupt discontinuation or sudden changes in dose.
Withdrawal effects are more severe in those who took large doses of Xanax and/or for long periods of time. Such people are more likely to experience at least one seizure, which can be life-threatening. However, seizures have been reported by those who were taking low doses for a relatively short time period.1
Risks of Withdrawal
Withdrawal can pose many risks and complications for those quitting or tapering off of Xanax. These include:1
- Significant weight loss.
- Seizures, which can be severe and life-threatening.
- First phase (1-4 days). Xanax withdrawal typically begins with a period of rebound insomnia and anxiety, usually around 1-4 days after discontinuation or dose reduction.
- Second phase (10-14 days). Following the onset of these symptoms, the full-blown Xanax withdrawal syndrome usually occurs and lasts about 10-14 days.
- Third phase (2 weeks and beyond). Symptoms typically peak around week 2 and then begin to subside. In some cases, however, symptoms may persist for weeks, months, or even years if not treated by a medical professional.1,3,4
Post-Acute Withdrawal Syndrome
Some users of Xanax may experience post-acute withdrawal syndrome (PAWS). PAWS refers to effects that may occur after an initial withdrawal period from alcohol, opiates, and benzodiazepines (such as Xanax). Post-acute withdrawal syndrome may occur at any time in previous Xanax users. People have reported experiencing symptoms of PAWS several years after their last dose of the drug.
Common symptoms of PAWS include:4
- Mood swings.
- Difficulty concentrating.
- Memory problems.
- Sleep problems.
- Poor cognitive performance (learning, problem solving, etc.).
- Relationship problems.
- Negative attitude or outlook.
- Increased sensitivity to stress.
- Drug cravings.
Causes of Withdrawal
If a person suddenly stops taking Xanax after years, months, or sometimes even weeks of use, they will often experience withdrawal symptoms.
Withdrawal symptoms can also occur if the person lowers the dose rapidly (i.e., taking 4 mg a day for several weeks and suddenly switching to 1 mg per day) or simply forgets to take a single dose.1 Symptoms can occur after as little as 4 to 6 weeks of continuous use.1, 2
Withdrawal symptoms are due to the development of physical dependence, in which the body becomes accustomed to the presence of Xanax. The risk of dependence is high in those who take doses larger than 4 mg per day as well as in those who combine Xanax with other drugs or alcohol, and/or take Xanax in a way other than prescribed (i.e., crushing pills, snorting). However, dependence has even been reported in those taking less than 4 mg per day. 1
Treatment for Withdrawal
Because the symptoms of withdrawal can be severe, it is safest for Xanax users to attend a medically assisted detox program where they can taper off the drug under medical supervision.
Ongoing addiction treatment after the detox period is crucial to recovery. A recovery program that includes group and individual therapy, as well as aftercare planning, can help minimize the risk of relapse and help individuals better manage their drug cravings in the long-term.
A professional detox program may take place at a detox center or be part of the treatment offered at inpatient treatment centers, partial hospitalization programs, and outpatient programs.
- Detox centers: Detox facilities provide medical supervision during the withdrawal process.A healthcare provider, such as a physician or a nurse, can provide medication and monitoring for any complications. These programs may include counseling, and the person is usually discharged after completing withdrawal. When needed, arrangements will be made for the person to transfer to another location for ongoing substance abuse treatment once the detox program is completed.
- Inpatient or residential rehab programs: Inpatient recovery programs may include detox, or people may be referred to an inpatient program after going through withdrawal in a detox center. Inpatient programs usually include group and individual therapy, 12-step meetings, recreational activities, medical supervision, and aftercare planning. Treatment can last anywhere from 28 days to several months.
- Partial hospitalization programs: Partial hospitalization programs offer medical care, individual and group counseling and may provide detox care to people with less severe withdrawal symptoms. A person usually attends the program 3-5 days a week for about 4-6 hours each day and returns home at night. Partial hospitalization can be a primary form of treatment, or a person may transition into this program after completing a detox or inpatient program.
- Outpatient rehab programs. Some outpatient programs offer detox, though people with more severe withdrawal symptoms may be more appropriately treated at a detox facility or inpatient program. Outpatient programs are part-time programs in which the person returns home after the day’s treatment ends. The programs usually offer group therapy, and may offer individual counseling.
Medications Used for Withdrawal
A physician may taper Xanax or use a long-acting benzodiazepine.
When there is a risk of severe withdrawal, a person may be treated with successively smaller doses of Xanax (tapering) or another benzodiazepine drug to help reduce negative effects during the detox period.1, 5, 6
A physician should always supervise a Xanax taper or the use of other medications.
- Xanax tapering: Tapering involves slowly reducing the dose of Xanax over time to minimize withdrawal symptoms and cravings.
- Long-acting benzodiazepines: A physician may also prescribe a longer-acting benzodiazepine such as chlordiazepoxide, clonazepam (Klonopin) or diazepam (Valium) to help make the withdrawal process more comfortable. These drugs can help reduce withdrawal symptoms over a relatively long period of time, and in many cases may be easier to taper off of than Xanax itself.
- Antihypertensives and antiseizure medications: Propranolol, clonidine, or carbamazepine may also be prescribed to help ease anxiety, tremors, and seizures.
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. Federal and Drug Administration. (2006). Xanax CIV.
. Neale, G. & Smith. A. (May 1, 2007). Self-harm and Suicide Associated with Benzodiazepine Usage. The British Journal of General Practice: 57(538): 407-408.
. Petursson, H. (November 1994). The Benzodiazepine Withdrawal Syndrome. Addiction Journal: 89(11). 1455-9.
. UCLA Dual Diagnosis Program. (2016). Post-Acute Withdrawal Syndrome (PAWS).
. National Institute on Drug Abuse. (2014). Treating Addiction to CNS Depressants.
. Semel Institute: UCLA Dual Diagnosis Program. Benzodiazepine Addiction. Treatment for Valium, Xanax, and Other Benzodiazepine Addiction.
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