Xanax (alprazolam) is a sedative, or central nervous system depressant medication, that is commonly used to address issues with clinically significant anxiety, to initiate sleep, and to address agitation. It is also used to treat seizures and as a preanesthetic.
Xanax is classified as a benzodiazepine, which is a major class of medications that are primarily designed to treat clinically significant anxiety (not everyday nervousness) and seizures. These drugs can also be useful in addressing withdrawal symptoms from drugs like alcohol, other benzodiazepines, and stimulants when given under the supervision of a physician. The primary effects of Xanax include:
- A reduction in feelings of anxiety or stress
- An immediate slowing of the functioning of the central and peripheral nervous system
- A relatively quick onset of the effects of the drug and a relatively short duration of action
When the drug has a fast or intermediate onset of action, it means that its effects are realized relatively quickly after using it. When the drug has a short duration of action, it means that the peak effects of the drug will typically not last very long.
Xanax was designed primarily as a replacement for a very addictive benzodiazepine, Valium (diazepam). With Xanax’s short duration and quick onset of action, it was believed to have far less abuse potential. Nonetheless, Xanax has become a significant drug of abuse, as most of the benzodiazepines are.
Abusers of prescription drugs like Xanax most often do not have prescriptions for them, according to data that is supplied yearly by the Substance Abuse and Mental Health Services Administration (SAMHSA). Instead, chronic abusers of prescription drugs often get them from family or friends, steal them, or buy them illicitly. The majority of individuals who are prescribed these drugs do not go on to abuse them; however, a portion of individuals who do begin with a prescription for the drug will develop an abuse issue. Individuals who abuse drugs are more likely to experience untoward or detrimental effects of the drug compared to individuals who use the drug according to their physician’s instructions.
Effects of Xanax
Individuals who take Xanax for a short period of time to address a medical issue are far less likely to experience serious effects of Xanax than individuals who use or abuse the drug on a long-term basis.
Moreover, abusers of benzodiazepines commonly take them with other drugs of abuse; generally, the benzodiazepine drug (e.g., Xanax) is not their primary drug of abuse. This can complicate any effects that are associated with long-term Xanax abuse.
The National Institute on Drug Abuse (NIDA) and SAMHSA report that benzodiazepines like Xanax are most common secondary drugs of abuse taken in conjunction with narcotic pain medications, alcohol, other benzodiazepines, other sedatives, cannabis, and stimulants. For instance, Xanax may be taken in conjunction with alcohol to enhance the effects of both drugs, or it may be taken with a drug like cocaine to “cut” the effects of the cocaine. Polysubstance abuse can produce numerous complex effects, which are often more severe than the effects associated with the abuse of either drug alone.
According to professional sources, such as the four-volume set The Neuropathology of Drug Addictions and Drug Abuse, the short-term effects of Xanax use and abuse include:
- A significant reduction in anxiety or the subjective experience of perceived stress
- A reduction in the speed of thinking processes
- A reduction in reflex actions
- A reduction in impulse control
- A reduction in the ability to make rational decisions
- Decreases in rates of respiration, heart rate, and blood pressure
- A rapid development of tolerance
These effects are typically short-lived. If the individual only uses Xanax for a short period of time, it will not result in any significant issues in most cases. All drugs are associated with potential side effects that can occur in some individuals, and some of the side effects of Xanax include nausea, paradoxical anxiety (with the drug actually producing the symptoms it is designed to control), lethargy, and confusion.
In some individuals, Xanax may produce an allergic reaction, such as swelling of the lips, hives, anxiety, or rapid heartbeat. These individuals should immediately stop using the drug and consult a physician. Side effects and allergic reactions are relatively rare when the drug is used according to the prescription instructions.
When used in conjunction with other drugs that are central nervous system depressants (e.g., other benzodiazepines, alcohol, and narcotic pain medications), there is an enhancement of the effects of Xanax, whereas when used in conjunction with drugs that have opposite mechanisms of action, such as cocaine or other stimulants, these effects are diminished or enhanced. When Xanax is used in conjunction with other drugs, there can also be interactions that can produce atypical effects that are not normally associated with either drug.
The continued use of Xanax or any benzodiazepine results in alterations in the central nervous system and the peripheral nervous system. When the drug is used for medicinal reasons such as for the control of seizures or anxiety, doses are typically controlled, and the long-term effects of these alterations are not as significant as the long-term alterations that occur in individuals who abuse Xanax. Abusers typically take higher amounts of the drug than individuals who are prescribed it, use it in conjunction with other drugs of abuse, and take it more frequently, often bingeing on the drug.
It should be noted that every medication changes the body or brain in some way. Medications alter the functioning of a person’s system according to their specific mechanism of action. When the system is altered artificially by the use of a medication or abuse of a drug, there are going to be potential long-term changes. Some of the changes associated with long-term use or abuse include:of Xanax
- Changes in the neuropathways of the brain.
- Potential changes in behavior.
- Susceptibility to chronic conditions or diseases as a result of the drug’s mechanism of action.
- Increased tolerance that can lead to the development of physical dependence.
The changes in the neuropathways of the brain that occur as a result of long-term Xanax abuse include, but are not limited to:
- A decrease in the number of neuron receptors for inhibitory neurotransmitters like gamma-aminobutyric acid (GABA), referred to as down regulation.
- An increase in the number of neurons that are associated with neurotransmitters that produce the opposite effects of Xanax, referred to as upregulation.
- Significant alterations in the pathways of the so-called reward center of the brain associated with the reinforcing effects of the drug, leading to positive associations with use of the drug.
- Tertiary effects due to other variables, such as changes in behavior, alterations in appetite, and changes in the sleep cycle.
The potential behavioral problems that can be associated with use of Xanax can be numerous and depend on the context in which the drug is regularly used. Alterations in the pathways of the brain can extend to other areas of the brain that are not associated with the drug’s medicinal effects, particularly in abusers of the drug. There are numerous potential cognitive and behavioral issues that can occur as a result of chronic Xanax abuse, and these issues are much less more likely to occur in individuals who use the drug medicinally
- Long-term issues with attention and concentration
- Issues with the ability to form new memories and retain information
- Issues with problem-solving and judgment
- Issues with impulse control, especially controlling emotions
- An increased susceptibility to stress
- Cravings to use Xanax.
- Physical dependence on Xanax.
- The development of a substance use disorder
- Behavior alterations, such as not being able to control use of the drug and continuing to use the drug in spite of experiencing negative consequences
- Other psychological issues, such as anxiety, depression, and stress
- Increased vulnerability to be the victim of a crime or to commit a crime
There are some potential physical vulnerabilities associated with long-term abuse of Xanax.
- Respiratory issues can develop as a result of chronic respiratory suppression produced by the drug. Respiratory issues can exacerbate any of the above issues and increase vulnerabilities for the development of other potential health conditions, including contracting many infectious diseases.
- Long-term benzodiazepine abuse is associated with potential cardiac problems, including blood pressure issues, heartbeat irregularities, and an increased potential for heart attack and stroke.
- Other organ systems, such as the liver and kidneys, can be damaged by chronic abuse of Xanax and polysubstance abuse.
- Substance abusers are at an increased risk to develop numerous other physical health issues, including different forms of cancer.
- Substance abusers have significantly higher early mortality rates than individuals who do not abuse drugs or alcohol.
The development of physical dependence on Xanax is not as common as the development of physical dependence on some of the other benzodiazepines, but it can occur. There are no reliable estimates of the number of individuals who develop physical dependence on benzodiazepines. In fact, the research suggests that many individuals who have developed physical dependence on a benzodiazepine like Xanax may be unaware that they have done so.
For individuals who are using Xanax for some medical condition, and only use it as prescribed and under the supervision of their physician, the development of mild physical dependence is typically not a problem. For people who abuse Xanax, the development of physical dependence can be a serious and potentially dangerous issue. This is because many of these individuals begin to use Xanax and other drugs to avoid the early signs of the withdrawal syndrome, which will often include anxiety, aches and pains, nausea, jitteriness, fever or chills, or other flulike symptoms. When individuals begin to experience these symptoms, they may become desperate and use Xanax in dangerous situations or take extreme measures to get drugs to treat the symptoms of withdrawal.
Withdrawal from benzodiazepines like Xanax is known to produce seizures in some individuals, and seizures can produce significant brain damage and can even be fatal. Because Xanax is often used in conjunction with other drugs and it has a relatively short half-life, individuals may begin to experience mild withdrawal symptoms within 24 hours after discontinuing it if they have developed significant physical dependence on it. Moreover, overdoses on drugs like benzodiazepines often occur when individuals are emotionally distraught and unable to make rational decisions, which often occurs during withdrawal or when they are intoxicated.
Benzodiazepine Abuse in Elderly Individuals
According to research studies , elderly individuals may be prescribed benzodiazepines for the treatment of anxiety or for sleep at a higher rate than would be expected. The potential effects of Xanax abuse are enhanced in older individuals due to differences in the metabolism of older people compared to younger people. Xanax may have a longer duration (remain in the system longer) in elderly individuals than it does in younger individuals. This can lead to numerous potential risks for this group.
Elderly individuals may be at an increased risk for:
- Cognitive issues, such as problems with attention and the ability to form new memories.
- Increased sedation and lethargy that can result in problems with coordination, decreased reflex actions, and accidents.
- Cardiac and respiratory issues.
- Gastrointestinal issues, such as diarrhea, which can lead to dehydration.
- Atypical neurological effects, such as tremors, headache, vertigo, and double vision.
- Psychological issues, such as anxiety and depression.
Elderly individuals are often on numerous medications, and there may be numerous interactions that can exacerbate the above effects. The use of prescription medications may also be something that elderly individuals are more comfortable with, and they may rely on medications for issues that do not require them. This can result in significant issues, including the rapid development of tolerance and potential physical dependence on Xanax (a withdrawal syndrome).
Do The Issues Ever Resolve?
When a person takes any medication for a significant length of time, there are changes that occur in the central nervous system, and these changes will remain to some extent, even after extended abstinence. This is why individuals who have substance use disorders and have developed physical dependence on a substance will often experience a more rapid decline during a relapse, even after a long period of abstinence, than they did when they originally started using their substance of choice. Extended abstinence can weaken the changes to the pathways in the brain, and new alterations in the brain can help to circumvent these older issues, but for most individuals with prior substance use disorders, especially with severe and chronic substance use disorders, there are always some residual effects even after years of abstinence. The actual extent of any residual effects will vary significantly from person to person, and will be contingent on various factors, including how long they used the drug, how much of it they typically took, whether they mixed it with other drugs, their own metabolism, and other physical factors.
Many of the cognitive and behavioral issues that occur as a result of Xanax abuse will also resolve to some extent. Respiratory issues, cardiac issues, and problems in other organ systems can also resolve, depending on the extent of damage. Damage to an individual’s career, personal relationships, and educational goals may or may not be reversible, depending on the situation. Long-term treatment is designed to help individuals cope with these issues and institute positive changes.
Treatment for Xanax abuse helps clients to remain abstinent, develop new goals and coping methods, build a support system, and obtain a new outlook on life. Continued participation in treatment is one of the most important factors for a successful recovery. Individuals who remain in treatment-related activities for years following their initial abstinence have far greater success in instituting positive changes than individuals who only participate in treatment for a short period of time.