Alprazolam, commonly known by its brand name Xanax, is a short-acting benzodiazepine prescribed to treat anxiety and panic disorders. As a central nervous system depressant, alprazolam produces a calming effect that can relieve symptoms of anxiety. However, due to its high potential for dependence and abuse, alprazolam is classified as a controlled substance. So is alprazolam considered a strong drug?
What is Alprazolam?
Alprazolam is a benzodiazepine, a class of psychoactive drugs that act on the brain and central nervous system to produce a calming effect. Benzodiazepines enhance the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA works to reduce neuronal excitability, resulting in a drowsy, calming sensation. Other benzodiazepines include drugs like diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan).
By binding to benzodiazepine receptors in the brain that modulate GABA neurotransmission, alprazolam acts as a central nervous system depressant. This means it slows down brain activity, which inhibits anxiety, promotes relaxation, and can induce sleep.
Medical Uses of Alprazolam
Alprazolam is primarily used for the short-term management of anxiety disorders like:
- Generalized anxiety disorder (GAD)
- Panic disorder
- Social anxiety disorder (SAD)
- Specific phobias like agoraphobia
It works quickly to relieve symptoms like excessive worry, panic attacks, sweating, pounding heart, and other physical signs of anxiety. Alprazolam may also be used off-label to treat symptoms of depression or insomnia.
Alprazolam Dosage
Alprazolam comes in immediate and extended release oral tablet forms as well as orally disintegrating tablets. It is also available as an oral solution. Dosage depends on the severity of symptoms and the formulation, but usually ranges from 0.25 mg to 1 mg taken 2 to 3 times per day.
Extended release and orally disintegrating tablets may be taken at a dose of 0.5 mg to 1 mg once daily. The oral solution is commonly prescribed at a dose of 1 mg/mL.
Dosage may be increased gradually if symptoms do not improve. However, the daily maximum dose should not exceed 4 mg. Alprazolam begins working within an hour of ingestion and has a relatively short half-life of roughly 11 hours.
Is Alprazolam Addictive?
Yes, alprazolam has a high potential for dependence and addiction. Tolerance to the drug develops rapidly, meaning you need more of it to get the same effects. Stopping alprazolam suddenly after regular use can lead to severe, even life-threatening withdrawal.
According to the United States Drug Enforcement Administration (DEA), alprazolam is a Schedule IV controlled substance. Drugs in this schedule have a low potential for abuse and limited physical or psychological dependence relative to Schedule I, II, or III substances.
However, among benzodiazepines, alprazolam is considered to have the highest risk of misuse and addiction. Tolerance and dependence can develop within just a few weeks of regular use.
Risk Factors for Alprazolam Addiction
Certain factors that may increase someone’s risk of becoming dependent on alprazolam include:
- Taking higher doses more frequently
- Using other substances like alcohol, opioids, or stimulants
- Having a history of substance abuse or addiction
- Taking alprazolam without a prescription or in a way other than prescribed
- Having an existing mental health condition
- Experiencing significant early life trauma or stress
Signs of Alprazolam Addiction
Signs that someone may be addicted to alprazolam include:
- Taking more alprazolam than prescribed
- Frequently running out of alprazolam early
- Continuing use despite physical, social, or interpersonal problems caused or worsened by alprazolam
- Failed attempts to cut back or quit using alprazolam
- Spending significant time trying to obtain alprazolam
- Experiencing withdrawal symptoms like tremors, sweating, insomnia, or anxiety when not taking alprazolam
- Using alprazolam in physically hazardous situations like driving
Those addicted to alprazolam will compulsively seek and use it despite negative consequences. They may try to obtain it through multiple prescriptions from different doctors, borrowing medications from friends or family, or purchasing it illicitly.
Alprazolam Withdrawal Symptoms
When someone dependent on alprazolam stops taking it suddenly, they will experience withdrawal symptoms. Alprazolam withdrawal can begin within 6-12 hours of the last dose. Psychological and physical symptoms may include:
- Increased anxiety, panic attacks
- Depression, suicidal thoughts
- Irritability
- Insomnia, nightmares
- Headaches, migraines
- Tremors
- Muscle tension, pain
- Nausea, vomiting, diarrhea
- Sweating
- Tingling in hands and feet
- Sensory hypersensitivity
- Seizures
Alprazolam withdrawal can be extremely uncomfortable. The most dangerous symptoms are seizures, which can be fatal. To avoid potentially life-threatening complications, medical detox under the care of addiction professionals is strongly recommended when quitting alprazolam.
Medical Detox for Alprazolam
Medical detox provides around-the-clock monitoring and access to medications that can ease withdrawal symptoms. Detox may take place in an inpatient facility or outpatient clinic. Medications used during detox may include:
- Benzodiazepines like diazepam are tapered slowly to help wean the body off its dependence on alprazolam.
- Beta blockers to relieve tremors and high blood pressure.
- Antidepressants to help stabilize mood.
- Anticonvulsants to prevent seizures.
- Over-the-counter medications like NSAIDs help manage headache, muscle aches, nausea.
The tapering schedule and duration of detox depends on factors like dosage amount, length of use, co-occurring disorders, and polydrug abuse. With proper medical detox, alprazolam withdrawal symptoms can be significantly reduced in intensity.
Dangers of Alprazolam Abuse
Alprazolam abuse involves taking the medication in a way or dose other than prescribed. Abuse may entail:
- Taking higher doses than recommended
- Taking alprazolam without a prescription
- Crushing/snorting tablets to intensify effects
- Combining alprazolam with other central nervous system depressants like alcohol or opioids
Alprazolam abuse, especially long-term, can have severe medical, psychological, and social consequences including:
Physical Effects
- Fatigue, drowsiness
- Slurred speech
- Muscle weakness
- Impaired coordination, balance
- Headaches
- Nausea, vomiting
- Sleep disturbances
- Slowed breathing
- Irregular heartbeat
- Low blood pressure
Mental Effects
- Memory impairment
- Confusion
- Depression
- Disinhibition
- Impaired judgment
- Difficulty concentrating
- Delirium
Overdose
High doses of alprazolam can slow breathing and heart rate to dangerous levels. This increases the risk of respiratory depression, coma, and death. Alprazolam overdose is more likely when combined with other substances like opioids, alcohol, or antidepressants.
Accidents and Falls
The drowsiness and loss of coordination caused by alprazolam increases risks of falls and accidents, especially when driving. Alprazolam abuse makes you more likely to be involved in an accident resulting in injury or death.
Unsafe Behavior
Alprazolam disinhibits behavior and impairs judgment. Intoxication increases the likelihood of engaging in risky behaviors like unprotected sex, violence, or criminal activity.
Mental Health Problems
Chronic alprazolam abuse may worsen anxiety or depression when the drug wears off. It can cause or exacerbate mood disorders.
Other Substance Abuse
Those addicted to alprazolam are more likely to abuse other drugs like stimulants or alcohol.
Social/Financial Issues
Obtaining alprazolam illegally can lead to criminal charges, financial loss, and relationship conflicts.
Treatment for Alprazolam Addiction
Treatment for alprazolam addiction may combine detox, behavioral therapies, and medications. Options include:
Inpatient Rehab
Inpatient rehab facilities provide 24/7 supervised care. They offer medical detox, individual and group counseling, behavioral therapies, medications for withdrawal management, and aftercare planning. The structured environment removes triggers and distractions while promoting recovery.
Outpatient Programs
Outpatient addiction treatment takes place at a clinic during the day and allows clients to return home at night. It provides step-down care following inpatient rehab or as a stand-alone option for milder addictions. Outpatient treatment also utilizes counseling, therapy, and medications.
12-Step Groups
Programs based on the 12-step model, like Narcotics Anonymous, provide peer support and tools to achieve and maintain sobriety. Members work through the 12 steps with the aid of a sponsor.
Cognitive Behavioral Therapy (CBT)
CBT helps identify unhealthy thought and behavior patterns that perpetuate addiction. Clients are taught coping skills to prevent cravings and recognize drug-seeking triggers.
Contingency Management
This provides positive reinforcement like vouchers or privileges to reward abstinence from alprazolam.
Relapse Prevention
Relapse prevention strategies identify high-risk situations for drug use and develop plans to avoid or manage triggers and cravings.
Conclusion
In conclusion, alprazolam is considered a strong prescription drug due to its high addiction potential compared to other FDA-approved medications. Though legally prescribed for anxiety, alprazolam can easily be abused recreationally due to the rapid tolerance and dependence that develops.
Even when taken as directed, alprazolam has powerful effects on the brain and body. And abruptly discontinuing long-term alprazolam use leads to a difficult and dangerous withdrawal syndrome.
The DEA categorizes alprazolam as a controlled Schedule IV substance because it carries risks of physical and psychological dependence. However, among benzodiazepines, alprazolam poses the greatest risk of addiction and subsequent withdrawal complications.
Alprazolam abuse can have devastating health effects and spirals into polydrug abuse and addiction in vulnerable individuals. Integrated treatment incorporating detox, behavioral therapy, medications, and lifestyle changes offers the best chance for overcoming alprazolam addiction.
