Tag: Benzodiazepines

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Cross-Tolerance: A Comprehensive Guide to Understanding Drug Interactions and Safety

Have you noticed that your pain medication isn’t working as well as it used to? Or wondered why you need higher doses of anxiety medication after using other substances? This might be due to cross-tolerance, a fascinating but often misunderstood process that affects people taking multiple medications or using substances alongside their medications.

Cross-tolerance happens when building tolerance to one substance affects how your body responds to another, seemingly different substance. This isn’t just a curiosity; it has real impacts on medication effectiveness, overdose risk, addiction recovery, and your everyday health management. 

Let’s explore how cross-tolerance develops, look at some real-world examples, and discuss practical strategies for managing its effects on your treatment and your health.

What Is Cross-Tolerance?

Cross-tolerance is when your body’s adaptation to one substance lessens your response to another substance that works in similar ways. If your brain gets used to one type of substance, it might also become less responsive to other substances that affect similar receptors. 

The American Psychological Association defines cross-tolerance2 as: 

A condition in which tolerance to one drug results in a lessened response (i.e., increased tolerance) to a related drug. 

This happens because many substances share common pathways in your brain and body. In pharmacology, this is understood as a shared mechanism of action, meaning the substances influence the same biological targets in the body.

When you use a substance repeatedly, your brain adapts to maintain balance. It might produce fewer natural chemicals, become less sensitive to the substance’s effects, or create more enzymes to break down the substance faster. These adaptations don’t just affect the original substance—they can also impact other substances that work through the same biological systems.

Different Substances, Similar Neural Pathways

Cross-tolerance is most common between substances that affect the same brain receptors2 or neurotransmitter systems. For example, if you develop tolerance to prescription opioid painkillers, you might also have reduced sensitivity to other opioids, including illegal ones like heroin. This happens because all opioids work on the same receptor system in your brain.

The process isn’t always predictable or complete. You might have strong cross-tolerance between some substances but not others. Your degree of cross-tolerance depends on factors like how similar the substances are, how much you’ve used, how long you’ve been using, and your individual biology.

Cross-tolerance can happen between a lot of different types of substances. The APA notes that cross-tolerance is commonly seen with “amphetamines,1 benzodiazepines, hallucinogens, and opiates, among other drugs.” It can also occur between alcohol and various medications, different types of antidepressants, and even between prescriptions and street drugs.

Why This Matters to You 

Understanding cross-tolerance is important for both medical treatment and harm reduction. It affects how doctors prescribe medications, how effective treatments might be, and what risks you face when combining different substances. It’s also a major factor in addiction treatment and recovery planning.

Common Examples of Cross-Tolerance

Cross-tolerance can show up in a lot of different situations, from prescription medications to recreational substances. Here are some of the most important patterns to understand.

Cross-Tolerance Between Opioids

Because they work on the same opioid receptors, all opioids can cause cross-tolerance3 (most commonly, incomplete cross-tolerance) with each other. That means if you’ve been taking prescription painkillers like oxycodone or morphine for a while, your body might also be less sensitive to other opioids, including illegal ones like heroin or fentanyl.

This causes serious risks. Someone who has built tolerance to prescription opioids might think they need a large amount of street opioids to feel effects. But because street drugs are often much stronger and less predictable than prescription medications, this miscalculation can lead to overdose.

For people in medical treatment, opioid cross-tolerance can complicate pain management. If you’ve developed tolerance to one type of pain medication, your doctor might need to try different approaches or higher doses to help manage your pain effectively.

If you or someone you know uses opioids, see our article on How to Use Naloxone to learn about this life-saving overdose reversal medication.

Alcohol and Benzodiazepines 

Alcohol and benzodiazepines (like Xanax, Valium, or Ativan) are both agonists that work on the same brain system called GABA.4 That means people who drink regularly often need higher doses of these medications to feel the same effects.

This type of cross-tolerance is especially dangerous because both alcohol and benzos slow down your breathing and heart rate. When people have cross-tolerance, they might use more of both substances, which can lead to life-threatening overdose.

Barbiturates, an older drug class of sedatives sometimes used for seizure control or anesthesia, also act on the GABA system. People with alcohol or benzodiazepine tolerance may also be less sensitive to barbiturates, which makes dosing less predictable and increases overdose risk.

Doctors need to know about your drinking habits when they’re prescribing benzodiazepines. If you have alcohol tolerance, you might need different medications or special monitoring to stay safe.

Learn more about how to keep yourself safe in our article on the risks of mixing benzos and alcohol.

Other Important Cross-Tolerance Patterns

Prescription stimulants can cause cross-tolerance with cocaine,5 meth, and other stimulants. This includes ADHD medications like Adderall and Ritalin, and it can affect both the effectiveness of ADHD treatment and the risks of using other stimulants.

Cannabis can also show partial cross-tolerance with other substances6 that affect similar brain receptors, such as certain sedatives. Regular cannabis use may also influence how your body responds to medications that impact mood, sleep, or appetite.

Psychedelic drugs also show cross-tolerance patterns.7 If you use LSD, you might find that mushrooms (psilocybin) or mescaline don’t work as well for several days afterward. These substances all affect similar brain pathways.

Different types of sedatives and sleep medications often have cross-tolerance too. This includes prescription sleep aids, muscle relaxers, and some seizure medications. If you take one regularly, others in the same category might be less effective.

How Cross-Tolerance Develops in Your Body

Your brain is constantly working to keep things balanced. When you use a substance regularly, your brain notices and starts making changes to cope. You can think of it as a thermostat that’s trying to keep the temperature just right. When a substance comes in and turns up the heat, your brain responds by turning down its own systems to balance things out.

Your brain has special spots called receptors that substances attach to. When you use a substance often, your brain might make fewer of these receptors or make them less sensitive. Your brain also makes its own natural “feel-good” chemicals like dopamine and serotonin. But when you use substances regularly, it starts making less of these natural chemicals. 

Cross-tolerance usually develops gradually over weeks or months of regular use, but some people develop it faster than others based on their genetics, age, and overall health. The changes that cause cross-tolerance can last for weeks or even months after you stop using a substance.

Cross-Tolerance and Substance Use

If you use drugs recreationally, cross-tolerance can significantly impact both their effects and the risks involved.

Impact on Drug Effectiveness

Cross-tolerance often means you won’t get the effects you’re expecting from substances. If you’ve built tolerance to one drug, you might find it much harder to achieve the same desired effect with a different drug that has similar effects on your brain.

This can be frustrating and dangerous. You might end up using more of a substance than you planned to, thinking it’s not working. But the problem isn’t with the substance—it’s that your brain has adapted to other substances that work on the same pathways.

Overdose Risks

Cross-tolerance creates a serious risk of overdose that many people don’t realize. Just because you can handle large amounts of one substance doesn’t mean you’re safe with large amounts of another—even if they seem similar.

Here’s why this is so dangerous: tolerance affects how high you feel, but it doesn’t always protect you from overdose. Your brain might be less sensitive to the euphoric effects of heroin, for example, but your respiratory system can still shut down from too much of it.

Street drugs are especially risky because you never know exactly what you’re getting or how strong it is. Someone with opioid tolerance might take what seems like a reasonable amount of street fentanyl, not knowing it’s much more potent than their usual pills.

Fentanyl is an extremely potent synthetic opioid that’s causing overdoses even among people who aren’t aware that it’s in their drugs. Learn more about what you can do to prevent these risks in our article on fentanyl use and addiction.

Complications With Polydrug Use 

Cross-tolerance often leads people to mix different substances to get the effects they want. This is called polydrug use, and it’s much more dangerous than using one substance at a time.

The unpredictability of polydrug use makes it especially risky. You might be fine mixing substances one day but have a dangerous reaction the next, depending on factors like how much you’ve eaten, how tired you are, or what other medications you’re taking.

Researchers warn about the dangers of this practice, even going so far as to call it “Russian roulette”. According to one study, 

Using benzos or z-drugs and opioids together was likened to playing Russian roulette due to an unregulated drug market, unpredictable potency, availability and contents of illegal drugs and a lack of information about how these drugs work together.

When you combine substances, they can interact in unpredictable ways. Even if you have tolerance to each substance individually, combining them can overwhelm your body’s ability to cope. 

For more insight into the risks and treatment options for using multiple substances, see our article on polydrug addiction.

Cross-Tolerance and Medical Treatment

Cross-tolerance can significantly impact your medical care, making treatment more complex and sometimes less effective.

Challenges in Pain Management 

The development of tolerance to opioid analgesics like oxycodone or morphine can make managing pain much more difficult. Your doctor might need to prescribe higher doses, try different types of pain medications, or use a completely different approach.

This puts both you and your doctor in a tough spot. Higher doses increase the risk of side effects and addiction. But undertreated pain can seriously impact your quality of life and ability to heal.

Some doctors might be hesitant to prescribe adequate pain medication if they know you have tolerance. It’s important to be honest with your healthcare team about your substance use history so they can find safe, effective ways to manage your pain.

Effects of Psychiatric Medication 

Cross-tolerance can affect medications for depression,8 anxiety, bipolar disorder, and other mental health conditions. If you have tolerance to substances that affect the same brain systems as your psychiatric medications, those medications might not work as well.

For example, if you take medication for anxiety and drink heavily, Your provider may adjust your treatment plan to ensure it works effectively and safely. If you use stimulants, your ADHD medication might be less effective. This can make treating mental health conditions much more challenging.

Your psychiatrist needs to know about any substance use to prescribe medications safely and effectively. They might need to adjust doses, try different medications, or monitor you more closely.

Learn more about the importance of regularly reviewing and updating your medication plan in our article on medication management.

Managing Chronic Diseases 

Cross-tolerance can impact medications used for conditions like high blood pressure, diabetes, and heart disease. When the medication doesn’t work as expected, it can be harder to control these serious health conditions.

This is especially concerning because a lot of chronic diseases require precise medication management. If your medications aren’t working properly due to cross-tolerance, your health condition could get worse.

Surgery and Emergency Care 

Cross-tolerance significantly affects surgical procedures and emergency medical care. If you have tolerance to opioids or other substances, anesthesia might not work as expected during surgery.9 You might wake up during procedures or experience inadequate pain control afterward.

Emergency situations become more complicated when cross-tolerance is involved. Emergency room doctors might struggle to provide effective pain relief or sedation if they don’t know about your tolerance. This can make traumatic situations even harder to manage.

It’s important to make sure everyone on your medical care team knows about your substance use history, even in emergencies. This information helps them provide safer, more effective care and can prevent dangerous complications during treatment.

Cancer Treatment and Chemotherapy 

Cancer patients often face unique challenges with cross-tolerance. Chemo and other cancer treatments affect how your body processes medications. If you also have substance tolerance, managing pain and other symptoms becomes much more complex.

Cancer pain is often severe and requires strong medications. If you have cross-tolerance to opioids, your oncology team might need to use higher doses, different medications, or alternative pain management approaches. This requires careful coordination between all your healthcare providers.

Addressing Cross-Tolerance in Addiction Recovery

Cross-tolerance creates unique challenges during treatment for substance use disorders.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) programs use medications like methadone, buprenorphine, or naltrexone to help people recover from opioid addiction. If you have cross-tolerance, these medications might not work as expected, and your treatment team might need to adjust the approach.

Detox and Withdrawals

Cross-tolerance makes managing withdrawals more complicated. You might experience withdrawal symptoms from multiple substances, even if you were only actively using one. This can make detox longer and more uncomfortable.

Risk of Relapse

Cross-tolerance also affects relapse risk. If you’re in recovery and your usual substances don’t give you the effects you remember, you might be tempted to try stronger substances or use multiple substances together. Both of these approaches are highly dangerous.

Recovery programs need to address cross-tolerance specifically. Good-quality treatment programs will assess your complete substance use history and create a personalized plan that takes any possible effects of cross-tolerance into account.

Cross-Tolerance in Specific Patient Groups

Different groups of people face unique challenges with cross-tolerance that require special consideration and care.

People Who Are Pregnant and Breastfeeding 

Cross-tolerance during pregnancy can create complex medical situations. Pregnant people might need different pain medications during labor and delivery if they have tolerance to opioids. Healthcare needs to balance effective pain relief with safety for both the birthing parent and the baby.10

Substance use during pregnancy affects babies’ developing brains, potentially making them more likely to develop tolerance issues later in life. If you’re pregnant and have substance tolerance, specialized maternal care programs11 can help manage both your health and your baby’s safety.

Those who are breastfeeding while managing cross-tolerance need to choose medication carefully. Because so many substances can pass through breast milk, healthcare providers need to select treatments that are safe for nursing babies while still effective for their caregiver.

Medication Interactions for Older Adults

Older adults often take multiple medications for different health conditions, making cross-tolerance more dangerous and more likely. Their bodies also process medications differently than younger people, which also makes the effects of tolerance less predictable.

Falls and confusion are serious risks for elderly people with cross-tolerance.12 If their medications aren’t working properly, they might be more likely to have accidents or experience dangerous side effects from taking higher doses.

Family members and caregivers should be aware of cross-tolerance risks in elderly loved ones. Regular medication reviews and honest communication with healthcare providers are especially important for this population.

Teenagers and Young Adults

Young people’s brains are still developing, which makes them more vulnerable to developing cross-tolerance quickly. What might take months to develop in adults can happen in weeks for teenagers who use substances regularly.13

ADHD medications are a common concern for this age group. Many teens and young adults take stimulant medications for ADHD, and cross-tolerance with other stimulants can affect both their treatment effectiveness and their risk if they use other substances.

College environments often involve alcohol and substance use, which can interact dangerously with prescription medications. Young adults need education about these risks to make informed decisions about their health and safety.

For more information about the risks and treatment options for stimulant medications, see our article on Adderall addiction.

Risk Factors for Developing Cross-Tolerance

Several factors make some people more likely to develop cross-tolerance14 than others:

  • Individual sensitivity: Some people’s brains are naturally more or less sensitive to substances, which affects how quickly tolerance develops.
  • Frequency and duration of use: Regular, long-term use increases your chances of developing cross-tolerance compared to occasional use.
  • Age and developmental factors: Teenagers and young adults develop tolerance faster because their brains are still developing and more adaptable to change.
  • Environmental influences: High stress, trauma, and chaotic environments can speed up tolerance development and make cross-tolerance more likely.
  • Underlying health conditions: Mental health conditions, chronic pain, and some genetic factors can increase your risk of developing cross-tolerance.
  • Genetic predisposition: Your family history and genetics affect how your body processes substances and how quickly you develop tolerance.
  • Polydrug use patterns: Using multiple substances regularly increases your risk of developing cross-tolerance between them.
  • Metabolism differences: How fast or slow your body breaks down substances affects how quickly tolerance develops.

Managing and Preventing Cross-Tolerance

Professional Treatment Approaches

Healthcare providers use several strategies to manage cross-tolerance effectively. The first step is always a thorough assessment of your substance use history that includes prescription medications, over-the-counter drugs, alcohol, and any illegal substances.

Regular medication reviews are essential. Your doctor should check how well your medications are working and watch for signs of tolerance or cross-tolerance. They may need to adjust doses, switch medications, or try a combined approach.

What works for one person might not work for another, especially when cross-tolerance is involved. That’s why it’s so important for your care to take place according to a personalized treatment plan that takes your specific tolerance patterns into account. 

Advocating for Yourself in Healthcare Settings

Being honest with your healthcare providers is important for safe, effective treatment. This includes telling them about all substance use, even if you’re worried about judgment. Healthcare providers need this information to keep you safe.

If you’re using multiple substances and not ready to quit, harm reduction strategies can help keep you safer. This includes using one substance at a time when possible, having someone with you who can get help if needed, and knowing the signs of overdose.

If your doctor isn’t already doing them, ask for regular medication reviews. If your medications don’t seem to be working as well as they used to, cross-tolerance might be the reason.

Keep a record of all medications and substances you use, including over-the-counter drugs, supplements, and any recreational substances. This information can be vital in emergency situations and helps your healthcare team make better treatment decisions.

Consider working with specialists who understand cross-tolerance, such as addiction medicine doctors or pain management specialists. These providers have extra training in managing complex tolerance situations and can often offer more effective treatment options.

Common Misconceptions About Drug Tolerance

A lot of dangerous myths surround cross-tolerance that can put people at serious risk. Understanding the truth can help you make safer decisions.

“If I have tolerance to one drug, I’m safe taking larger amounts of similar drugs.” 

This is extremely dangerous thinking. Tolerance affects how high you feel, but it doesn’t protect you from overdose. Your brain might be less sensitive to euphoric effects, but your body can still shut down from too much of a substance. Many overdoses happen to people who midjudge their tolerance.15

“Cross-tolerance means all similar drugs affect me the same way.” 

Cross-tolerance isn’t complete or predictable. You might have strong tolerance to one opioid but much less tolerance to another. Street drugs especially vary in strength and purity, making this assumption potentially fatal.

“If my medication isn’t working, I just need a higher dose.” 

While dose adjustment might be necessary, jumping to higher doses without medical supervision is dangerous.16 Your reduced response might be due to cross-tolerance, but it could also be due to other factors that require different solutions.

“Cross-tolerance goes away quickly when I stop using substances.” 

Brain changes from cross-tolerance can last weeks or months after stopping substance use. Don’t assume your medication sensitivity has returned to normal right away. This is why medical supervision is important during recovery.

“Prescription drugs don’t cause cross-tolerance with illegal drugs.” 

Many prescription medications can cause cross-tolerance with illegal substances. Prescription opioids and street opioids, for example, affect the same brain systems. Benzodiazepines prescribed for anxiety can cause cross-tolerance with alcohol. Just because a drug is legal doesn’t mean it can’t have dangerous effects.

“I can prevent cross-tolerance by switching between different drugs.” 

Rotating between substances that affect the same brain systems won’t prevent cross-tolerance. In fact, it might make it worse by exposing your brain to multiple substances17 that cause similar adaptations.

Current Research and Future Directions

Research on cross-tolerance continues to reveal important findings that could improve treatment approaches.

Recent studies on heroin addiction recovery show that cross-tolerance to buprenorphine18 (a medication used in addiction treatment) is linked to faster relapse rates. This research is helping doctors understand how to adjust treatment plans for better success.

Emerging research on anesthesia shows that people with substance tolerance often need different approaches during surgery.19 Anesthesiologists are developing better ways to provide safe, effective anesthesia for people with cross-tolerance.

Studies on ADHD medications reveal that using multiple stimulant medications can lead to cross-tolerance20 and reduced effectiveness over time. This research is helping doctors find better ways to manage ADHD treatment long-term.

Future neuroscience research directions include mapping exactly how different substances affect brain pathways, identifying genetic markers that predict cross-tolerance risk, and developing new medications that are less likely to cause cross-tolerance.

Understanding Cross-Tolerance Is the First Step Toward Safer, More Effective Care

Cross-tolerance is a complex but important concept that affects millions of people taking medications or using substances. Understanding how it works can help you make safer decisions and get better medical care.

The key takeaway is that substances often affect each other in ways you might not expect. Being honest with healthcare providers about all substance use—prescription, over-the-counter, and recreational—is essential for your safety and effective treatment.

If you’re struggling with substance use and cross-tolerance is complicating your situation, professional help is available. Find a treatment center near you that understands these complex issues and can provide the specialized care you need.

FAQs

Q: How long does cross-tolerance last after stopping substance use? 

A: Cross-tolerance can persist for weeks to months after stopping substance use, depending on how long you used substances, what types you used, and your individual biology. Some people notice their medication sensitivity returning to normal within a few weeks, while others may take several months.

Q: Can cross-tolerance be reversed? 

A: Yes, cross-tolerance often decreases over time when you stop using the substances that caused it. However, the process is gradual and varies a lot from person to person. Working with healthcare providers during this time is important for safe medication management.

Q: How do doctors calculate medication doses when cross-tolerance is present? 

A: Doctors consider your substance use history, current tolerance levels, and individual response to medications. They often start with standard doses and adjust based on your response, monitoring you closely for both effectiveness and side effects.

Q: Does cross-tolerance affect all medications the same way? 

A: No, cross-tolerance only affects medications that work on similar brain pathways as the substances you’ve used. For example, opioid tolerance won’t affect your blood pressure medication, but it might affect other pain medications.

Q: Can you prevent cross-tolerance from developing? 

A: The most reliable way to prevent cross-tolerance is to avoid using substances that affect the same brain systems. If you need to take medications long-term, work closely with your doctor to monitor for tolerance and adjust treatment as needed.

Q: Is cross-tolerance the same as drug interactions? 

A: No, these are different concepts. Drug interactions happen when substances affect each other directly in your body. Cross-tolerance is when your brain’s adaptation to one substance affects your response to another.

Q: How quickly does cross-tolerance develop? 

A: Cross-tolerance can develop anywhere from days to months, depending on the substances involved, how often you use them, and individual factors like genetics and age. Some people notice changes within just a few weeks of regular use.

Q: Can cross-tolerance affect emergency medical treatment? 

A: Yes, cross-tolerance can affect emergency treatments, especially pain medications and anesthesia. This is why it’s important to be honest with emergency medical staff about your substance abuse history, even in crisis situations.

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Xanax Addiction: 12 Warning Signs and Treatment Options

Xanax, a prescription medication that’s often used to treat anxiety and panic disorders, can Xanax, a prescription medication that’s often used to treat anxiety and panic disorders, can be a helpful tool when you use it responsibly under medical supervision. But its potential for misuse and addiction raises concerns among healthcare providers and those looking for solutions for acute anxiety. 

We explore what Xanax is, how and why people use it incorrectly, and the addiction risks involved—plus treatment options for those seeking help.

What Is Xanax?

Xanax (the brand name for alprazolam)1 is a medication that’s part of the benzodiazepine family. It’s often prescribed to treat anxiety disorders because it helps calm the mind and body.

It’s usually prescribed by medical professionals who are licensed to evaluate and treat conditions like anxiety and panic disorders. These include primary care physicians, psychiatrists, nurse practitioners, addiction medicine specialists, and pain management specialists.

Because Xanax has a high potential for abuse, prescribers are cautious about certain risk factors:

  • Any history of substance use disorders
  • Monitoring for signs of dependency
  • Encouraging therapy or other non-benzodiazepine strategies for long-term management

It’s best to take Xanax as part of a medication management plan under the guidance of a qualified behavioral health professional.

How Xanax Affects the Brain

Xanax works by boosting the effects of GABA,2 a neurotransmitter that slows down nerve signals in the brain. GABA acts like the brain’s natural brake pedal, helping you feel calm and relaxed. By boosting GABA activity, Xanax reduces symptoms of anxiety, helps with sleep, and creates feelings of relaxation.

The medication is fast-acting, which makes it especially effective for acute anxiety episodes. However, this quick action also contributes to its addiction potential—even with short-term use. 

Why Do People Misuse Xanax?

Xanax use often begins with a desire for relief from stress, insomnia, or emotional distress. But whether or not they have a prescription, people misuse Xanax for a lot of reasons. Some might take more than prescribed to feel calmer. Others may use it recreationally for the sense of relaxation or euphoria it can provide.

Sometimes, people combine Xanax with other substances, like alcohol, to intensify the effects—which can be extremely dangerous. Misuse often starts because of:

  • Stress relief – People often self-medicate to cope with anxiety, stress, or their inability to sleep.
  • Tolerance – Over time, the body gets used to Xanax, so people need higher doses to get the same effect.
  • Fear of withdrawal – Xanax can cause uncomfortable withdrawal symptoms. This causes many people to keep taking it even when they want to stop.

The National Institutes of Health (NIH) explains:

Alprazolam may be habit forming.3 Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tell your doctor if you have ever drunk large amounts of alcohol, if you use or have ever used street drugs, or have overused prescription medications. Do not drink alcohol or use street drugs during your treatment. Drinking alcohol or using street drugs during your treatment with alprazolam also increases the risk that you will experience these serious, life-threatening side effects. Also tell your doctor if you have or have ever had depression or another mental illness.

How Is Xanax Abused?

People abuse Xanax in a number of ways, including:

  • Taking higher doses than prescribed
  • Taking it more frequently than prescribed
  • Using it without a prescription
  • Crushing and snorting pills to feel the desired effects more quickly
  • Combining Xanax with other substances like alcohol or opioids to heighten its effects (a dangerous practice that significantly increases the risk of overdose)

Taking Xanax in ways other than prescribed or mixing it with other substances can have unpredictable and potentially life-threatening consequences.

The Scope of the Problem: Xanax Misuse by the Numbers

Xanax misuse isn’t rare. In fact, it’s a growing problem:

These numbers show just how serious Xanax misuse has become—and why it’s so important to understand the risks.

How Addictive Is Xanax?

Xanax is highly addictive,7 especially when compared to other prescription drugs. Its effects are strong and fast, which makes it more likely for people to develop a dependency. This can happen over even a short period of time. Compared to antidepressants like Zoloft, which work gradually over weeks and have lower drug addiction potential, the effects of Xanax are stronger and more immediate, which can lead to psychological dependence much faster.

The NIH explains how Xanax dependence sets in:

Alprazolam may cause a physical dependence (a condition in which unpleasant physical symptoms occur if a medication is suddenly stopped or taken in smaller doses), especially if you take it for several days to several weeks.

What makes Xanax so addictive?

  • Short-lasting effects: Xanax works quickly but wears off fast, which can make you want more.
  • Feel-good effects: The sense of calm it provides can be hard to give up, especially if the cause of your anxiety persists.
  • Tolerance: As your body adjusts, you might want to take larger doses, which increases your risk of addiction.

Signs of Xanax Addiction

If you’re worried about your relationship with Xanax, look for these warning signs:

Behavioral Indicators

  1. Taking more Xanax than you were prescribed or using it without a prescription
  2. Seeing multiple doctors to get extra prescriptions (a practice called “doctor shopping”)
  3. Avoiding your responsibilities at work, school, or home
  4. Acting secretive or withdrawing from your social circle

Physical Symptoms

  1. Constant drowsiness or feeling sedated
  2. Slurred speech or trouble staying balanced
  3. Constantly feeling tired or weak
  4. Muscle aches and tremors

Psychological Effects

  1. Feeling anxious, irritable, or panicked when you don’t have Xanax
  2. Trouble concentrating or memory lapses
  3. Depression or mood swings
  4. Craving Xanax even when you know it’s causing problems in your life

Risks of Xanax Misuse and Addiction

The use of Xanax doesn’t just put you at risk for addiction—it can also seriously affect your physical and mental health.

Xanax Overdose

Xanax slows down your central nervous system,8 which controls vital functions like breathing and heart rate. Taking too much—or mixing it with other substances like alcohol—can cause your breathing to slow to dangerous levels. This respiratory depression is the main cause of fatal overdose.

Withdrawals

If you’re dependent on Xanax, stopping suddenly is dangerous. It can cause severe withdrawal symptoms that include seizures, panic attacks, and insomnia. Quitting “cold turkey” without medical help is risky—it’s hugely important to taper off under a doctor’s supervision.

The NIH warns:

Do not stop taking this medication or take fewer doses without talking to your doctor. Stopping alprazolam suddenly can worsen your condition and cause withdrawal symptoms that may last for several weeks to more than 12 months. Your doctor probably will decrease your alprazolam dose gradually. Call your doctor or get emergency medical treatment if you experience any of the following symptoms: unusual movements; ringing in your ears; anxiety; memory problems; difficulty concentrating; sleep problems; seizures; shaking; muscle twitching; changes in mental health; depression; burning or prickling feeling in hands, arms, legs or feet; seeing or hearing things that others do not see or hear; thoughts of harming or killing yourself or others; overexcitement; or losing touch with reality.

Not all doctors are trained in addiction-related care. It’s important to get professional help from a prescriber who has experience helping patients taper off benzodiazepines.

Long-Term Health Consequences

Prolonged Xanax abuse can lead to:

  • Memory and focus problems: Over time, Xanax leads to cognitive impairment in areas like concentration and recall.
  • Physical dependence: Your body can become so reliant on Xanax that it’s hard to function without it.
  • Emotional instability: Xanax misuse can worsen anxiety,9 depression, or other mental health conditions over time.

How Can I Help Someone Struggling With Xanax Addiction?

If someone you care about is struggling with Xanax addiction, your support can make a major difference in their recovery journey.

Start by approaching them with compassion rather than judgment or blame. Express your concerns calmly and offer your support. When you’re ready to have a conversation, encourage them to speak with a therapist or addiction specialist. You can offer to help them look into treatment options or even go with them to appointments.

Take time to learn about addiction yourself. Understanding how Xanax addiction works can help you provide better support and set realistic expectations for recovery. It’s also hugely important to take care of your own wellness— supporting someone with addiction is emotionally draining. You can also join a support group for loved ones of people with substance use disorders.

While you can’t force someone to get help, you can create an environment that supports their recovery.

If you’re ready to have this important conversation, learn effective strategies and find the right words in our guide to talking to a loved one about going to rehab.

Treatment for Xanax Addiction

The good news is that Xanax addiction is treatable, and there are plenty of resources to help you recover. Effective treatment for Xanax addiction usually involves a combination of medical intervention, evidence-based and complementary therapies, and ongoing support.

Detox

The first step is detoxification, where the body gets rid of Xanax. Because withdrawal can be intense, it’s important to do this under medical supervision. Usually, your doctor will taper the dose slowly to make the process safer and more manageable.

Medication-Assisted Treatment (MAT)

In some cases, your doctor might prescribe other medications to manage withdrawal symptoms or address co-occurring mental health issues.

Comprehensive Xanax Addiction Treatment Programs

Inpatient rehab programs provide 24/7 medical supervision and intensive therapy in a controlled environment. These programs typically last 30–90 days and are ideal for people with more severe addiction or those who feel they can benefit from a more immersive treatment experience. You’ll participate in individual counseling, group therapy, and behavioral therapies that help you identify and change the patterns that lead to misuse.

Outpatient rehab programs allow you to continue living at home while attending scheduled treatment sessions. These programs offer flexibility for people who have work or family responsibilities but still need structured support. Outpatient treatment includes individual counseling to work through personal struggles related to addiction, group therapy for peer support, and educational sessions about addiction and recovery strategies.

When you start rehab, your care team will do a thorough assessment and create a treatment plan according to your needs.

Aftercare and Ongoing Support

Continuing care is important to maintain your recovery progress after you complete initial treatment. This ongoing support includes regular therapy sessions to reinforce coping strategies and address any emerging challenges. Many people find support groups like Narcotics Anonymous (NA) or SMART Recovery helpful for connecting with others in recovery. Lifestyle changes such as developing healthy stress management techniques, establishing regular sleep patterns, and building a strong support network are also important aspects of preventing relapse and maintaining sobriety.

Long-term recovery often involves a combination of continuing care approaches, such as:

  • Regular check-ins with your healthcare provider
  • Outpatient addiction treatment
  • Ongoing individual therapy
  • Support groups like Narcotics Anonymous (NA)

Find a Treatment Center

If you want to stop using Xanax but are having a hard time doing so on your own, finding the right treatment facility is a great step toward recovering safely and effectively.

Rehabs offer personalized addiction treatment programs that are tailored to your needs. They provide a combination of therapies to address underlying issues, and resources for long-term recovery. Many also have medical detox facilities on-site, or can help you arrange detox prior to starting treatment.

Explore benzodiazepine addiction treatment options to find a facility near you.

FAQs

Q: What makes Xanax so addictive?

A: Xanax is highly addictive due to its fast-acting, short-lasting effects, which can create a cycle of dependency. Over time, as tolerance builds, people often feel they need higher doses for the same relief. This increases the risk of benzodiazepine addiction, especially if you’re taking Xanax without medical supervision.

Q: How can Xanax withdrawal be managed safely?

A: Xanax withdrawal should always be managed under medical supervision. Gradual tapering, as directed by a healthcare provider, reduces the risk of severe symptoms like seizures, panic attacks, or insomnia. Detox programs also offer safe and effective support.

Q: What are the risks of mixing Xanax with alcohol?

A: Mixing Xanax with alcohol can severely depress the central nervous system, leading to slowed breathing, impaired coordination, and increased risk of overdose. This combination is extremely dangerous and should always be avoided.

Q: What are the withdrawal symptoms of alprazolam?

A: Xanax withdrawal symptoms can range from mild to severe and may include:

  • Anxiety and panic attacks
  • Insomnia and sleep disturbances
  • Tremors and muscle twitching
  • Sweating and hot flashes
  • Nausea and vomiting
  • Headaches
  • Difficulty concentrating
  • Memory problems
  • Seizures (in severe cases)
  • Depression and mood changes
  • Sensitivity to light and sound

Withdrawal symptoms can last from a few weeks to more than 12 months, depending on factors like dosage and length of use.

Q: Is Xanax more addictive than Zoloft?

A: Yes, Xanax is significantly more addictive than Zoloft.10 Xanax belongs to the benzodiazepine class and produces immediate calming effects, making it highly habit-forming. Zoloft is an antidepressant (SSRI) that works gradually over several weeks and has a much lower addiction potential. While some people may experience withdrawal symptoms when stopping Zoloft, it doesn’t create the same physical dependence and craving patterns as Xanax.

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How Long Does Xanax Stay in Your System? Your Guide to Test Detection

When the anxiety-calming effects of Xanax wear off, you might assume the drug has left your system—but testing tells a different story. Xanax (alprazolam) can be detected in your body even if you no longer feel its effects. If you’re starting a new medication, preparing for a drug test, or concerned about interactions with other substances, it’s important to know how long Xanax stays in your system.

Detection times for Xanax can vary depending on a few factors. The type of drug test being used, your personal health, and your usage patterns all affect how long Xanax can be detected. While one person might clear Xanax from their system relatively quickly, another might test positive days later.

We’ll explore exactly how long Xanax is detectable via different testing methods, what affects these timeframes, and what you should know if you’re taking Xanax.

Infographic showing typical drug test detection windows for Xanax: Blood test for 1 to 3 days, saliva test for 1 to 3 days, urine test for 1 to 6 days, and hair test for up to 90 days. Note states detection may last longer for chronic or heavy users.

What Is Xanax?

Xanax is the brand name for alprazolam, a type of benzodiazepine. Doctors prescribe Xanax to treat anxiety disorders, panic disorders, and sometimes anxiety caused by depression. Like other benzodiazepines such as Valium (diazepam) and Klonopin (clonazepam), Xanax works by enhancing the calming effects of a naturally occurring brain chemical called gamma-aminobutyric acid (GABA).

When you take Xanax as prescribed, it can effectively reduce feelings of nervousness, tension, and panic attacks. It comes in immediate-release tablets, extended-release tablets, and liquid form. The standard immediate-release Xanax starts working right away, usually within 15-30 minutes, which makes it helpful for managing sudden anxiety episodes.

However, Xanax is also classified as a Schedule IV controlled substance1 by the DEA. This classification exists because Xanax carries a risk for dependence and potential misuse. Your body can develop tolerance to Xanax over time, meaning you might need higher doses to achieve the same effects. This is why doctors typically prescribe Xanax for short-term use—usually no more than 2-4 weeks—to reduce the risk of dependence.

How Xanax Works in the Body

When you take Xanax, your digestive system absorbs the medication into your bloodstream. From there, it travels to your brain where it increases GABA activity, slowing down central nervous system functions2 and producing a calming effect. But what happens to the Xanax molecules after they’ve done their job?

Why does Xanax still show up on drug tests even after the effects of the substance wear off?

Xanax (alprazolam) is an anti-anxiety medication with a relatively short half-life when it comes to how you feel; its sedative effects typically wear off within 6-12 hours. Xanax can remain in your system and be detectable for days or even weeks after the calming effects fade. The body continues to metabolize the drug long after you feel ‘normal’ again. This disconnect often surprises people, but feeling back to normal doesn’t necessarily mean the drug is completely gone.

How the Body Metabolizes Xanax

Your liver does most of the work to process Xanax. Through a process called metabolism, your liver breaks down Xanax into several metabolites3—mainly alpha-hydroxyalprazolam. These metabolites eventually leave your body through urine. This entire process, from the moment Xanax enters your body until it exits, is what determines the amount of time it stays in your system.

We know certain medications can significantly affect how quickly someone metabolizes Xanax. What common drug interactions do you find yourself warning patients about most frequently, especially those that might unexpectedly extend detection times?

There are many medications that can cause Xanax to have stronger, longer-lasting effects on the body. It is important to check with your provider (prescriber or pharmacist) about any interactions you should be aware of. Some of the most common medications that can extend the time of Xanax in the body are fluoxetine (brand name Prozac), fluvoxamine (brand name Luvox), and oral contraceptives. Some less frequently used medications that have a significant effect on Xanax are ketoconazole, itraconazole, and erythromycin.
Zachary Reale, PharmD
Zachary Reale, PharmD Choosing Therapy

Xanax Half-Life

An important concept to understand is “half-life,” which refers to the time it takes for your body to eliminate half of the drug from your bloodstream. Xanax has an average half-life of about 11-12 hours4 in healthy adults. This means that 11-12 hours after taking Xanax, roughly half of the drug remains in your system. After another 11-12 hours, half of that remaining amount (or 25% of the original dose) is left, and so on.

Illustration of factors that affect how long Xanax stays in the body, including metabolism speed, age, liver function, dosage and frequency, body fat, and use of other medications, shown alongside a human figure marked with the word XANAX.

Detection Windows for Different Drug Tests

Different drug tests can detect Xanax for different lengths of time after your last dose. 

Urine Tests

Urine testing is the most commonly used method to detect Xanax.5 For most people who take Xanax occasionally, it can show up in a urine test for about 1-4 days after the last dose. However, if you’ve been taking Xanax regularly for an extended period, it might be detectable for up to a week or even longer.

When Xanax shows up on a urine test, what the test actually detects are metabolites—the breakdown products of alprazolam. These metabolites have chemical structures that standard drug panels can identify as benzodiazepines. Some tests specifically look for alprazolam metabolites, while others detect a wider range of benzodiazepines.

Blood Tests

Blood tests offer a shorter detection window for Xanax compared to urine tests. Xanax is detectable in blood for about 1-3 days6 after the last dose. Blood testing is less common for routine drug screening but might be used in certain medical or legal situations.

Blood tests aren’t as easy to administer as urine tests, but they provide a more accurate measure of how much Xanax is actively in your system at the time of testing. This makes blood tests useful in emergency situations where doctors need to know exactly what substances are affecting a patient.

Saliva Tests

Saliva tests can detect Xanax7 for approximately 1-2 days after use. These tests are becoming more popular because they’re less invasive and harder to tamper with than urine tests. Collecting a saliva sample is as simple as swabbing the inside of your cheek.

Many people don’t realize that regular Xanax use can build up in body tissues over time. How do you explain this accumulation effect to people who might be concerned about upcoming drug tests or who want to discontinue their medication?

Xanax can build up in your body over time, especially if you take it regularly. It tends to accumulate in fat tissues, which means it can persist longer than people expect, even after stopping the medication. This is why it may still show up on a drug test days or even weeks later. If you’re thinking about stopping or have concerns about testing, it’s important to talk with your doctor so you can come off the medication safely and understand what to expect.
Janelle Salo, RN
Janelle Salo, RN Healthy Earth Living

Hair Tests

Hair testing has the longest detection window of all test types. Benzodiazepines can be detected in hair for up to 4 weeks,8 or even longer in some cases. Hair tests work by detecting drug metabolites that enter your bloodstream and then get absorbed into your hair follicles.

Hair tests can detect benzo use over a longer period, but they’re less common for Xanax testing specifically. They’re also less useful for detecting very recent benzo use, as it takes time for the metabolites to appear in hair.

False Positives

It’s worth noting that some substances can trigger false positives for benzodiazepines9 like Xanax on drug tests. These include certain antibiotics, antidepressants, and even some over-the-counter medications like Benadryl (diphenhydramine). If you believe a test has produced a false positive result, you can request confirmation testing, which uses more precise methods to identify specific substances.

Infographic listing safe, natural ways to help the body process Xanax: stay hydrated, exercise regularly, eat liver-friendly foods, avoid alcohol and other substances, get enough sleep, and consult a doctor about drug interactions. A woman is shown holding a large funnel filled with Xanax pills.

What Factors Affect How Long Xanax Stays in Your System?

Detection times can vary from person to person because of a few factors that influence how long Xanax stays in your system. 

Age and Metabolism

As we age, our metabolism naturally slows down. Older adults often process Xanax more slowly10 than younger people. This means the drug stays in their systems longer and may be detectable for extended periods.

Your metabolic rate—how quickly your body processes substances—also plays a major role. People with faster metabolisms tend to eliminate Xanax more quickly than those with slower metabolisms.

Liver Function

Since your liver is primarily responsible for breaking down benzodiazepines, liver health directly impacts how long Xanax stays in your system.11 People with liver diseases like cirrhosis or hepatitis may take much longer to process and eliminate Xanax. In some cases, doctors might even adjust dosages for patients with liver problems.

Dosage and Frequency of Use

Among the key factors affecting how long Xanax stays in your system, how much and how often you take it are especially important. Your body takes longer to process larger doses. And if you’ve been taking Xanax regularly for weeks or months, it builds up in your system, which takes longer for your body to clear than if you’ve only taken it once or twice.

When you use Xanax regularly, it collects in your body’s fat tissues,12 creating storage that takes longer to leave your body completely. This effect is especially pronounced for people who take high doses over long periods of time.

Body Composition

Your body mass index (BMI) and fat percentage also affect how long Xanax stays in your system. Xanax is lipophilic,13 meaning it can be stored in fat cells. People with higher body fat percentages may end up storing alprazolam in their systems for longer than those with less body fat.

Other Medications

Some medications can affect how quickly you process Xanax.14 For example, certain antifungal medications and antibiotics can impede enzymes in your liver that break down Xanax, causing it to stay in your system longer. On the other hand, some medications might induce these enzymes, making your body clear Xanax faster.

Duration of Xanax Effects vs. Detection Time

Many people don’t realize that Xanax stays in their body long after they stop feeling its effects. This is why you might feel completely normal but still test positive on a drug test.

For regular Xanax tablets, the calming effects typically last up to 6 hours before wearing off. Extended-release Xanax (Xanax XR)15 works more gradually, with effects lasting up to 12 hours. But in both cases, the drug remains in your system much longer than you can feel it.

You need a certain concentration of Xanax in your bloodstream to feel its anxiety-reducing effects. When levels drop below that threshold, the effects wear off. But the drug is still there at lower levels until your body completely processes it, which takes several days. During this time, drug tests can still detect Xanax even though you no longer feel its effects.

Safely Stopping Xanax Use

Never stop taking Xanax suddenly if you’ve been using it regularly. Abruptly stopping can trigger withdrawal symptoms16 that range from uncomfortable to dangerous, including intense cravings, rebound anxiety (which can be worse than your original anxiety), insomnia, irritability, muscle tension, and potentially seizures.

Medical professionals recommend a gradual tapering schedule under supervision. Your prescribing doctor or a qualified treatment professional will create a personalized plan for your specific situation.

Always seek medical guidance for stopping Xanax—even if you’ve been taking it without a prescription or at higher doses than prescribed. Healthcare providers can safely manage your tapering process, adjust your plan if needed, and recommend treatments to ease your withdrawal symptoms.

Finding Support for Xanax Dependence

Knowing how long Xanax stays in your system is just one piece of a larger puzzle. If you’ve found yourself taking Xanax more frequently than prescribed, needing higher doses to get the same effect, or experiencing withdrawal symptoms when you try to stop, these may be signs of physical dependence.

Xanax dependence17 is a medical condition that requires proper detox and addiction treatment—not willpower alone. The good news is that effective, compassionate treatment options exist. With the right support, people can and do recover from benzodiazepine dependence every day.

Treatment for Xanax addiction typically involves a medically supervised tapering process combined with therapy to address any underlying anxiety or mental health concerns. This comprehensive approach helps not just with safely stopping Xanax, but also developing healthy coping strategies to avoid becoming addicted in the future.

If Xanax abuse has become a problem for you or someone you care about, effective treatment is available. Recovery.com can connect you with specialized centers experienced in benzodiazepine dependence treatment. Take the first step toward recovery by exploring treatment programs that match your specific needs and speaking with an admissions specialist today.

FAQs

Q: How is alprazolam cleared from the body? 

A: Alprazolam is primarily metabolized by the liver, which converts it into several metabolites. These metabolites are then eliminated through urine.

Q: How long is .25 mg of Xanax effective? 

A: A 0.25 mg dose of Xanax typically produces therapeutic effects for about 4 hours. However, individual responses vary based on metabolism, body composition, and other prescription drugs you might be taking.

Q: How long after taking Xanax can it be detected in a blood test? 

A: Xanax is usually detectable in blood tests for 1-3 days after you used Xanax last. However, this window may be longer for people who use Xanax regularly or have certain health conditions that slow metabolism.

Q: How does Xanax show up on a urine test? 

A: Xanax appears on urine tests as benzodiazepines or specifically as alprazolam metabolites, depending on the test. Standard drug use panels typically detect these substances for 3-4 days after last use, though this can be longer with regular use.

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Xanax and Alcohol: 5 Critical Risks of Mixing These Substances

Mixing Xanax and alcohol is more common than you might think—and that’s concerning because this combination carries some serious risks. Both substances affect your brain in similar ways, and when they’re taken together, they can amplify each other’s effects to a potentially life-threatening degree. 

Most people don’t realize that having “just a few drinks” while taking Xanax can harm their health.

Some people mix these substances on purpose; others don’t fully understand their risks. Either way, the combination can cause lasting damage to your physical and mental health.

We’ll help you understand how Xanax and alcohol affect your body, why the combination is so risky, and how to get help if you’re concerned that you or your loved one is becoming dependent.

Illustration warning about the dangers of mixing Xanax and alcohol. A prescription bottle and liquor bottle pour into a bubbling beaker, symbolizing a dangerous chemical reaction. Text reads: Xanax and alcohol don’t just mix—they multiply. Even small, combined doses can be life-threatening. Recovery.com branding appears in the corner.

What Happens When You Mix Alcohol and Xanax?

When you mix Xanax (the brand name for alprazolam) and alcohol, you’re combining two substances that both slow down your central nervous system. Xanax works by boosting the effects of GABA1 (Gamma-aminobutyric Acid), a natural neurotransmitter that reduces brain activity. Alcohol affects many of the same brain systems, also increasing GABA’s effects while blocking other brain chemicals.

This creates what behavioral health experts call a synergistic effect. This means that when combined, Xanax and alcohol don’t just add their effects together—they multiply them. This is why the combination is especially dangerous.

Why do people mix Xanax and alcohol?

People mix Xanax (alprazolam) and alcohol primarily for enhanced sedative effects, as both substances depress the central nervous system which can lead to increased relaxation, euphoria, or intoxication. Some individuals may do this intentionally to heighten the effects, while others may mix them unintentionally, not realizing how dangerous the combination can be.  It is important to ask what intention the person had when mixing the substances or if it was consumed unintentionally.

Andrew J. Schreier, ICS, CSAC, LPC, ICGC-II, BACC

Infographic titled, What Happens When You Mix Xanax and Alcohol, showing five risks: enhanced sedation, impaired judgment, memory blackouts, slowed breathing, and increased overdose risk. Visual icons accompany each effect, with illustrations of a prescription bottle and alcohol bottle on the right. Recovery.com logo appears in the bottom left.

1. Enhanced Sedation

Both Xanax and alcohol are central nervous system depressants2 that cause sedation on their own. When combined, this sedative effect becomes much stronger.

You might feel extremely drowsy, dizzy, or uncoordinated. Tasks that require alertness, like driving or using machinery, become highly dangerous. Even just walking around normally is more dangerous, as you’re more likely to fall and hurt yourself.

2. Life-Threatening Breathing Problems

One of the most life-threatening side effects of mixing Xanax and alcohol is respiratory depression—when your breathing becomes dangerously slow or shallow. Both substances suppress the part of your brain that controls breathing.

Together, they can slow your breathing to the point where your body doesn’t get enough oxygen, potentially leading to brain damage, coma, or death.

When combined, Xanax and alcohol suppress your autonomic respiratory drive.3 That means they interfere with the brain stem’s ability to detect carbon dioxide in your blood—the primary trigger that tells your body to breathe. Without this signal functioning properly, your breathing can slow or even stop completely without even feeling like you’re having trouble breathing.

3. Increased Overdose Risk

This combination increases your risk of overdose. Even amounts of each substance that would be safe individually can become deadly when combined. In fact, one report finds Alprazolam (Xanax) is even more toxic than other benzodiazepines in overdose,4 warning that “severe toxicity is often related to co-ingestants, especially alcohol.”

This is particularly dangerous because the effects of alcohol and Xanax can be unpredictable—what might seem like a small amount of alcohol can dramatically increase the effects of Xanax in your system.

Maybe you’ve taken your normal prescribed dose of Xanax with a moderate amount of alcohol before without serious consequences. But taking higher doses, changes in your physical condition, timing between doses, or even what you’ve eaten that day can suddenly make the same amounts deadly.

4. Memory Impairment and Blackouts

Both Xanax and alcohol affect your memory. Used together, they can cause severe memory problems. You might find yourself having more blackouts or periods of time you can’t remember at all.

One participant in a study on benzo use by young people in the UK5 reflects on his experience with frequent blackouts: 

I don’t know how many memories or experiences I have lost due to my benzo use back then, but they are parts of my life that I will never be able to get back.

These memory gaps can be frightening—and potentially dangerous—if you made decisions or took actions you can’t recall.

What are the risks of combining alcohol and Xanax?

In your brain, alcohol increases the release of the neurotransmitter GABA, which produces slower brain activity that you perceive initially as relaxation. But both alcohol and Xanax also enhance the effect of the GABA-A receptor, making the increased GABA levels much more potent. This creates a particularly dangerous situation since a dose of either Xanax or alcohol that might be “safe” on its own can combine in the brain in dramatically more powerful and unpredictable ways. They also have synergistic effects on muscle control, short-term memory, judgment, and breathing- meaning that alcohol and Xanax are incredibly dangerous and potentially fatal when combined.

W. Lee Warren, MD

Infographic showing the health impact of Xanax and alcohol individually and when combined. One Xanax leads to moderate sedation, and one alcoholic drink causes a mild buzz. Together, they result in severe health risks. A skull and crossbones image emphasizes the danger. The graphic is titled Xanax and Alcohol Dose Comparison, with a subtitle stating they are safe on their own but dangerous when combined. Recovery.com logo is visible at the bottom.

5. Behavioral Changes

Over time, the combination of substances can cause noticeable changes in how you feel and act. You might become more aggressive, emotional, or take risks you normally wouldn’t. Severely impaired judgment can lead you to make poor decisions with lasting consequences. While most people start taking Xanax for anxiety or panic disorders, abusing Xanax can make you feel more anxious or agitated rather than calmer.

Why Do People Mix Xanax and Alcohol?

People mix Xanax and alcohol for several reasons, often without realizing how serious the risks are.

  • Seeking Stronger Effects: Some people combine these substances intentionally to feel a stronger effect. Since both Xanax and alcohol reduce anxiety and make you feel relaxed, some people think taking them together will increase these pleasant feelings. They might be seeking deeper relaxation or trying to escape stress, anxiety, or other emotional discomfort.
  • Self-Medication: Someone whose prescribed Xanax isn’t fully controlling their anxiety disorder might drink alcohol for additional relief. This often happens when anxiety breaks through between doses6 or when someone has developed tolerance to their medication.

For more information on how substances can interact with each other and affect your body’s response to medication, see our article on cross-tolerance. Understanding this concept is especially important if you take Xanax or other prescription drugs.

  • Unintentional Mixing: Many people mix these substances unintentionally. Someone might take their prescribed Xanax and later attend a social event where they have a drink, not realizing the interaction they’re creating. Others might simply not know about the risks or might think that “just one drink” won’t cause problems.
  • Social Pressure: Social pressure can play a role too. In settings where drinking is expected, someone who takes Xanax might feel awkward explaining why they can’t drink, especially if they don’t want to discuss their mental health.

Regardless of the reason, mixing Xanax and alcohol is never safe, even in small amounts—the risks far outweigh any perceived benefits.

How Long After Taking Xanax Can You Drink?

If you’re taking Xanax, you might wonder if there’s a safe time to wait before having alcohol. The short answer is that there’s no truly safe window—the risks remain even after you think the Xanax has worn off.

Xanax has what medical professionals call a half-life, which is how long it takes for half of the drug to leave your system. For Xanax, the average half-life is about 11 hours,7 but this can range from 6 to 27 hours depending on several factors.

This means that even if you took Xanax in the morning, a significant amount could still be in your body when you have a drink that evening.

A few factors affect how long Xanax stays in your system:

  • Your age (older adults eliminate the drug more slowly)
  • Your liver function (liver problems can slow down elimination)
  • Your weight and metabolism
  • Whether you’re taking other medications that interact with Xanax
  • How long you’ve been taking Xanax (regular users may metabolize it differently)

Even if you can’t feel the long-term effects of Xanax, the drug is still in your body and can still interact with alcohol. Just because you don’t feel sedated from a dose you took earlier doesn’t mean it’s safe to drink.

If you’re taking Xanax, it’s best to avoid alcohol completely. If you’re concerned about interactions, talk to your healthcare provider about your specific situation.

How do you treat alcohol and Xanax addiction?

Xanax and alcohol use can lead to psychological and physiological dependence after long-term use. If a person is thinking about quitting Xanax or alcohol after prolonged use, it is crucial for them to consider the need for medically monitored withdrawal management, as these are two substances that can lead to death as a result of withdrawal. It’s important to assess the history of withdrawal, the intensity of those experiences, and the need for current medical support. Post-withdrawal management placement criteria should be performed to assess the level of care a person may need to move forward with their recovery goals. Outpatient and residential treatment, individual therapy, and self-help groups are all appropriate levels of care for people who struggle with Xanax and alcohol addiction.

Tanya Kraege LCSW, CSAC, CCAR RC, WI CPS | Ventus Rex

Do You Need Medical Detox for Alcohol and Xanax?

If you’ve been using both Xanax and alcohol regularly, especially in combination, you should not try to quit on your own. Withdrawal from either substance can be dangerous, but withdrawing from both at the same time can be life-threatening.

Withdrawal symptoms from Xanax8 and alcohol can include:

  • Seizures
  • Hallucinations
  • Severe anxiety and panic
  • Dangerous changes in blood pressure and heart rate
  • Delirium tremens (DTs),9 a severe (and potentially deadly) symptom of alcohol withdrawal

Professionally supervised detox is a safe environment where healthcare specialists can monitor your health and help you manage withdrawals. In a medical detox program, your doctor may give you medications to ease withdrawal symptoms and prevent complications.

Detox typically lasts 5-7 days but can take longer depending on your history of use. During this time, your medical team will gradually taper your dosage to minimize symptoms as your body adjusts to functioning without these substances.

After detox, it’s important to continue with a comprehensive treatment program to address your underlying reasons for substance use and learn strategies for long-term recovery.

Treatment Options for Alcohol and Xanax Addiction

Recovery from Xanax and alcohol addiction involves several phases of treatment: 

Medication-Assisted Treatment

Some medications can help manage cravings and support recovery. While there are no specific medications approved for benzodiazepine addiction, certain medications may help with anxiety symptoms or co-occurring conditions.

If you’re curious about medication options that can help with recovery from substance abuse, see our article on medication-assisted treatment (MAT) to learn if this approach might be right for you.

Inpatient Rehab

In inpatient Xanax and alcohol rehab, you live onsite and receive round-the-clock care in a structured, substance-free environment. Residential rehab typically lasts 30 to 90 days and includes:

  • Evidence-based and holistic therapies
  • Addiction education and recovery coaching
  • Learning and practicing healthy coping skills
  • Treatment for co-occurring mental health conditions

Outpatient Programs

For those with less severe substance use disorders or who have completed inpatient treatment, outpatient programs allow you to live at home while attending treatment sessions several times a week. These programs offer similar therapies to inpatient care but with more flexibility.

Support Groups and Aftercare

Long-term recovery often involves ongoing support through:

  • Ongoing one-on-one therapy 
  • Alumni programs through your treatment center
  • Meeting regularly with sober community via AA, SMART Recovery, or other support groups
  • Building your social support network

The best treatment plans are individualized and created specifically for you and your unique situation. They don’t just focus on helping you stop using substances—they also address any underlying trauma or mental health concerns that might have led you to use them in the first place. Everyone’s journey to well-being looks different, and finding the right combination of support is the key to long-term success.

Ready to find help for Xanax and alcohol use disorder? Our treatment finder can show you rehab options that match your location and specific needs—just a few clicks can connect you with centers that can help.

FAQs

Q: What happens when you mix alcohol and anxiety medication?

A: When you combine alcohol with anxiety medications like Xanax, you significantly increase the sedative effects of both substances. This can lead to extreme drowsiness, breathing problems, memory impairment, and increase your risk of overdose. The combination affects brain function more severely than either substance alone and can be life-threatening even “moderate” amounts.

Q: Do people go to rehab for Xanax?

A: Yes, many people go to rehab specifically for Xanax addiction. Benzodiazepine addiction is a serious condition that often requires professional help to overcome safely. Because Xanax withdrawal can be dangerous, addiction specialists typically recommend medically supervised detox, followed by comprehensive addiction treatment that addresses both physical dependence and underlying causes.

Q: Can you drink on Xanax if you wait long enough?

A: There is no completely safe time frame for drinking after taking Xanax. Even if you wait 24 hours or longer, residual amounts of the drug may remain in your system. Individual factors like age, liver function, and metabolism affect how long Xanax stays in your body. The safest approach is to avoid alcohol completely while taking Xanax.

Q: What are the main risks of combining Xanax and alcohol?

A: The main risks include respiratory depression (dangerously slow breathing), enhanced sedation, memory blackouts, impaired coordination, behavioral changes, increased addiction risk, and increased risk of fatal overdose. This dangerous combination creates unpredictable effects that can vary significantly from one person to another.

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Prescription Drugs Misuse and Addiction

Prescription drugs are powerful tools in modern medicine, offering relief and healing for a wide range of conditions; however, when misused, these medications can lead to serious consequences, including addiction. 

By understanding the signs, treatment options, and proactive prevention measures, we can work together to promote safe use and support recovery for those affected.

If someone is overdosing, call 911 or your local emergency services number immediately. If you are qualified, administer CPR. Use Naloxone (Narcan) if available.

What Are Prescription Drugs?

Prescription drugs are medications that healthcare providers prescribe to treat specific health conditions. Unlike over-the-counter (OTC) medications available for purchase, prescription drugs are carefully selected and dosed by a medical professional to address unique health needs. 

Prescription drugs can range from antibiotics that fight infections to pain relievers for managing discomfort to medications that help control conditions like diabetes, anxiety, or high blood pressure. When used as prescribed, prescription drugs can significantly improve quality of life, but they must be taken correctly to ensure safety and effectiveness.

What Does It Mean to Misuse Prescription Drugs?

Someone may use prescription drugs in a way that isn’t aligned with a healthcare provider’s instructions—this could look like taking higher doses than prescribed, using the drug more frequently, or taking it for reasons other than intended, such as using a pain reliever to achieve a “high” rather than to manage physical pain. Some may even use someone else’s prescription, believing it will help with issues like studying or dealing with stress. 

Using prescription drugs outside their intended purpose can alter the body and brain’s functioning, leading to physical dependence, health risks, and addiction. 

Types of Commonly Misused Prescription Drugs

While prescription drugs are intended to support health, certain types are more prone to misuse and addiction due to their effects on the body and mind. 

Opioids

Opioids are powerful pain relievers, such as oxycodone, hydrocodone, morphine, and fentanyl. They are typically prescribed to manage severe pain, especially after surgery or for chronic pain conditions like cancer. When used as directed, opioids can provide relief by blocking pain signals to the brain.

Opioids affect the brain’s reward system, causing euphoria—factoring into their potential for misuse1. When misused—either by taking higher doses, using them more frequently, or combining them with other substances—opioid use can lead to dangerous consequences. Tolerance builds, meaning users may need more of the drug to achieve the same effect, leading to a cycle that ends in addiction. Opioid use also increases the risk of overdose, which can be fatal2, necessitating detoxing with professional medical care.

Benzodiazepines

Benzodiazepines, or “benzos,” are a type of sedative prescribed for anxiety, panic disorders, and sleep disorders. Medications like diazepam, alprazolam, and lorazepam calm the nervous system3, providing short-term anxiety and stress relief.

Similar to opioid misuse, benzodiazepine misuse can quickly lead to tolerance and dependence by increasing dopamine and GABA neurotransmitter release4, triggering the brain’s reward system. Long-term use may cause memory impairment, mood swings, and coordination issues. 

Benzodiazepine detox requires tapering and medical care, as abrupt cessation is extremely dangerous.

Stimulants

Stimulants, including medications like amphetamines (Adderall) and methylphenidate, are prescribed for attention-deficit hyperactivity disorder (ADHD) and certain sleep disorders like narcolepsy. These drugs enhance the release of dopamine, which can improve focus and concentration5.

When misused, someone may take higher doses of stimulants to increase energy and focus—which is commonly seen in academic or high-stress environments in an attempt to enhance performance. 

However, stimulant misuse can lead to serious side effects, such as increased heart rate, high blood pressure, paranoia, and even psychosis5. Over time, misuse may also result in dependency, as the brain relies on the increased dopamine levels for motivation and focus.

How Do People Misuse Prescription Drugs?

Taking medication differently from how it was prescribed leads to misuse:

  • Taking Higher Doses: Someone may take more than the recommended dose for enhanced effects, like stronger pain relief or a more intense sedative or stimulant effect. 
  • Using Them More Frequently Than Prescribed: Even if the dose is correct, taking medication more often than prescribed can lead to tolerance and dependence. For example, unnecessarily taking a pain reliever can reduce its effectiveness over time, leading to a cycle where the person feels they need even more of the drug.
  • Taking Someone Else’s Prescription: Prescription drugs are tailored to individual health needs, so using someone else’s medication can be risky. A medication that helps one person might have dangerous side effects for another.
  • Ingesting Them Differently Than Prescribed: To enhance drug effects, people may snort or inject prescription drugs to enter the bloodstream quickly. This behavior heightens the risk of addiction, overdoses, and severe physical damage, such as respiratory problems or infections.
  • Combining Them With Other Substances: Mixing prescription drugs with alcohol, over-the-counter medications, or illicit drugs can amplify side effects and lead to dangerous reactions. For example, someone may combine benzodiazepines with alcohol for a stronger effect; however, this severely slows the respiratory system, increasing the chance of negative health effects. Refer to your doctor for what you should avoid when taking prescription drugs.

All of these practices increase the risk of overdose, addiction, and adverse health effects. Taking medication strictly as prescribed and staying informed about its effects can help avoid these adverse reactions.

Signs and Symptoms of Misuse and Addiction

Wellness Resource Center describes the physical symptoms6 of those misusing sedatives like opioids or benzodiazepines, including drowsiness, confusion, or slowed breathing. For stimulant misuse, symptoms look like increased energy, rapid speech, reduced appetite, dilated pupils, and heightened blood pressure. 

Behavioral changes can be equally telling, including erratic behavior, social withdrawal, or unexplained financial troubles as the person attempts to obtain more medication. Drug use and addiction significantly impact an individual’s emotional and psychological state, causing heightened anxiety, irritability, mood swings, or depression. 

Addicted individuals may prioritize obtaining and using the drug over their responsibilities, relationships, and personal well-being. Developing a tolerance, needing increasingly higher doses to achieve the desired effect, and experiencing withdrawal symptoms like nausea or agitation also signal dependence. 

Prescription Drugs Misuse and Addiction Statistics

Prescription drug misuse is a significant concern in the United States. In 2021, approximately 14.3 million individuals ages 12+ reported misusing prescription psychotherapeutic drugs7 within the past year. Breaking this down, about 8.7 million people misused prescription pain relievers, 4.9 million misused tranquilizers or sedatives, and 3.7 million misused stimulants. Additionally, an estimated 5 million individuals had a prescription opioid use disorder during the same period. 

Alarmingly, there were approximately 16,706 overdose deaths involving prescription opioids, underscoring the critical need for effective prevention and treatment strategies.

Why Do People Get Addicted to Prescription Drugs?

Addiction is complex—while these medications are often prescribed with the best intentions, their misuse can lead to physical dependence and addiction. This happens not only because of their chemical effects on the brain but also due to psychological, societal, and environmental factors. 

Psychological Factors

Mental health disorders, such as anxiety, depression, and trauma, can be significant risk factors for prescription drug addiction. People struggling with mental health challenges may turn to prescription drugs as a form of self-medication to alleviate their emotional pain or manage symptoms. 

For example, someone with anxiety may misuse benzodiazepines to feel calmer, while a person with chronic depression might misuse stimulants for a temporary sense of energy or motivation. Over time, this reliance can create a cycle of misuse, tolerance, and dependence as the underlying mental health condition remains untreated.

Societal Influences

Societal pressures can play a powerful role in prescription drug addiction. Peer pressure could encourage the misuse of stimulants like Adderall to enhance academic performance or opioids to achieve a euphoric effect. 

Social media and film can further glamorize prescription drug misuse by showcasing it as a trend or coping mechanism. These societal influences can make it difficult to resist experimenting with prescription drugs, even when they understand the potential dangers.

Accessibility and Availability of Prescriptions

Many people have unused medications in their homes, making it easier for others to obtain them without a prescription. Also, healthcare systems sometimes overprescribe certain medications, such as opioids or benzodiazepines, which can unintentionally create opportunities for misuse. So, easy access lowers the barriers for initial experimentation and increases the likelihood of repeated use.

Misunderstanding of the Risks Associated with These Medications

Often, people assume that medications prescribed by a doctor are inherently safe, even when taken in ways not intended. This can lead to downplaying the risks of increasing their dosage, sharing medications, or using them for recreational purposes. 

Treatment Options for Prescription Drug Addiction

Recovering from prescription drug addiction requires a well-rounded approach that addresses both physical and emotional challenges. Medical detox is often the first step, helping patients safely manage withdrawal symptoms under professional supervision. While detox is essential, it’s only the beginning, as lasting recovery requires addressing the root causes of addiction.

Medication-assisted treatment (MAT) is particularly effective for opioid or benzodiazepine addiction8, using medications like buprenorphine or naltrexone to ease cravings and withdrawal symptoms. When combined with counseling, MAT helps individuals focus on rebuilding their lives. Therapists play a key role in offering tools like cognitive behavioral therapy (CBT) to identify harmful patterns and develop healthier coping strategies.

For those with co-occurring mental health issues, dual diagnosis treatment is essential, addressing addiction and mental health conditions simultaneously to reduce relapse risk and improve overall well-being. Support groups like Narcotics Anonymous (NA) or SMART Recovery also provide community and accountability, offering encouragement from others with shared experiences. 

Preventing Prescription Drug Misuse

Preventing addiction requires proactive measures—from yourself, healthcare providers, and communities. Patient education from healthcare providers can explain proper medication use, risks of misuse, and the importance of not sharing prescriptions. Safe prescribing practices, such as using prescription drug monitoring programs and prescribing the lowest effective dose, can also reduce misuse.

At home, secure storage and proper disposal of medications help prevent unauthorized access. You can look up your local community take-back programs to find a safe way to dispose of unused drugs. 

Especially for influential adolescents and young adults, awareness campaigns in schools and communities can educate about the risks of misuse. And encouraging open communication in the family and peer groups can support responsible medication use, creating a strong foundation for prevention. Together, these measures create a comprehensive approach to reducing prescription drug abuse before it begins.

Find Treatment for Prescription Drug Misuse

View treatment centers for prescription drug misuse in your area to see reviews, methods of care, and accepted insurances. 

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Ativan vs. Xanax: Differences, Uses, and Risks

If you’re exploring options for anxiety treatment, you’ve likely heard of Ativan (lorazepam) and Xanax (alprazolam). These medications belong to a group called benzodiazepines, and while they’re similar in many ways, they each have unique characteristics that make them better suited for different situations.

While these medications are related and share many traits, each has its own distinct profile. Understanding the differences between Ativan and Xanax can help you have more productive conversations with your healthcare provider about which option might work best for you.

Both of these medications work with your brain’s natural calming system by enhancing the effects of GABA, a neurochemical that helps reduce anxiety. But they differ in important ways—including how quickly they kick in, how long their effects last, and what they’re typically used for.

Ativan vs. Xanax: Key Differences

Duration of Action

One of the main things that sets these medications apart is how long they stay active in your system. Ativan typically works for 6-8 hours,1 making it helpful for people who need steady anxiety relief throughout the day. Think of it like a slow-release capsule that provides consistent support over a longer period.

The effects of Xanax peak at around 1-2 hours2 and last for up to 6 hours. While this shorter duration means you might need to take it more often, it can be helpful for people who need quick relief from sudden anxiety or panic attacks and prefer not to have long-lasting effects.

Onset of Effects

These medications also differ in how quickly they start working. Xanax typically starts working within 15-30 minutes, making it especially effective for managing unexpected anxiety or panic attacks. It’s like having a rapid-response remedy ready when you need quick relief.

Ativan usually takes 30-60 minutes to kick in. While this slower onset might not be ideal for panic attacks, many people appreciate its more gradual approach. This gentler onset can mean less intense initial effects, which some people find more comfortable.

Approved Uses

Doctors prescribe these medications for slightly different purposes, based on how they work in the body and what they’re approved to treat.

Ativan is usually prescribed for:

  • Managing ongoing anxiety
  • Helping with anxiety before surgery
  • Treating severe seizures
  • Supporting sleep in some cases

Xanax is often prescribed for:

  • Managing different types of anxiety
  • Treating panic disorders
  • Helping with anxiety that occurs alongside depression

How Do Ativan and Xanax Work?

Both Ativan and Xanax work by boosting GABA’s effects in the brain. GABA is a brain chemical that reduces neural activity, helping to create a calming effect. However, these medications process through the body differently.

Xanax vs. Ativan effects in the Body

Ativan metabolizes directly into an inactive compound, while Xanax breaks down into several active metabolites3 before your body then eliminates them. This metabolic difference partly explains why Xanax may have more pronounced effects initially but can also cause more complicated withdrawal symptoms.

Side Effects of Ativan and Xanax

Common Side Effects

Both Ativan and Xanax’s side effects4 typically include:

  • Drowsiness or fatigue
  • Dizziness
  • Reduced coordination
  • Mild memory problems
  • Changes in appetite
  • Dry mouth

Most people experience mild side effects when they start taking anxiety medications. These usually improve as your body adjusts. If you’re concerned about any effects you’re experiencing, discuss these with your prescribing doctor.

Severe Side Effects

While less common, both medications can potentially cause more serious effects:

  • Severe confusion or disorientation
  • Significant memory problems
  • Mood changes
  • Trouble balancing
  • Breathing problems, particularly when combined with other substances

People commonly combine benzos with alcohol, either recreationally or to cope with anxiety. This dramatically increases the risk of adverse side effects, addiction, and overdose. Learn more in our article on mixing alcohol and other substances.

Differences in Side Effects 

While both medications share many similar effects, there are some differences in how people typically experience them:

Ativan often causes:

  • More pronounced sedation
  • Less intense rebound anxiety between doses
  • Fewer morning-after effects

Xanax typically involves:

  • More noticeable initial effects
  • More pronounced rebound anxiety between doses
  • Greater likelihood of morning grogginess if you take it at night

Risks of Dependency and Withdrawal

It’s important to have an open conversation about the risks associated with these medications. Both Ativan and Xanax can lead to physical dependence, even if you take them exactly as prescribed. This is simply a result of how these medications work in the brain.

Dependency Risks

When you take benzodiazepines regularly, your brain adjusts to their presence. Over time, you might notice that you need a higher dose to get the same calming effect—this is called tolerance. Some people may become dependent on benzos5 within just a few weeks, which is why healthcare providers typically prescribe these medications for short-term use or as needed.

If you’re experiencing any of the following, it could be a sign that you’re developing a dependency:

  • Feeling like you need anti-anxiety medication to get through normal situations
  • Experiencing increased anxiety about not having your medication available
  • Needing higher doses to get the same feeling of relief
  • Having trouble sleeping or feeling anxious if you miss a dose

Withdrawal Symptoms

If you’ve been taking Xanax or Ativan regularly, you should not stop taking it suddenly. Always work with your healthcare provider to create a safe tapering plan. Withdrawal symptoms can be uncomfortable—and potentially dangerous—if they’re not managed properly.

Common withdrawal experiences include:

  • Return of anxiety symptoms (often stronger than before)
  • Restlessness and irritability
  • Sleep problems
  • Muscle tension
  • Difficulty concentrating

Xanax’s shorter half-life6 means withdrawal symptoms might appear more quickly and feel more intense. Ativan’s longer-acting nature usually means a more gradual withdrawal experience.

Safe Usage Recommendations

Using these medications safely means taking them exactly as prescribed and avoiding alcohol and other sedating substances while taking them. That said, it’s also crucial to be honest with your healthcare provider about any other substances you’re using. Keep attending your regularly scheduled medication management appointments to monitor your progress. And of course, store your medications securely and never share your prescription with others.

Which Is Better: Ativan or Xanax?

When deciding between Ativan vs. Xanax for anxiety, there’s no one-size-fits-all answer. Think of these medications like different tools in a toolbox—each has its ideal use. Your prescriber will consider several factors to determine which might work better for you.

Factors to Consider

Type of Anxiety

Ativan might be your better option if you have persistent, daily anxiety that needs consistent management. If you deal with panic attacks or sudden anxiety spikes, Xanax could be more suitable.

Lifestyle Considerations

Which anxiety medication is best for you also depends on your:

  • Work schedule (including whether you operate machinery or drive frequently)
  • Daily responsibilities
  • Sleep patterns
  • Other medications you take

Personal Factors

Other factors can also affect your treatment plan:

  • Your medical history
  • Previous experiences with anti-anxiety medications
  • Your age and overall health
  • Personal preferences about medication scheduling

Doctor’s Recommendation

Your healthcare provider brings valuable expertise to this decision. They’ll consider:

  • Your specific symptoms and diagnosis
  • Other health conditions you might have
  • Potential interactions with other medications
  • Your treatment history
  • Your lifestyle and daily routine

Keep an open line of communication with your doctor about your concerns and preferences. This will help them make the best recommendation for your situation.

Alternatives to Ativan and Xanax

While benzodiazepines are helpful for a lot of people, they’re not the only option for managing anxiety. There are many effective alternatives, both in terms of other medications and non-medication approaches.

Non-Benzodiazepine Medications

Several other types of medications can help manage anxiety symptoms:

SSRIs and SNRIs

These medications (like Zoloft, Lexapro, or Effexor) work differently from benzodiazepines. Instead of providing immediate relief, they help regulate brain chemistry over time. They’re typically used to treat depression, but many people find them effective for long-term anxiety management without the risk of dependence.

Beta Blockers

These medications primarily help with the physical symptoms of anxiety, like racing heart and trembling. They’re usually used for specific situations like public speaking or performances.

Buspirone

This medication specifically treats anxiety without causing significant sedation or dependency.7 It works well for many people, though it typically takes a few weeks to feel the full effects.

Behavioral Therapies and Coping Strategies

Medication isn’t the only way to manage anxiety. Many people find these approaches helpful, either on their own or alongside medication:

Cognitive Behavioral Therapy (CBT) and Other Talk Therapies

CBT helps you understand and change thought patterns that contribute to anxiety. It’s like learning a new language—at first it takes conscious effort, but it becomes more natural with practice. Research shows CBT can be just as effective as medication for anxiety. According to the American Psychological Association, 

For anxiety disorders, cognitive-behavioral therapy, antidepressant medications and anti-anxiety medications have all been shown to be helpful. Research generally shows that psychotherapy is more effective than medications, and that adding medications does not significantly improve outcomes from psychotherapy alone.

Mindfulness and Meditation

Mindfulness is the practice of staying grounded in the present moment. Many people find this helps ease their anxiety, as the brain tends to get caught up in anxiety about the future. Significant scientific evidence supports this. A study of 187 adults seeking treatment for mood and anxiety disorders found that mindfulness helps reduce anxiety by reducing worry.8 Even a few minutes of daily mindfulness can make a noticeable difference in managing anxiety symptoms. 

Exercise and Lifestyle Changes

Getting daily physical activity, maintaining good sleep hygiene, and learning techniques for managing stress can help lower your anxiety levels. Some people find that making these changes reduces or even completely eliminates their need for anxiety medication.

Getting Support

Remember, seeking help for anxiety is a sign of strength, not weakness. Whether you’re considering starting one of these medications, currently taking them, or looking for alternatives, your healthcare provider can discuss your options and create a treatment plan that’s personalized to your needs.

Working with your treatment team to find the right approach—whether that includes Ativan, Xanax, other medications, or non-medication alternatives—is an important step in managing anxiety and improving your quality of life. Don’t hesitate to ask questions and share your concerns as you work together to find the best solution for your specific situation.

If you’re looking for a strong start to your anxiety healing journey, anxiety treatment programs offer comprehensive treatment in an immersive, recovery-focused setting. Search for an anxiety treatment center that fits your needs and speak directly with an admissions specialist today.

Frequently Asked Questions About Ativan vs. Xanax

Can you take Ativan and Xanax together?

No, healthcare providers don’t prescribe these medications together because they work in very similar ways. Taking both could increase the risk of side effects without providing additional benefits.

How long can you safely use Ativan or Xanax?

Most healthcare providers recommend using benzodiazepines for short periods (a few weeks to months) or as needed for specific situations. Long-term use should be carefully monitored by your healthcare provider.

Are there non-addictive alternatives to benzodiazepines?

Yes, many alternatives exist, including SSRIs, SNRIs, buspirone, and various non-medication treatments like therapy and mindfulness practices. Work with your healthcare provider to find the best option for your situation.

What should I do if I want to stop taking Ativan or Xanax?

Always work with your healthcare provider to create a tapering plan. Never stop taking these medications suddenly, as this can lead to withdrawal symptoms that can range from uncomfortable to very dangerous.

Is it safe to drive while taking these medications?

Until you know how either medication affects you, avoid driving or operating machinery. Some people experience significant drowsiness or decreased coordination, especially when first starting the medication or after dose changes.

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What Does Xanax Do?

Xanax (alprazolam) is a widely prescribed medication for managing anxiety and panic disorders. It works by calming the brain and nervous system, providing relief from overwhelming fear, tension, and restlessness. While it’s effective in reducing symptoms of anxiety, it also carries significant risks, including addiction. Here’s what you need to know about how Xanax works, its uses, and the potential consequences of both short- and long-term use.

Understanding Xanax

To understand what Xanax does and why it’s effective, it helps to know how it interacts with your brain to ease anxiety and panic symptoms.

How It Works 

Xanax is part of a class of medications called benzodiazepines that work by enhancing the effects of gamma-aminobutyric acid (GABA), a naturally occurring chemical messenger in your brain. Think of GABA as your brain’s natural calming system: It helps regulate brain activity by reducing excitability in the nervous system. When you take Xanax, it amplifies this natural calming effect, which is especially helpful when anxiety or panic has kicked your brain into overdrive. Essentially, Xanax increases the effects of GABA1 to turn down the volume on excessive brain activity, making it easier to feel relaxed and in control.

Immediate Effects 

One reason Xanax is often prescribed for anxiety and panic disorders is its rapid onset of action. Most people start to feel its calming effects within 30-60 minutes of taking the medication. During this time, Xanax works to reduce common anxiety symptoms:2

  • Physical tension and restlessness that make it hard to sit still
  • Racing heart rate and chest tightness
  • Excessive sweating and trembling hands
  • Overwhelming feelings of worry or irrational fears
  • Racing thoughts that feel difficult to control

The quick-acting nature of Xanax makes it helpful for managing acute anxiety episodes or panic attacks, where the person experiencing symptoms needs rapid relief.

Uses of Xanax

Most people take Xanax for anxiety or panic disorders, though it has occasional off-label applications.

Anxiety Disorders

Xanax is most commonly prescribed for generalized anxiety disorder (GAD),3 a condition marked by more than just occasional stress or nervousness. People with GAD feel persistent worry that’s hard for them to control, which is often accompanied by physical symptoms like fatigue, irritability, and muscle tension that can significantly impact daily life. By working with the brain’s natural calming system, Xanax can provide relief from both the emotional overwhelm and physical discomfort of anxiety.

Panic Disorders

For people living with panic disorder, Xanax can be a key part of their treatment plan. Panic attacks often strike without warning, triggering intense physical and emotional symptoms4 that can feel terrifying:

  • Rapidly heartbeat
  • Chest discomfort or pain
  • Difficulty breathing or shortness of breath
  • Feeling lightheaded or dizzy
  • An intense sense of impending doom

During these episodes, Xanax’s quick-acting properties can help break the cycle of panic, allowing the person to regain their sense of control.

Off-Label Uses

Healthcare providers sometimes prescribe Xanax for conditions beyond its FDA-approved uses, a practice known as “off-label” prescribing. These might include:

  • Insomnia: When anxiety is preventing sleep, Xanax’s calming effects might help establish better sleep patterns.
  • Depression: In some cases, particularly when anxiety and depression occur together, a doctor might prescribe Xanax alongside antidepressants.
  • Social anxiety: Though not its primary use, some providers may prescribe Xanax for specific social situations.

Off-label use should always happen under close medical supervision, with clear communication about benefits and risks.

You should always use high addiction-risk medications like Xanax with careful guidance from a qualified medical professional. To learn more about who can prescribe benzos and what to look for in a provider, see our article on clinical staff qualifications.

Effects of Xanax

A closer look at Xanax’s effects—including the short-term benefits and the potential long-term changes that can occur with extended use—helps us understand how it affects the body and mind.

Short-Term Effects

When you take Xanax, you’ll likely notice its effects within an hour. Most people experience:

  • A sense of calm spreading through the body
  • Reduced muscle tension and physical restlessness
  • Relief from racing or intrusive thoughts
  • Mild drowsiness or feeling more relaxed than usual

While these effects can provide welcome relief from anxiety symptoms, they can also affect your ability to perform certain tasks. Do not drive or operate machinery until you understand how Xanax affects you personally. Some people also notice temporary changes in appetite or mild dizziness as their body adjusts to the medication.

Long-Term Effects

Using Xanax over an extended period can change how your body and brain respond to the medication:

Tolerance often develops first. This means your body gets used to the current dose and starts to need higher amounts to achieve the same calming effect. While this is a normal biological response, it’s important to discuss any changes in the medication’s effectiveness with your prescribing doctor rather than adjusting the dose yourself.

Physical dependence can develop even when you’re taking Xanax exactly as prescribed. This doesn’t necessarily mean you’re addicted; it simply means your body has adapted to the presence of the medication. However, this physical dependence does mean you’ll need medical supervision to safely stop taking Xanax when the time comes.

Some people notice subtle changes in their memory or concentration with long-term benzodiazepine use. One scientific review of 13 studies on the cognitive effects of benzodiazepine use5 found that “long-term benzodiazepine users were consistently more impaired” than people who didn’t take benzos. These effects often improve over time, after reducing or discontinuing use under medical guidance.

Risks of Xanax Use

While benzos provide relief that some people find very helpful in acute situations, understanding the risks of Xanax use—including side effects and the potential for dependence—helps to ensure you’re using it as safely as possible.

Dependency and Addiction

The calming properties that make this medication effective for anxiety are also what make Xanax habit-forming.6 As your brain adapts to taking Xanax regularly, physical dependence sets in. Here’s what that looks like: 

  • Needing higher doses for the same therapeutic effect
  • Experiencing uncomfortable symptoms when you miss a dose
  • Difficulty reducing or stopping the medication without support

One woman in recovery, Grace, talks about her struggle to quit taking Xanax7 after realizing she had become addicted: 

It’s honestly miserable. It’s definitely a mind game because I want nothing to do with this, yet in order to function and in order to get off of it I have to keep taking it.

Grace’s Xanax use started as many others’ have: with a standard prescription from her doctor. But Grace’s doctor didn’t sufficiently warn her about its risks. Unfortunately, Grace’s story is not uncommon. Many medical professionals don’t receive adequate training in addiction—which is why it’s important to educate yourself on the true ins and outs of benzos.

If you start to feel you can’t cope with stress or anxiety without Xanax, this could also be a sign that psychological dependence is taking hold. That’s why it’s essential to combine medication with other anxiety management strategies, like therapy and lifestyle changes.

Side Effects

Like all medications, Xanax can cause side effects that range from mild to more serious. Most common Xanax side effects are temporary and usually lessen as your body adjusts.

Common side effects tend to be mild and manageable. You might notice:

  • Feeling more tired than usual, especially when you first start taking it
  • Slight dizziness or unsteadiness on your feet
  • Changes in your appetite
  • Mild headaches
  • Feeling fuzzy-headed

While these effects are usually not cause for concern, keeping track of how you feel and sharing this information with your prescribing doctor helps them adjust your treatment plan if needed. 

More serious side effects require immediate medical attention. Watch for: 

  • Significant changes in mood
  • Unusual aggression or agitation
  • Severe confusion
  • Problems with memory and coordination

The risk of serious side effects increases significantly when you combine Xanax with alcohol or other sedating medications. That’s why it’s important to tell your healthcare provider about all substances you use, including over-the-counter medications and supplements.

Safely Using Xanax

Following Prescription Guidelines

Getting the most benefit from Xanax while minimizing risks requires careful attention to how you use it. 

Start with the lowest effective dose. This gives your healthcare provider room to adjust your dose as needed while minimizing side effects. Take the medication exactly as prescribed, even if you’re tempted to take an extra dose during extra-stressful times.

Attend all follow-up appointments with your healthcare provider. These check-ins are important for monitoring how well the medication is working and addressing any concerns early on in the process. Be honest about any side effects or changes you notice—this helps your provider to accurately guide your treatment plan.

Never share your prescription with others, even if they have similar symptoms. Xanax affects everyone differently, and what works for you could be dangerous for someone else.

When to Avoid Xanax

Some situations make Xanax use particularly risky:

Pregnancy and breastfeeding require special consideration—Xanax can affect fetal development and pass through breast milk. Always discuss family planning with your healthcare provider.

Mixing Xanax with alcohol significantly increases the risk of dangerous side effects. Even small amounts of alcohol can intensify Xanax’s effects on your nervous system.

If you have a history of substance use disorders, you might be at higher risk of developing patterns of problematic use. If this is the case, you may need to explore alternative treatments for anxiety.

How to Stop Using Xanax

Risks of Sudden Withdrawal

Never stop taking Xanax abruptly, as this can cause withdrawal symptoms that range from uncomfortable to dangerous:

  • Rebound anxiety8 that feels worse than before
  • Sleep disturbances and irritability
  • Physical symptoms like tremors or sweating
  • In severe cases, seizures or other serious complications

Tapering Off Safely

The key to safely discontinuing Xanax is working closely with a qualified medical professional who can create and oversee a personalized tapering plan. This typically involves:

  • Gradually reducing your dose over time
  • Regular check-ins to monitor your progress
  • Support for managing any withdrawal symptoms
  • Development of alternative anxiety management strategies

Treatment for Xanax Dependence

If you find yourself struggling with Xanax use, a range of treatment options are available:

  • Medical detox programs provide supervised support during the withdrawal process, ensuring your safety and comfort. These programs often combine medical care with counseling to address both physical and psychological aspects of dependence.
  • Addiction rehab programs, both inpatient and outpatient, offer comprehensive care that combines talk therapy, complementary therapies, and peer support to kickstart your healing process.  
  • Individual therapy helps you understand patterns around anxiety and medication use while developing healthier coping strategies. Many people find cognitive behavioral therapy (CBT) particularly helpful for managing anxiety without medication.
  • Support groups connect you with others who understand your experience. Whether in person or online, these communities provide an outlet to process what you’re going through and motivation for sticking with your recovery.

While Xanax can be helpful for severe anxiety in the short-term, longer-term use can lead to addiction. If you’re struggling to quit Xanax, there are plenty of options available to detox safely and learn alternative strategies for managing anxiety. Search for a benzo addiction treatment center to start your journey to a healthy, Xanax-free life. 

Frequently Asked Questions About Xanax

Can Xanax Be Used Long-Term?

Medical professionals do not recommend using Xanax long-term because of its risks of tolerance, dependence, and cognitive impairments. It’s safer to use Xanax short-term under medical supervision.

What Should I Do If I Miss a Dose?

If you miss a dose of Xanax, don’t double up on doses to make up for the missed one. Contact your prescribing doctor to learn how to manage this situation in accordance with your treatment plan.

How Can I Recognize Signs of Xanax Misuse?

Signs of Xanax misuse include:

  • Taking Xanax more often than indicated on your prescription
  • Taking higher doses than what you’re prescribed
  • Using Xanax without a prescription
  • Experiencing withdrawal symptoms between doses
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Benzodiazepine Misuse and Addiction: Symptoms, Risks, and Recovery

Benzodiazepines, commonly known as “benzos,” are prescription medications that help manage conditions like anxiety, panic disorders, and insomnia. While they can be very effective in treating symptoms temporarily, they carry a high risk for addiction and serious side effects—which makes it extra important to intervene early and prevent long-term harm. We explore the medical uses of benzodiazepines, their addiction risks, and the steps to recovery if you’ve become dependent.

Clinical Uses of Benzodiazepines

Managing Anxiety and Panic Disorders

Benzodiazepines are widely prescribed for short-term relief from anxiety and panic disorders. Medications like Xanax, Ativan, and Valium work quickly to calm overwhelming feelings of anxiety or panic by promoting relaxation. Unlike antidepressants which are taken regularly over a period of time, anxiety medications are usually prescribed to be used as needed.1 Because of their addictive potential, they’re generally intended for short-term use.

Treating Insomnia and Sleep Disorders

Benzos are also commonly used to treat insomnia and other sleep issues. Medications like Restoril (Temazepam) help people fall asleep faster, which can be a relief for those who struggle with chronic sleep problems. The quality of sleep, however, may not be the same. Family medicine doctor Eric Matheson explains in an article in the American Family Physician (AFP) Journal:

Beyond the immediate effects, chronic benzodiazepine use disrupts the quality of sleep2 by distorting sleep architecture and diminishing deep sleep time, which may account for the fact that persons who take long-term benzodiazepines report much greater fatigue than self-reported good sleepers.

As with anxiety treatments, the risk of dependency is real—especially if you start relying on these medications every night. That’s why, Matheson says, “Behavioral interventions are the mainstay of treatment for insomnia.” And, “if benzodiazepines are prescribed, they should be used for the shortest possible time3 at the lowest possible dose.”

Other Therapeutic Applications

Benzodiazepines are also used to manage a range of other conditions aside from anxiety and sleep disorders. For example, they can help control seizures, reduce muscle spasms, and ease symptoms of alcohol withdrawal. In these cases, benzos can be life-saving. But long-term use can still lead to tolerance and addiction if your treatment plan isn’t managed very carefully.

Neurochemical Effects of Benzodiazepines

Mechanism of Action in the Brain

Benzodiazepines work by enhancing the effect of a brain chemical called GABA. GABA’s role is to slow down brain activity,4 which is why benzos are so effective at reducing anxiety, calming panic attacks, and promoting sleep. They’re a sedative for the brain.

Impact on Neurotransmitter Systems

While the immediate effects are calming, long-term benzo use alters brain chemistry. Over time, the brain becomes dependent on benzodiazepines to maintain its normal function. This is how tolerance develops: you need higher doses to feel the same effects. This “rewiring” of the brain is what makes quitting any addictive substance so difficult without help.

Benzos, however, pose a particularly insidious risk. Researchers at the University of Colorado Anschutz “link benzo use to long-term neurological complications” in a syndrome they call BIND: benzodiazepine-induced neurological dysfunction.5 These complications include brain injury, job loss, and suicidal ideation. More than half of the 1,207 benzodiazepine users studied reported suicidal thoughts or attempted suicide. 

Side Effects of Benzodiazepines

Benzos have been hugely popular for decades because of their fast-acting calming effects. But a growing body of research points to some seriously concerning side effects. Pharmacology researchers warn that benzodiazepines’ “side effects and toxicity6 can result in morbidity and mortality for some patients,” and that “For any patient taking a [benzo], the prescribing physician must carefully evaluate the risks and benefits, and higher-risk patients require careful considerations.” 

Short-Term Effects

In the short term, side effects of benzos include drowsiness, dizziness, respiratory depression, and impaired coordination. These are why benzodiazepines come with warnings not to drive or operate heavy machinery. Other common side effects include confusion, blurry vision, and trouble concentrating.

Long-Term Effects

When used for extended periods, benzodiazepines have more serious effects.7 Long-term users often experience cognitive impairment, emotional numbness (also known as emotional blunting), and memory issues. Benzos slow down brain function, making it harder to think clearly, concentrate, and remember things. Over half of the participants in the CU Anschutz study reported symptoms lasting over a year: 

  • Low energy
  • Trouble focusing
  • Memory loss
  • Anxiety
  • Insomnia
  • Sensitivity to light and sounds
  • Digestive problems
  • Symptoms triggered by food and drink
  • Muscle weakness 
  • Body pain

“Particularly alarming,” the study adds, “these symptoms were often reported as new and distinct from the symptoms for which benzodiazepines were originally prescribed.” That is, the benzos themselves created conditions where none existed before.

Long-term benzo use can also have toxic side effects, including “impaired liver and/or kidney function”8 due to their accumulation in the body.

Memory Impairment and Cognitive Issues

Prolonged benzo use is linked to significant memory problems. Some people have difficulty forming new memories, and others may struggle with remembering things they once knew well. This is especially true for episodic memory, and even more so for people who drink heavily while taking benzos. Many people also find it harder to concentrate.

It’s possible to experience side effects of benzos even when taking them as prescribed.9 One study reports that “specific deficits in visuospatial ability and sustained attention have also been described in patients who have taken therapeutic doses of benzodiazepines regularly for longer than one year.” 

Emotional Blunting and Psychomotor Effects

Many people who take benzos long-term find that it numbs their emotions, making it harder to feel the range of feelings that colors human life—a term some behavioral scientists call “emotional anesthesia.” While feeling less emotion might sound like a relief for someone who often experiences them intensely, it also means they’re missing opportunities to learn healthy skills like processing and regulation. 

Interestingly, there is evidence that high-dose benzo use can increase depression:10 

Some evidence indicates that higher benzodiazepine dosages are associated with an increased risk of depression and that reducing the dosage or discontinuing therapy may resolve the depressive symptoms. 

Benzos also slow psychomotor functions, which affects physical coordination and reaction time.

Benzodiazepine Addiction and Misuse

Risk Factors for Addiction

Benzos generally pose a high addiction risk. According to the AFP Journal,

The risk of developing physical dependence to benzodiazepines is high; 15% to 40% of long-term users report severe withdrawal symptoms after cessation.11

Several risk factors make someone more likely to misuse benzos and develop an addiction. These might include: 

  • Taking benzos for a longer time 
  • Having a history of substance abuse 
  • Dealing with mental health issues like depression or anxiety

Using benzos in higher doses than prescribed, or mixing them with other substances like alcohol or opioids, further increases addiction risk.

Tolerance Development

As the body gets used to benzodiazepines, it requires higher doses to feel the same effects. This is known as tolerance. Over time, someone who initially takes a low dose to manage an anxiety disorder may need much more to feel calm or relaxed. This can quickly spiral into dependence, where the body needs the drug to function normally.

Psychological Factors

Benzodiazepine misuse and addiction are often linked to psychological factors like stress, trauma, and other untreated mental health concerns. Some people turn to benzos to self-medicate, hoping to ease symptoms like anxiety, depression, or panic attacks. But while they may provide temporary relief, they don’t address the root causes of mental health conditions—and eventually, they only make things worse.

Co-Occurring Disorders

A lot of people who misuse benzodiazepines have co-occurring mental health disorders like depression, PTSD, or bipolar disorder. Living with these challenges can drive someone to use benzos to self-medicate or escape their feelings—whether or not they recognize the addiction risk. Co-occurring disorders are complex conditions. If this is a concern for you, look for a specialized treatment program that can treat addiction and mental health at the same time.

Signs of Benzodiazepine Misuse

Behavioral Indicators

There are several behavioral signs that someone may be misusing benzos: 

  • “Doctor shopping,” seeing multiple doctors to get prescriptions
  • Taking higher doses than prescribed
  • Acting secretively 
  • Neglecting their responsibilities
  • Withdrawing socially 

Physical Symptoms

Physical signs of benzodiazepine abuse include:

  • Slurred speech
  • Drowsiness
  • Poor coordination
  • Blurred vision 
  • Headaches 
  • Constantly feeling tired or “out of it” 

Psychological Manifestations

Psychologically, benzodiazepine misuse and addiction can cause: 

  • Mood swings
  • Paranoia
  • Heightened anxiety
  • Depression

It’s ironic, but the very drugs prescribed to reduce anxiety can, over time, make anxiety much worse. Benzos are known to cause rebound anxiety12—an increase in anxiety from stopping use. This is especially true if they’re used incorrectly.

Withdrawal Management

Understanding Withdrawal Symptoms

Benzodiazepine withdrawal can be severe and even dangerous. The National Institute on Drug Addiction describes benzodiazepine withdrawal syndrome:13

Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes.

People usually notice rebound anxiety and insomnia within the first few days, followed by full withdrawals for up to 2 weeks. Withdrawal symptoms of benzodiazepines can last for far longer and usually require professional treatment. Because of the risks involved, it’s always important to detox from benzos under medical supervision.

Tapering Protocols

The safest way to come off benzodiazepines is by gradually tapering. This means slowly reducing the dose over time to minimize withdrawal symptoms. Going “cold turkey,” or stopping benzodiazepines abruptly, can be highly dangerous and is not recommended. A qualified professional should manage this process. 

How quickly you can taper off benzos14 depends on a variety of factors, says the Oregon Health Authority: 

There is no evidence for a one-size-fits-all approach to tapering benzodiazepines. The rate of taper will depend on the severity of withdrawal symptoms, which are influenced by several factors: the original dose, type, potency, duration of action and length of use of the benzodiazepine; the reason the benzodiazepine was originally prescribed; and the personality and individual vulnerability of the patient, their lifestyle, personal stresses and past experiences, and the degree of social support during the taper.

Tapering can take as little as 2 weeks or as long as a year or more. 

Medical Supervision and Support

Medical detox programs help you manage benzo withdrawal symptoms in a controlled, supervised environment. Doctors, nurses, and addiction-specialized therapists monitor your progress and provide support to make sure the withdrawal process is as safe and comfortable as possible. Some rehabs even have detox centers on-site, making it easy to transition directly into inpatient addiction treatment. 

Treatment Options

Medication-Assisted Treatment

In some cases, treatment specialists use medications to help manage withdrawal symptoms and cravings. Substitution or maintenance therapy15 can help people with more severe dependencies, or serious mental health concerns, taper off benzos without destabilizing themselves too severely. For long-term recovery, these treatments should be part of a comprehensive addiction treatment plan.

Psychotherapy

Therapy plays a huge role in long-term benzo addiction recovery. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and other talk therapies can help you understand and change the thought patterns and behaviors that play a role in your addiction. Other approaches, like process groups and holistic treatments, offer additional avenues for working through addiction by accessing different parts of the brain. In general, psychotherapies teach long-term coping strategies that help you address the underlying reasons for addiction and prevent relapse in the future. 

Support Groups and Behavioral Therapies

Support groups offer a sense of community and shared experience that keep you on track through the challenges of recovery. These can include Narcotics Anonymous (NA), other 12-Step programs, or non-12-Step alternatives.

A Path to Recovery From Benzodiazepine Misuse

Benzodiazepine use disorder is a serious issue. But recovery is entirely possible with the right combination of medical support, therapy, and ongoing care. If you or someone you love is struggling with benzo addiction, get help as early as possible. Recognizing the signs of misuse and reaching out to a professional can make all the difference. 

Start exploring your benzodiazepine addiction treatment options today and discover why recovery is a journey worth taking.

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Valium Misuse and Addiction: Signs, Symptoms and Treatment

Valium, or diazepam, is a widely recognized prescription medication that’s mainly used to treat anxiety, muscle spasms, and sometimes seizures. Although it’s highly effective for certain conditions, this strong benzodiazepine also has the potential to cause dependency and addiction, especially if it’s not used as prescribed. We explore what Valium is used for, how it works, its adverse effects, and addiction potential, plus how to tell if your Valium use is becoming a problem. 

What Is Valium?

Valium is a brand name for diazepam, one of the most commonly prescribed benzodiazepines1 (“benzos”) in the U.S. This class of medications is used for its calming properties. Doctors might prescribe Valium for: 

  • Anxiety 
  • Insomnia
  • Panic disorders 
  • Muscle tension or spasms
  • Seizures or convulsive disorders 
  • Restless leg syndrome
  • Withdrawals from other substances (usually alcohol or opioids)

Benzos are also sometimes used to help patients relax before medical or dental procedures,2 especially if they have very bad anxiety in medical settings. They might also be used to keep patients sedated after an operation. Valium is usually prescribed to treat acute symptoms temporarily and is not meant to be used long-term.  

Diazepam has been hugely popular3 since its introduction in the ‘50s, largely because of widespread applications and its fast-acting calming effects. 

In the U.S., Valium is a Schedule IV controlled substance,4 which the DEA considers “drugs with a low potential for abuse and low risk of dependence.”

How Valium Works

Valium affects the brain and body by interacting with GABA, a naturally occurring brain chemical5 that calms the nervous system. GABA reduces the brain’s excitement levels, creating feelings of sedation and relaxation. Valium enhances GABA’s effect by binding to certain receptors in the brain, which is why it’s so effective in reducing symptoms of anxiety and muscle tension.

When you take Valium as prescribed, its impact is usually manageable. But Valium can be used recreationally at higher doses because of its relaxing effects. Over time, this leads to addiction, as the brain starts to depend on Valium to feel “normal.”

Depending on what your doctor recommends, you might take Valium only as needed,6 or regularly for a period of time. As with any prescription medication, you should take Valium according to a treatment plan that’s designed, managed, and revised as needed by a qualified clinical professional. 

Side Effects of Valium 

The most concerning adverse effects of Valium are respiratory depression. Diazepam can have side effects7 that range from relatively mild to very serious: 

  • Sedation
  • Fatigue
  • Confusion
  • Depression
  • Irritability
  • Headache
  • Tremor
  • Nausea
  • Constipation
  • Changes in sex drive
  • Menstrual irregularities
  • Respiratory depression
  • Suicidality
  • Cardiovascular collapse

*Paraphrased from “Diazepam,” StatPearls, National Library of Medicine.

Why Valium Is Misused

Valium abuse can happen for various reasons. These are some of the most common reasons why people take Valium in ways other than prescribed: 

Self-Medication

Some people who aren’t prescribed Valium still use it as a way to relieve their anxiety or manage chronic stress. Unsurprisingly, people who are trying to self-medicate anxiety tend to choose substances like Valium8 that slow brain function and help them relax. They may not realize how risky it is to take a potent benzodiazepine without medical guidance.

Recreational Use

The relaxing, euphoric effects of Valium can make it appealing to those who want to “escape” or feel detached from the pressures of their day-to-day life. Recreational Valium use often involves taking higher doses, which significantly increases the risk of dependency.

Prescription Overuse

Even people who are prescribed Valium can misuse it if they start taking higher doses or continue to use it after their treatment period ends.

Signs of Valium Misuse

Recognizing the signs of Valium misuse can help prevent dependency from progressing into a full-on addiction. Signs can be both behavioral and psychological, and early detection often leads to better outcomes.

Behavioral Indicators

  • Taking higher doses: Increasing your doses beyond what’s prescribed or taking Valium without a prescription are strong signs of misuse.
  • Frequent refills or “doctor shopping:” Getting multiple prescriptions or visiting multiple doctors to get more Valium than you need can indicate dependency.
  • Loss of interest: People who misuse Valium may become detached from social activities, work, or hobbies they used to enjoy.

Psychological Signs

  • Mood swings: Misusing Valium can cause unpredictable mood changes, from moments of calm to sudden agitation or irritability.
  • Increased secrecy: Often, people hiding a dependency on Valium will act secretive about their drug use, making excuses or isolating themselves to prevent others from finding out.

Is Valium Addictive?

Yes, Valium can be addictive, especially when used for longer periods or in high doses. Several factors add to its addictive potential:

Duration of Use

The longer you use Valium (even when following dosage guidelines) the more likely you are to develop a tolerance, which can then lead to dependence. This is why doctors generally don’t recommend using Valium for more than 4 weeks.9 Valium has addictive potential even when it’s taken as prescribed. Per the National Alliance on Mental Illness (NAMI), 

Benzodiazepines, such as diazepam, are often used for short periods of time only. They may produce emotional and/or physical dependence (addiction) even when used as recommended.10

Dosage

A higher amount of Valium also increases the risk of addiction. Excessive use can cause dependency as your brain begins to rely on Valium to feel normal.

Symptoms of Valium Addiction

Addiction progresses over time, and recognizing its symptoms early on can help you address the situation before it worsens. Valium addiction shows up via physical and emotional symptoms that can be easy to spot if you know what to look for.

Physical Symptoms

While generally considered safe for short-term, doctor-supervised use, experts agree that “chronic diazepam use11 is associated with tolerance, dependence, and withdrawal.”

  • Tolerance: Over time, you may feel like you need increasingly higher doses of Valium to feel the same effects.
  • Withdrawal symptoms: Once you’re dependent on Valium, suddenly stopping can cause physical symptoms like muscle pain, nausea, or seizures.

Emotional and Psychological Symptoms

  • Anxiety and depression: In a phenomenon called rebound anxiety,12 Valium addiction often worsens the same symptoms it initially relieved (like anxiety and depression).
  • Loss of interest and motivation: The intense cravings and mood changes associated with Valium addiction can drain a person’s energy and motivation, leading to social isolation.

Risks and Dangers of Valium Misuse

Valium is a strong drug that can have serious consequences. Long-term Valium misuse can lead to severe cognitive and memory impairments. Persistent misuse also heightens the risk of accidents, injuries, and the loss of relationships and employment due to changes in mood and behavior. Neuroscientists explain the adverse effects of Valium:13 

More moderate adverse effects from chronic diazepam use include amnesia, dizziness, ataxia, confusion, sedation, depression, and tachycardia. Also, worsening of seizures or anxiety can occur in some patients being treated for epilepsy or anxiety disorders…The most common fatal events are respiratory arrest and prolonged seizures resulting from prolonged habitual use, rather than acute overdose.

Withdrawals 

Withdrawing from benzos like Valium can be dangerous. If you plan to stop using Valium, it’s important to do so with the help of a qualified, addiction-specialized medical professional. NAMI advises:

Do not stop taking diazepam or change your dose14 without talking to your health care provider first. Stopping diazepam abruptly may result in one or more of the following withdrawal symptoms: trouble sleeping, anxiety, irritability, nausea, tremor, dizziness, blood pressure changes, rapid heart rate, and seizures. Withdrawal reactions may occur when dosage reduction occurs for any reason.

Overdose 

Misusing Valium increases the risk of overdose. This risk is heightened if you mix Valium with other depressants like alcohol or opioids. “The use of diazepam with opioid medications15 has led to serious side effects including slowed and difficulty breathing and death,” says NAMI. Both benzos and opioids depress the central nervous system (CNS), and these sedative effects multiply when they’re taken together.   

Statistics on Valium Misuse and Addiction

Valium misuse has become a serious issue in the U.S. and around the world. Over 30 million adults in the U.S. use diazepam16 in a given year, and addiction researchers estimate that around 17% of those who take Valium misuse it. 

In recent years, benzodiazepines like Valium have been involved in around 12% of all overdose deaths in the United States. Additionally, over 30 million Americans have a prescription for some form of benzodiazepine, and approximately 2% of the population struggles with benzodiazepine misuse.

Valium’s addictive nature and widespread use continue to increase addiction and overdose rates. As these numbers continue to rise, treatment professionals recommend that “patients who are prescribed stimulants or opioids should be monitored for benzodiazepine misuse,”17 and encourage exploring other, nonaddictive methods of addressing issues like insomnia: “Improved access to behavioral interventions for sleep or anxiety may reduce some misuse.”

Treatment Options for Valium Misuse and Addiction

Fortunately, Valium addiction is treatable, and a wide range of treatment options are available. The most successful recovery plans often combine several treatment approaches for comprehensive support.

Medical Interventions

If you’ve been taking it for some time, you’ll likely need to taper off Valium18 under medical supervision. Your treatment team might use medications like flumazenil, a benzodiazepine receptor antagonist, to reduce cravings and manage withdrawal symptoms. Your rehab, primary care doctor, or another qualified addiction specialist can help you determine whether you need detox before starting addiction treatment. 

Behavioral Therapies

Along with treating the symptoms of addiction, talk therapies like cognitive behavioral therapy (CBT) can help you identify and change the thoughts and behavioral patterns that drive your substance use. Ongoing mental health treatment can help you learn healthy coping strategies to manage anxiety and other concerns without relying on Valium.

Support Groups

Support groups like Narcotics Anonymous (NA), non-12-Step groups, and other sober communities provide important support throughout your journey in recovery. These allow you to connect with others who have similar experiences, reminding you that you’re not alone and motivating you to stay sober even in challenging times.

Paths to Recovery From Valium Addiction 

Valium misuse is a serious issue with potentially life-altering consequences—but recovery is entirely achievable with the right help and resources. Whether you’re seeking to understand the signs of misuse, looking for treatment options, or supporting a loved one who needs resources for anxiety relief, there are plenty of avenues to healing. Search for Valium addiction treatment programs by location, pricing, and more, and reach out to a support specialist directly today.  

Frequently Asked Questions About Valium Misuse and Addiction

How addictive is Valium?

Valium, a benzodiazepine, is highly addictive when used long-term or in high doses. Over time, it alters your brain chemistry, which can lead to tolerance, dependence, and withdrawal symptoms. Misuse or prolonged use significantly raises the risk of addiction, but Valium can be addictive even when used as prescribed. Always follow medical advice to minimize risks.

How long does it take to get addicted to Valium?

Addiction to Valium can develop in as little as a few weeks, especially with frequent use or higher doses. The risk increases with prolonged use, even at prescribed levels, as tolerance and dependence build quickly. Short-term, medically supervised use is generally safer to avoid addiction. You can also consider exploring alternative, nonaddictive ways of managing issues like insomnia and anxiety.

Can you get high on valium?

Yes, Valium can cause a high when if you take it in large doses or without a prescription. It makes people feel relaxed by enhancing GABA activity in the brain. However, using Valium recreationally significantly increases the risk of dependency, addiction, and dangerous side effects. Always use Valium as prescribed by your healthcare provider.

Do people snort valium?

Some people misuse Valium by snorting it to feel its effects more quickly. This method is dangerous—it bypasses the digestive system, which can increase your risk of overdose, respiratory issues, and damage to your nasal tissues. Misusing Valium in any form greatly increases the likelihood that you’ll become addicted, in addition to other serious health consequences.

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Navigating Pre-Employment Drug Screening: Identifying the Substances Tested

A pre-employment drug test verifies if you are using illegal substances. These drug tests help employers understand if you are using any substances that may interfere with your ability to work. 

Although the legalization status of substances can vary across regions, such as marijuana, the test results can be used at the employer’s discretion. Drug tests can also be conducted at random, post-injury, if medications were used during recovery, with reasonable suspicion, or periodically during employment.

Commonly Screened Substances

Employers may test for various substances depending on the line of work, the location, the job role, and other factors. Commonly screened substances include, but are not limited to:

  1. Marijuana
  2. Cocaine
  3. Opioids (including heroin, morphine, codeine, and oxycodone)
  4. Amphetamines (including methamphetamine and MDMA)
  5. Benzodiazepines
  6. Alcohol
  7. Phencyclidine (PCP)

Detection Methods

Depending on the substances and desired time period of detection, employers have a few testing methods to choose from1: 

  1. Urine testing is the most common method that detects recent use of drugs. You will pee into a small cup and give it to a worker for testing. A urine test can typically detect substances used in the past few days.
  2. Hair testing can detect drug use over longer periods of time. A small hair sample is taken from the crown of the head or the armpit and must be at least 1.5 inches long. This method can detect drug use up to 90 days prior. 
  3. Blood testing is an accurate drug detection approach; however, it is costly and more invasive. A clinician uses an IV to draw a small amount of blood, and the test detects substances used in the past couple of hours or days. 
  4. Saliva testing uses a swab to collect a sample inside your mouth. This method detects drug use in the past 48 hours.

Factors Affecting Detection

Test results can be unique to each person’s circumstances, including factors such as:

  1. Frequency and amount of substance use: A chronic daily user will likely have the substance readily detected. An occasional user may be harder to detect, depending on the test.
  2. Metabolism and body composition: Your metabolic rate can influence how quickly drugs are processed and eliminated from your body2. Age, gender, genetic makeup, and overall health play significant roles in metabolism speed. For example, someone with a slower metabolism will take longer to eradicate substances.
  3. Sensitivity of testing methods: Different testing methods have varying sensitivities and detection windows. The cutoff levels (the minimum amount of drug residue required for a test to be considered positive) also vary by test. They can affect whether a result is positive or negative.
  4. Time elapsed since substance use: Depending on the test, if substance use is more than two weeks prior to the test, most methods will not detect it; however, hair testing can detect drug use for months.

Legal Implications

Employers must comply with federal and state drug test regulations, which can vary by region. 

In most cases, employers must give reasonable notice before the test and obtain the employee’s or job applicant’s consent. Drug testing policies must be fair to all employees or candidates to avoid discrimination. The Americans with Disabilities Act (ADA) protects individuals with disabilities who must take medication for their condition.

In some regions, laws and regulations may limit the actions employers can take in response to a positive drug test, particularly for substances like marijuana, where legality varies by jurisdiction.

Wrongful termination or disciplinary actions based on drug test results can lead to legal disputes, so employers must be clear, consistent, and legally compliant when defending their actions.

Employer Policies and Procedures

Drug test results represent highly sensitive and strictly confidential health information. Unauthorized disclosure of test results can lead to legal action against the employer. Before taking the drug test, you must agree to your privacy and confidentiality rights.

If the test results are positive, the employer has the right to rescind the job offer or terminate employment. Companies can also take disciplinary action, such as suspension or mandatory participation in a drug treatment center.

In some professions, a positive drug test may result in the suspension or termination of professional licenses or certifications, potentially rendering an individual ineligible for promotions and transfers.

Preparation and Mitigation Strategies

If you’re worried that your substance use may interfere with obtaining employment, it might be time to look into professional treatment. 

Your recovery journey can begin with medical detox. With clinical support, this process rids the body of harmful substances and helps you quit drinking alcohol or using drugs. In the case of alcohol and opioids, detox can be life threatening if done improperly. You can search for qualified detox centers near you to see what substances they treat, insurances they accept, and treatment approach they use. 

Often, detox isn’t enough for full recovery. You and your care team can collaboratively decide which level of care is best for your needs:

  • Outpatient (OP): You’ll meet 1-2x per week with your provider and others in treatment.
  • Intensive outpatient (IOP): You’ll meet 3-5x per week for several hours at a time for more intensive care.
  • Partial hospitalization (PHP): You’ll meet 5-7 times a week for a full day.
  • Residential: You’ll live in a rehab for 28+ days and engage in treatment with a comprehensive staff and a community of peers. 
  • Inpatient: You’ll live in a treatment center or hospital-like setting and have 24/7 monitoring. 

Managing addiction can be a complex and individualized process. Licensed professionals can provide you with appropriate tools, techniques, and support tailored to your specific needs. You may engage in talk therapies such as: 

  • Cognitive behavioral therapy (CBT) to learn how to replace unhealthy thought patterns with more affirming ones.
  • Contingency management (CM) that provides positive reinforcement, such as rewards or incentives, for maintaining abstinence from heroin.
  • Relapse prevention counseling to learn techniques to manage addiction cravings and other symptoms.
  • Motivational interviewing to explore the reasons why you want to recover and use that purpose to motivate change. 

Resources and Support

In the case of employment-related drug testing issues, seeking legal assistance can be a crucial step in understanding your rights, navigating potential consequences, and challenging unjust or unlawful practices. 

If you are struggling with a substance use issue, professional addiction treatment can help you identify triggers and unhealthy behaviors, learn positive coping skills, and adapt lifestyle habits to change your life for the better. Treatment may involve a mixture of evidence-based talk therapies (like cognitive behavioral therapy (CBT)), holistic healing modalities (like yoga), and support groups (such as AA and NA).