Xanax Withdrawal – Symptoms, Dangers, Duration, and Treatment
Xanax, a brand name of alprazolam, belongs to a class of medications called benzodiazepines.1 Xanax is a relatively short-acting benzodiazepine used for treating generalized anxiety disorder or panic disorder in adults.1
Xanax, and other benzodiazepines, are central nervous system (CNS) depressants; and therefore, act on the brain produce a sedative or calming effect.1,2 However, Xanax has potential for misuse and addiction, especially when taken at higher doses or combined with other substances such as opioids and alcohol.1,3
In relatively recent years, healthcare professionals have prescribed benzodiazepines to more than 5% of adults in the United States.4 In fact, alprazolam is one of the most widely prescribed drugs for anxiety disorder and panic disorder.5 Yet, in 2020, nearly 4.8 million people aged 12 and older reported misusing benzodiazepine prescriptions in the past year.6
How Addictive is Xanax?
Xanax is classified as a Schedule IV controlled substance, meaning there is a recognized medical use for the drug, but there is also potential for abuse and addiction.7
Research indicates that individuals with a history of substance use disorder, a medical condition characterized by uncontrollable use of a substance despite its negative effects, are at particularly high risk for benzodiazepine misuse and addiction.5 Another study found that individuals with a history of alcohol or opioid use specifically preferred alprazolam because they found it to be more rewarding than other benzodiazepines.5
If any benzodiazepine is taken long enough, physical dependence can develop. Once physical dependence develops to a benzodiazepine like Xanax, people may experience several characteristic withdrawal symptoms if they stop taking it.5
Withdrawal from Xanax
The use of any benzodiazepine, even as directed, for as little as 3 to 6 weeks can result in dependence, including withdrawal upon discontinuation.8 When used for 6 months or more, research suggests that around 40% of people experience moderate to severe withdrawal symptoms when they stop taking the drug.8
Several researchers have described two distinct phases of benzodiazepine withdrawal—acute withdrawal, which lasts between 5 and 28 days after stopping benzodiazepines, and a more protracted withdrawal phase, which can last up to a year or more, in some cases.8
In general, symptoms of acute withdrawal from benzodiazepines can include:8
- Panic attacks.
- Sleep problems.
- Muscle spasms.
- Loss of appetite.
- General discomfort.
- Hypersensitivity to light, sound, or touch.
- Abnormal sensations.
- The sensation of being detached from your body.
- Psychosis, including hallucinations, delusions, and delirium (a type of severe confusion).
Studies indicate that between 10% and 25% of chronic benzodiazepine users experience protracted withdrawal when they stop taking the drug.8 Symptoms typically include new or worsening anxiety and depression.8
Additionally, benzodiazepines such as Xanax are associated with memory or cognition problems.1 Some research has suggested that benzodiazepine-related changes in cognitive function may persist to some degree, even after discontinuation.5
Factors that Affect Xanax Withdrawal
Several factors can influence Xanax withdrawal. More severe acute benzodiazepine withdrawal is associated with the use of higher doses, concurrent use of multiple benzodiazepines, longer durations of use, and the use of shorter-acting benzos (e.g., Xanax).8 Additionally, research suggests that alprazolam withdrawal may be associated with higher instances of rebound anxiety compared to other benzodiazepines.5 These rebound symptoms are often more severe than they were before Xanax was initiated.5
Concerns also exist surrounding certain populations and Xanax use. Changes in how the body is able to absorb, metabolize, and eliminate active forms of the drug can influence its pharmacological effects. Studies indicate that Xanax may be more slowly metabolized in older adults, individuals with liver disease, and those who are obese.10 Research suggests that Asian individuals may experience relatively higher peak serum concentrations and longer elimination times for Xanax compared to Caucasians.10
How Much Xanax Causes Withdrawal?
There appears to be an increased risk of physiological dependence and severe withdrawal in patients that consume more than 4 mg of Xanax per day for 12 weeks or more.10 However, people taking lower doses, especially for longer periods of time, may still have withdrawal symptoms when the medication is discontinued. Keeping Xanax dosing under 4 mg per day does not necessarily remove the risk of withdrawal.10 One study estimates that a third of people who use benzodiazepines for 6 months or longer experience withdrawal.3
Medications Used to Treat Xanax Withdrawal Symptoms
Many withdrawal management protocols involve administering benzodiazepines in gradually decreasing amounts. In some instances, a switch to a relatively longer-acting benzodiazepine—such as chlordiazepoxide, clonazepam, or diazepam—will take place to stabilize the patient in withdrawal prior to proceeding with a gradual dose reduction.12,13
There is some preliminary evidence that flumazenil, a medication which blocks the activity of benzodiazepines at specific receptor sites, could help to alleviate both acute symptoms for those actively going through withdrawal and more protracted withdrawal symptoms that persist after discontinuing benzodiazepines.8 One study found that individuals who took flumazenil experienced fewer withdrawal symptoms, had less cravings, completed withdrawal at better rates, and relapsed less.8
Additionally, studies show that anticonvulsants, antidepressants, and beta blockers have some efficacy in treating benzodiazepine withdrawal symptoms.8
Xanax Withdrawal Treatment
Due to the challenges associated with benzodiazepine withdrawal and discontinuation, the World Health Organization (WHO) recommends that healthcare professionals use a schedule to help individuals taper benzodiazepines safely.12 As mentioned, clinicians may use a relatively long-acting medication such as Valium (diazepam) to help stabilize individuals experiencing benzodiazepine withdrawal and then gradually decrease the dose over a period of days or weeks to keep the individual safe and as comfortable as possible.12
While detox is an effective first step in the journey to recovery, it is typically not enough to support an individual’s long-term recovery from a drug addiction.14 Medical detox can serve as an ideal entry point for more comprehensive treatment, where evidence-based behavioral therapies and counseling can help people to better prevent relapse and achieve long-term abstinence.14
Take Our Substance Abuse Self-Assessment
Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with drug addiction. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.
American Addiction Centers (AAC) is the nationwide leader in addiction treatment. If you’re struggling with Xanax dependence, we’re here to help. Quitting can be scary and challenging; but, quitting abruptly can be dangerous. AAC has the medical team and treatment staff to safely manage benzodiazepine withdrawal through medical detox. Don’t trust your life to chance. Achieve long-term sobriety with the professional support of a recovery program that offers medical detoxification and tailored rehabilitation treatment. Call our drug abuse hotline at
Coping with Xanax Withdrawal Symptoms
Withdrawing from Xanax can be challenging. If you are coping with Xanax withdrawal symptoms, know that they will subside with time. Consider the following coping strategies:15-17
- Access counseling support. Research suggests that psychological support coupled with a medically managed dose reduction schedule may be better than tapering alone.
- Utilize relaxation therapies. Early evidence indicates that mindfulness meditation may help individuals with a substance use disorder, although additional research is necessary.
- Don’t skip appointments. During the medication taper, regular doctor visits that include benzodiazepine education, the problems that they can cause, and information on withdrawal can be helpful.
- Celebrate your progress. When combined with positive reinforcement, celebrating the successes may improve outcomes.