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Xanax Tolerance: What to Do and Is a Break Necessary?

xanax toleranceAlprazolam is the generic name for a benzodiazepine typically prescribed under the brand name Xanax, which was approved for prescription use by the Food and Drug Administration (FDA) in 1981. This is a psychiatric medication used to treat immediate stress symptoms associated with various anxiety conditions, including panic disorder, general anxiety disorder, and anxiety associated with depression. Although many benzodiazepines are also used to treat insomnia and seizure disorders, Xanax is not used for this purpose very often.

This class of sedative medications has been popular since the 1960s, but current practice among physicians prescribing benzodiazepines is that they should be used “as needed” or, in rare cases, only taken regularly for a few weeks. The body quickly develops a tolerance to benzodiazepine drugs, especially fast-acting ones like Xanax. Once tolerance to any medication develops, it is important to work with the prescribing doctor to either safely increase the dose, switch to another drug, or detox from the drug and find another approach to treatment that will work long-term.


Xanax Tolerance Develops Quickly

The National Institute on Drug Abuse (NIDA) defines tolerance as the physical state in which a person’s body no longer responds to the presence of a drug or when a larger dose of the drug is needed to produce the substance’s original effects. Any drug that is taken repeatedly over time can produce tolerance.

With Xanax and other benzodiazepines, the sedative effects of the medication quickly decrease over two weeks of regular use. The medications bind to the gamma-aminobutyric acid (GABA) receptors in the brain to release the GABA neurotransmitter, which slows down communication between neurons. For people who have anxiety or a seizure disorder, calming these interactions induces a feeling of relaxation. For people who abuse sedative drugs, like Xanax, opioids, or alcohol, these drugs produce a pleasurable, relaxing high, which can also trigger the brain’s reward system and lead to substance abuse.

Xanax binds to GABA receptors within 15 minutes after it is ingested, so the drug quickly produces sedation and relaxation. The drug reaches peak effectiveness one or two hours after it is consumed and remains active in the body for up to six hours, depending on the size of the dose. In healthy adults, Xanax has a half-life of 11 hours, meaning metabolites of the drug remain in the body for about one full day. This means that consuming other sedatives, especially without a prescription, can be risky because they will interact with the Xanax metabolites.

 Many people struggle with abuse of this substance because it acts so quickly. NIDA reports that, in 2009, Xanax and other benzodiazepines were responsible for most of the emergency room visits that year.

Often, people who abuse drugs like Xanax mix the medication with another substance. Alcohol, opioids, and cocaine are the most common drugs in this type of polydrug abuse.

There are several forms of Xanax, including an extended-release version. The drug is predominantly prescribed to stop panic attacks or immediate anxiety about a situation, so the person can have a normal, functioning life. Doses range from 0.25 mg to 0.5 mg tablets, which may be prescribed up to three times per day. Higher doses of 1 or 2 mg tablets are not the starting dose for anyone and reserved for people who have a high tolerance but need regular doses of Xanax or for those who need more sedation due to their specific disorder.

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The Risks of Being Tolerant to Xanax

Tolerance to any intoxicating substance is risky because one may increase their dose of a drug like Xanax without consulting a doctor. Although tolerance itself is not the same as physical dependence, which occurs when the body needs the presence of the substance to feel normal, or addiction, it can lead to these conditions.

For people who have anxiety disorders or struggle with insomnia, studies have shown that the sedative effects, which produce the feeling of being high, are quickly lost, even though some of the pharmacological side effects like suppressed REM sleep still occur. One study reported that 10 days of alprazolam treatment led to a tolerance to the physical effects of sedation, like decreased movement speed. While many people with panic disorders still received the benefit of reduced anxiety from alprazolam after eight weeks of treatment, much of this may be a placebo effect, but it is hard to know for certain.

Many of those with serious anxiety disorders benefit from having access to Xanax as a treatment, either for a few weeks of consistent use or on an as-needed basis. However, people who abuse Xanax to get high quickly develop tolerance to these effects, which means they are at risk of increasing their dose rapidly. This not only triggers dependence and addiction, but it can also cause serious long-term harm.

Common side effects from Xanax include:

  • Drowsiness
  • Lightheadedness
  • Impaired physical coordination
  • Slurred speech as though drunk
  • Memory problems

These short-term effects put the individual at serious risk of an accident, like falling or crashing a car. Once the person develops a physical dependence on the drug, they are likely to suffer withdrawal symptoms if they try to quit taking it. Attempting to stop abusing a drug suddenly, without help, puts the person at risk of relapse and overdose because withdrawal symptoms may be uncomfortable. This is especially true for benzodiazepines like Xanax, since the withdrawal symptoms mimic conditions they were designed to treat.

They can include:

  • Dysphoria, or feeling restless and uneasy
  • Anxiety
  • Insomnia and other forms of disturbed sleep
  • Panic attacks
  • Sweating
  • Nausea, vomiting, or stomach problems
  • Physical tremors or shaking
  • Hallucinations
  • Convulsions or seizures

 Withdrawal can last for two weeks, although cravings for the drug may last longer if the person does not get evidence-based treatment through a rehabilitation program.

Taking a Break from Xanax Can Help

People who take Xanax on a regular basis and worry that they may be misusing their prescription should speak with their doctor. A medical professional can either help their patient taper off the drug or adjust the dose of Xanax so it does not feel like too much. Treating anxiety and insomnia can start with a rapid-acting medication like Xanax, but people who suffer from these chronic conditions should also seek talk therapy or other approaches to relaxation and stress management that do not solely rely on drugs. Taking a break from Xanax may be appropriate.

For those struggling with Xanax addiction, it is important to find medical supervision to safely detox. Some of the withdrawal symptoms, like seizures, can be life-threatening, so professional help is needed. Addiction specialists understand how to approach detox and rehabilitation for Xanax addiction, benzodiazepine abuse, and polydrug abuse involving these sedatives.

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