Xanax (alprazolam) belongs to the class of drugs known collectively as benzodiazepines. This is a large class that is one of the most commonly prescribed classes of drugs in America. Benzodiazepines were developed as a less addictive alternative to a similar class of drugs, barbiturates. Barbiturates were originally marketed as treatments for anxiety, seizure disorders, and as muscle relaxants; however, they were highly addictive. Benzodiazepines share many similar actions to barbiturates, and these drugs are also highly addictive: therefore, even though they are still commonly prescribed, nearly all benzodiazepines share moderately high potential for the development of physical dependence and abuse.
Xanax was developed and marketed as a less addictive alternative to the very popular benzodiazepine Valium because Xanax has a shorter half-life and a much quicker course of action. Xanax is primarily prescribed for treating psychological disorders that have a significant component of anxiety to them, as a sleep enhancer (to initiate sleep), and as a muscle relaxant in the treatment of muscle spasms. It may also be used for other purposes, such as seizure control or to control aggression in certain types of psychological disorders.
Abuse of Xanax
Although Xanax was hoped to be a less abused alternative to Valium, the drug is widely abused. According to figures from several sources:
- Prescription drug abuse is a major issue. Prescription drug abuse is a major concern in the United States. Over one-fifth of Americans over the age of 12 report using prescription drugs for nonmedicinal reasons at least once.
- Xanax is the most commonly abused benzo. Xanax is the most commonly abused benzodiazepine in the United States for many of the same reasons that is one of the most commonly prescribed benzodiazepines:
- It has a short onset of action, meaning that the effects are felt rather quickly.
- It is a high potency drug, meaning that low doses produce significant effects.
- It has a short half-life.
- It is deemed to be rather safe by many abusers due to its acceptance by the medical community and the notion that it is less addictive than Valium.
- There are high numbers of accidents and overdoses related to Xanax use. The Substance Abuse and Mental Health Services Administration (SAMSHA) reported that in 2005-2011, the number of people seeking medical attention due to Xanax abuse doubled.
- There are high instances of polysubstance abuse. Xanax is commonly a drug abuse in conjunction with other drugs due to its quick onset of action and short half-life. Thus, its effects are felt quickly but also wear off relatively quickly. The abuse of Xanax alone is relatively rare. Xanax is commonly abused in conjunction with alcohol, narcotic pain medications, other central nervous system depressants, and even stimulant medications.
Mixing Alcohol and Xanax
Like Xanax, alcohol is also a central nervous system depressant. This means that the drug suppresses the activities of the central nervous system when taken (slows down the actions of the brain and spinal cord). The major action of both alcohol and Xanax is to inhibit the firing of neurons (brain cells) and reduce overall activity in the central nervous system. While central nervous system depressants may not actually result in an individual feeling depressed, such as having a depressed mood, in certain individuals or in very high doses, this is not uncommon. Both drugs produce similar symptom profiles.
- Different effects at different doses: At very low levels or initially, they may produce mild stimulation; however, at higher levels or over time, they may produce significant feelings of relaxation, sedation, lethargy, and sleepiness.
- Euphoria: At low to moderate levels, both drugs result in mild euphoria, general feelings of wellbeing, disinhibition, reduced problem-solving abilities, reduced judgment, and issues with thinking and emotions.
- Physical effects: Physically, both drugs result in reduced blood pressure, reduced rate of breathing, issues with coordination, reduced reaction time, issues with balance and walking, and slurred speech.
- Dependence and abuse: Both drugs have high potential for the development of physical dependence (both tolerance and withdrawal) when used for significant periods of time. The development of physical dependence on both drugs results in a similar withdrawal syndrome, which can be potentially fatal due to the development of seizures in some individuals. Both drugs have a moderately high potential for the development of a substance use disorder when chronically abused.
- Overdose: Both drugs have a high potential for overdose. The symptoms of overdose to both drugs are similar and include confusion, stupor, reduce breathing rates, reduced heart rate, extreme lethargy, and even unconsciousness or coma. Both drugs can result in fatalities due to overdose.
Because both drugs are central nervous system depressants, mixing them can lead to some very dangerous consequences. Eight potential dangerous consequences of this combination are listed below:
- Mixing alcohol and Xanax can result in an increase in their central action (depressing the central nervous system) and in any negative side effects that they may produce (e.g., lethargy, poor judgment, etc.). Mixing these drugs together magnifies both of their effects.
- The combined effect when an individual mixes these drugs increases their potential for the risk of self-harm due to accidents or poor judgment. For example, both Xanax and alcohol impair memory and judgment. An individual taking both of these drugs may have forgotten how many Xanax they have taken and can easily take a lethal dose.
- Mixing alcohol and Xanax also increases the potential for overdose on either drug. As a result of both drugs working together, it can increase the potential for an overdose from smaller amounts of each drug.
- Mixing Xanax and alcohol can result in a number of unpredictable reactions in an individual. A number of individuals develop side effects to specific types of drugs, such as Xanax and/or alcohol. These side effects can be increased by mixing the drugs together.
- When alcohol and Xanax are mixed together, it takes an individual’s system longer to detoxify from both drugs. This means that the drug stay in the system longer.
- Chronic use of both drugs will result in the development of cognitive issues that can include problems with memory, attention, problem-solving, and judgment.
- Individuals who chronically abuse both alcohol and Xanax run the risk of developing a number of different psychiatric issues, including depression, anxiety, and even psychotic disorders.
- Chronic use of both drugs increases the potential for one to develop a substance use disorder to both. Individuals with polysubstance use disorders present complicated cases for treatment. Because both alcohol and Xanax have a potential for the development of physical dependence, an individual can also develop physical dependence on both drugs, and this can be extremely complicated.
Signs of Abuse
There are number of signs that an individual is abusing alcohol and/or Xanax.
- Compulsions to use the drug: Individuals with substance use disorders display compulsive behavior regarding their drug use that includes:
- Taking Xanax without a prescription for the drug, taking more Xanax than recommended by their prescription, or combining Xanax with drugs like alcohol
- Doctor shopping, or trying to obtain a prescription for Xanax from different physicians
- Spending significant amounts of time trying to obtain Xanax, using Xanax and/or alcohol, or recovering after using Xanax and/or alcohol
- Issues with control: Individuals with substance use disorders display significant issues with self-control regarding their drug use, such that:
- The person expresses a desire to either cut down or stop using drugs and/or alcohol but is not able to do so.
- The person uses larger amounts of either or both drugs than originally intended or uses them for longer periods of time than intended.
- The person begins to spend significant amounts of time trying to obtain Xanax, using Xanax and/or alcohol, or recovering after using Xanax and/or alcohol.
- Empty prescription bottles for Xanax are found in an individual’s room, home, car, close, etc.
- Negative consequences associated with substance use: Drug abuse results in a number of potential negative consequences. Individuals who abuse these drugs typically will have issues with their relationships, work, school, or other important areas of their lives. They also generally display a decrease in their previous self-maintenance activities, such as their appearance, doing regular chores, their diet, etc. If the person continues to use the drugs despite having issues with their health, work, or personal relationships, this is a sign of abuse.
- Physical dependence: The development of tolerance and withdrawal is a sure sign that the individual has a potential substance use disorder if they are not using the drug for purely medicinal purposes.
People who suffer from benzodiazepine use disorders, and typically those who abuse Xanax, are most likely abusing some other drug or alcohol in conjunction with their Xanax abuse. As mentioned above, this is a serious issue. It is crucial that the individual undergo a full assessment in order to determine the extent of any polysubstance addiction or abuse.
Because these individuals may have developed a serious physical dependence on Xanax and/or alcohol, the first step is to assess their need for withdrawal management and to place them in an appropriate residential program. Most likely, individuals who abuse both alcohol and Xanax will require long-term treatment that includes a full schedule of treatment services in addition to the withdrawal management program. These individuals will need counseling and therapy, family support, social support groups, the development of a functional long-term aftercare program, and other follow-up services as needed. This typically requires a multidimensional team approach that includes physicians, counselors, social workers, and other mental health and addiction specialists as well as other needed treatment providers (e.g., case managers, occupational therapist, vocational therapist, etc.).