A physical tolerance to a drug occurs as the brain gets used to the way it is altering its chemical makeup and the way that neurotransmitters (the brain’s chemical messengers) are sent and received. The National Institute on Drug Abuse (NIDA) explains that tolerance happens when regular doses of a drug no longer have the same effect that they did before. A person will then need higher doses to get the same effects.
Xanax (alprazolam) is a benzodiazepine sedative-tranquilizer medication that is prescribed for short-term management of anxiety and panic disorders.
It is designed only for use for short periods because regular use of the drug can lead to tolerance and dependence.
Xanax is considered to be a potentially addictive drug. It is also commonly misused. The National Survey on Drug Use and Health (NSDUH) estimates that more than 600,000 Americans battled addiction involving a tranquilizer medication in 2016.
Xanax interacts with the brain’s fight-or-flight, or stress, response. It works by increasing the presence of gamma-Aminobutyric acid (GABA) in the brain, which helps to calm nerves and anxiety naturally. When someone has anxiety, they may have lower than normal levels of GABA, and Xanax can help to counteract this.
With repeated use of Xanax, however, the brain can actually start producing even less GABA. It can be difficult for someone to stop taking Xanax as rebound anxiety can occur.
Drug dependence can set in rapidly with chronic Xanax use. The brain will start to count on the drug to stabilize its chemistry.
The prescribing data for Xanax, published by the U.S. Food and Drug Administration (FDA), warns that Xanax dependence and tolerance can happen even when the drug is taken for medical purposes exactly as directed. A person may begin to have anxiety symptoms in between regular doses of Xanax due to tolerance levels. Use will then need to be moderated.
Because of the potential hazards of Xanax withdrawal, it is not a medication that should be stopped abruptly. Tolerance needs to be addressed safely and managed with care.
The biggest identifier of tolerance is noticing that the medication is no longer effective at the same doses. When you first start taking Xanax, you are likely to feel relaxed and at ease from panic, anxiety, and high levels of stress. Muscle tension relaxes, as body temperature, heart rate, and blood pressure are lowered. It is likely easier to sleep while taking Xanax at first.
With regular use, however, Xanax will become less effective. Even within a few weeks, anxiety, tension, and sleep difficulties can start to creep back in. This is a sign of Xanax tolerance.
Drug cravings, feeling the need to take more Xanax with each dose, or wanting to take the drug in between doses are additional signs that physical tolerance is present.
You may be tempted to misuse Xanax —to take it in a way other than it is intended to be taken, such as chewing it or crushing it to then snort, smoke, or inject it for a faster onset of action. Your thoughts may become preoccupied with the next dose of Xanax.
Once tolerance is identified, there are several things you can do. Talk to your medical provider to discuss your Xanax use and be honest about the symptoms you are experiencing. Xanax may be switched with another medication that has a similar method of action but may be longer-acting; this means it will remain in your bloodstream longer.
Xanax is not intended to be a cure for anxiety and panic disorders. It’s merely a tool to manage symptoms on a short-term basis. This means that Xanax use should be coupled with behavioral therapies and counseling sessions that teach stress management techniques. These methods can help to minimize and alleviate stress on a long-term basis, so you no longer need to take Xanax. Dysfunctions in the brain and central nervous system can be positively retrained with cognitive behavioral therapy (CBT), the Journal of Neuropsychiatry and Clinical Neurosciences reports, helping to minimize anxiety without the need for medications.
Xanax is not a drug to stop taking suddenly and without professional help once tolerance, and especially dependence, has formed, Pfizer warns. Very difficult and even potentially life-threatening withdrawal symptoms — including psychosis, hallucinations, and seizures — may present when Xanax use is abruptly stopped after significant dependence has formed.
To decrease the use of Xanax to address tolerance, the drug is generally tapered off slowly to keep withdrawal symptoms from being significant. A drug taper can wean Xanax out of the bloodstream in a controlled manner while still leaving enough of the drug active in the body to prevent dangerous withdrawal symptoms.
A tapering schedule will differ from person to person. It is largely based on the specific level of tolerance and dependence on the drug.
The goal of a taper is getting the dosage down to zero in a safe manner. Xanax is not meant to be taken continuously for a long time. It really is for short-term use with the ultimate intention of getting off the drug completely.
Again, Xanax is a drug that is commonly misused and easy to abuse. Any use of the drug that is not exactly prescribed by a medical professional for a medical purpose is considered abuse. This means that taking more Xanax at a time, taking it in between doses, or altering the medication and the way it’s intended to be taken are all methods of abuse.
Tolerance can encourage abuse, which, in turn, amplifies drug dependence and the potential for addiction. Tolerance, dependence, and addiction are optimally managed through a comprehensive drug treatment program. Medical detox is considered the best method to manage withdrawal, allowing the drug to process safely out of the bloodstream.
The journal EmDocs publishes that Xanax withdrawal can begin within six hours to 12 hours of the last dose, and acute withdrawal can last for up to two weeks. In some cases, symptoms can even continue for several months. A professional detox protocol followed by a complete addiction treatment program can help to manage withdrawal symptoms and even reduce the intensity, severity, and duration of the symptoms.
Medical and mental health professionals can offer support and aid in moderating tolerance. Ultimately, they can help clients to decrease use, improve their emotional health, and minimize the need for the drug overall.
(January 2007). Neurobiology of Drug Addiction. 6. Definition of Tolerance. National Institute on Drug Abuse. Retrieved October 2018 from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved October 2018 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
(September 2016). Xanax. Alprazolam Tablets. U.S. Food and Drug Administration. Retrieved October 2018 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf
(Spring 2009). Does Cognitive Behavioral Therapy Change the Brain? A Systematic Review of Neuroimaging in Anxiety Disorders. The Journal of Neuropsychiatry and Clinical Neurosciences. Retrieved October 2018 from https://www.ncbi.nlm.nih.gov/pubmed/19622682
(2018). Xanax Alprazolam Tablets. Pfizer. Retrieved October 2018 from https://www.xanax.com/
(August 2017). Benzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management. EmDocs. Retrieved October 2018 from http://www.emdocs.net/benzodiazepine-withdrawal-syndrome-presentations-emergency-department-management/