Why Your Doctor May Be Hesitant to Prescribe Xanax (the brand name for alprazolam) is one of the most popular anti-anxiety medications in the United States. It has many legitimate medical uses—doctors often prescribe Xanax to treat anxiety, depression, panic disorders, and phobia. Xanax is part of the benzodiazepine family, known as “benzos” for short.
Despite their legitimate uses, benzos like Xanax are still mind-altering substances. Unfortunately, people misuse Xanax for a number of reasons. Repeated misuse can lead to full-blown Xanax addiction that requires treatment, but quitting Xanax cold-turkey can cause seizures and other life-threatening side effects. It’s a catch-22 for many people who suffer from debilitating anxiety and other mental health issues.
Before you start taking Xanax, it’s important to fully understand how the drug works and the risks associated with it.
The Basics about Benzos
First, the scientific explanation: benzos are a class of anti-anxiety medications, or anxiolytics, that increase the activity of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that helps brain cells (or neurons) communicate with each other and reduces anxiety by enhancing GABA inhibitory function. In layman’s terms, benzos slow a person’s brain activity, which brings feelings of relaxation and calmness.
In addition to Xanax, other drugs in the benzo family include diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan).
Most benzos have similar effects, but they differ in strength (how long it takes them to work) and half-life (how long the drug stays in your system). Drugs with a shorter half-life are linked with higher potential for addiction and dependence because the effects wear off faster. That is one reason why doctors are typically hesitant to prescribe Xanax for long periods of time. After taking Xanax in pill form, peak levels are found in your blood just 1-2 hours later. The average half-life of Xanax in the blood is only 11 hours in healthy adults.
How Benzos are Used
Benzos are mainly used for a short period at the beginning of treatment for an anxiety disorder because it usually takes a few weeks for the main pharmacological treatment for anxiety—antidepressants—to kick in. If someone’s anxiety is severe or debilitating, benzos may be prescribed for temporary use.
Benzos are also prescribed for occasional situations of high anxiety – for example, a person with a fear of flying who rarely goes on airplanes may choose to take a Xanax before they fly to calm their nerves. Someone who flies several times a month should not use Xanax as a long-term solution for their anxiety.
Benzos may be used for other medical conditions as well, such as treatment of seizures or alcohol withdrawal. But the use of benzos should not be taken lightly, as the risks of dependence and ultimately addiction are very real.
Dependence vs. Addiction
Benzo dependence, which affects every person who consistently uses these drugs, is different from addiction. Essentially, when a person takes benzos for multiple days or weeks, the brain adapts to the presence of the drugs and begins to depend on them to function. As this dependence develops, the brain starts to require larger doses to feel the same effects.
When someone who is dependent on a benzo stops taking the drug, they are likely to experience withdrawal symptoms. Stopping benzos abruptly can cause restlessness, irritability, aggressive behavior, insomnia, muscle tension, and blurred vision—just to name a few. Withdrawal from high doses of benzos (especially ones like Xanax with a shorter half-life) can be very dangerous, causing seizures or worse.
If you become dependent on benzos and have to continue increasing your dose to feel the same effects, you are entering addiction territory. Some benzos, including Xanax, actually have street value because of the pleasant, relaxed feeling they give the person who takes them. Benzos are to anxiety what opioids are to pain—a temporary escape, not a cure, with a high potential for addiction.
Benzo overdose, especially when mixed with alcohol or opioids, can be life-threatening. In 2015, approximately 20% of people who died of an opioid overdose also had benzos in their system.
The Lure of Xanax
A lot of people misuse Xanax and other benzos because they want relief from anxiety, and Xanax helps to calm them down. Others desire the relaxed, goofy feeling Xanax gives, which is often compared to how people feel when they get drunk. Like alcohol, Xanax is a depressant—in high doses, both substances make people feel carefree. Many people pass out after taking too much Xanax. Like alcohol abuse, Xanax abuse is dangerous.
Xanax can be a lifesaver for people with severe anxiety but if you take it recreationally or ignore your doctor’s guidelines, you are putting yourself at risk of developing an addiction.
There are safer treatments for anxiety, but they often require patience to work. Options such as psychotherapy and exposure therapy (where a person is gradually exposed to the feared situation under the guidance of a therapist) can teach you healthier ways to cope with the sources of your anxiety. Medications such as antidepressants, especially when combined with psychotherapy, can also be effective. Talk with your doctor to determine which option is best for you.