What causes Alprazolam withdrawal?

As previously mentioned physical addiction occurs because of the adaptations of specific neurons or areas of the brain to the continued presence of the drug. There is a tendency for shorter-acting benzodiazepines to produce more overt dependence and a more rapid onset of withdrawal symptoms than longer-acting agents.

When the drug is withdrawn, the chemicals in the brain are thrown out of balance. This usually causes an effect polar opposite to what the effect of the drug was, but it may manifest in bizarre ways.  Serious withdrawal symptoms may occur if the drug is stopped abruptly and should always be done slowly in consultation with a doctor. This is done to try and avoid life-threatening side effects and manage less severe symptoms as to have minimal disruption of the user’s life.

Withdrawal starts to occur within 6-12 hours of the last dose and symptoms become more prominent as time goes on.

 

Symptoms of withdrawal

Physical

  • Seizures
  • Agitation
  • Weight loss
  • Sweating
  • Perceptual changes e.g. sensitivity to light & sound, change in sense of smell
  • Dizziness
  • Muscle cramps
  • Myoclonic contractions
  • Tremors
  • Hypertension
  • Tachycardia

Mental

  • Insomnia
  • Anxiety
  • Panic
  • Paranoia
  • Tension

Duration of withdrawal

Withdrawal should be done as a slow measured reduction of dosage. This gives the brain time to adjust, which is safer than an abrupt withdrawal. The duration of the withdrawal schedule is highly dependent on each individual’s response and may take weeks to months for complete cessation. The longer the user has been abusing alprazolam, and at higher doses require longer withdrawal periods.

Other factors such as the method of ingestion, genetics, age at first use and mixing with other drugs all affect the development of dependence and the withdrawal from it. It is essential that during this period the user receives comprehensive counseling and support and may in some case require adjunct therapy. Detox centers exist that provide a professional service, offering supervision and monitoring in a controlled environment.

 

Withdrawal Timeline

Day 0-3: Withdrawal is at its worst, this is the ‘rebound’ phase. This period has the highest risk for the development of seizures – if that occurs immediately take them to a hospital or call an ambulance. Tachycardia, irritability, insomnia and nausea are the most common symptoms experienced. In this time, medical monitoring is essential.

Week 1: You have won the battle, but not the war. Now is the acute withdrawal phase which may last up to and including week 2. Any of the withdrawal symptoms may be present at this stage. Irritability and a strong craving for alprazolam may cause a relapse. A strong support system will help prevent this as the user’s perseverance will be tested.

Week 2: The risk for seizures has passed, but many of the same emotional problems of the previous week will persist. Sleep is the major problem now which can cause irritability and mood swings. Depression may even develop at this time.

Week 3 & 4: With the worst behind you, take heart that things will only improve. Sleep will become less of a problem, but not quite resolved. Most physical symptoms will have faded. The original indication for the use of alprazolam may recur, causing anxiety again. Cognitive behavioral therapy can be used to treat the presenting disorder. This stops the user returning to alprazolam. It takes 21 days for a habit to be learned and at this stage, the habit of drug abuse should be broken, though some minor signs of withdrawal may still persist for many months.

 

Many families are already fed up during the addiction phase that their support during withdrawal is lacking. This is the most important time for support; patience and empathy should be at the fore.

It is important to note that addiction is a chronic disease and there is always a risk for relapse. The user must have insight into why they abused the drug and why they should stop. The process of withdrawal is not an easy one and may not follow this timeline. Protracted withdrawal is not uncommon and about 10% of users report feeling some withdrawal symptoms for more than a year after they stopped.