Drugs Q & A

Do You Build Up A Tolerance To Xanax?

Most people think drug addiction, dependence, and tolerance are pretty much the same thing. But in fact, each term means something very different about how drugs affect a person’s body and brain. Learning the difference is important.

What is Tolerance?

Tolerance happens when a person no longer responds to a drug in the way they did at first. So it takes a higher dose of the drug to achieve the same effect as when the person first used it. This is why people with substance use disorders use more and more of a drug to get the “high” they seek.

What is Dependence?

Dependence means that when a person stops using a drug, their body goes through “withdrawal”: a group of physical and mental symptoms that can range from mild (if the drug is caffeine) to life-threatening (such as alcohol or opioids, including heroin and prescription pain relievers). Many people who take a prescription medicine every day over a long period of time can become dependent; when they go off the drug, they need to do it gradually, to avoid withdrawal discomfort. But people who are dependent on a drug or medicine aren’t necessarily addicted.

What is Addiction?

Unlike tolerance and dependence, addiction is a disease; but like tolerance and dependence, addiction can result from taking drugs or alcohol repeatedly. If a person keeps using a drug and can’t stop, despite negative consequences from using the drug, they have an addiction (also called a severe substance use disorder). But again, a person can be dependent on a drug, or have a high tolerance to it, without being addicted to it.

What is Xanax?

Xanax is a brand of alprazolam, a benzodiazepine that works by enhancing the activity of certain neurotransmitters in the brain. Generic Xanax is also available as the brand-name medications Xanax and Xanax XR. A generic drug is an exact copy of the active drug in a brand-name medication. Generic blue, green, and yellow Xanax are considered to be just as safe and effective as the original drug but tend to cost less.

Xanax is prescribed for the treatment of anxiety disorders and anxiety caused by depression. Xanax is also used to treat panic disorders with or without a fear of places and situations that might cause panic, helplessness, or embarrassment (agoraphobia).

Xanax is a federally controlled substance (C-IV) because it can be abused or lead to dependence. Xanax should be kept in a safe place to prevent misuse and abuse. Selling or giving away Xanax may harm others, and is against the law. Tell your healthcare provider if you have abused or been dependent on alcohol, prescription medicines, or street drugs.

Do you build up a tolerance to Xanax?

Yes, your body may develop a tolerance to Xanax in as little as 2-4 weeks after you start taking the drug, as the body and brain attempt to overcome, or workaround, the drug’s effects (also known as neuroadaptations). The tolerance or “tolerance withdrawal” phenomenon is often how patients initially discover that their Xanax is making them sick.

Tolerance to the many effects of Xanax develops with regular use. When this happens, the original dose of the drug has progressively less effect and a higher dose is required to obtain the original effect. This has often led doctors to increase the dosage in their Xanax prescriptions or to add another benzodiazepine so that some patients have ended up taking two benzodiazepines at once.

Xanax is formulated for the short-term treatment of anxiety and depression. The Food and Drug Administration (FDA) approved Xanax for very short-term treatment for most conditions. Eight weeks is the maximum amount of time they should be taken, specifically to treat panic disorder. Most physicians or therapists will prescribe Xanax for “as-needed” treatment.

Long-term use of Xanax induces a true chemical dependence as well as psychological dependence. Sudden cessation after long-term use can lead to seizures that can be fatal. Death from accidental acute overdose is uncommon. More often, people die when they perform dangerous activities, such as driving while under the influence, or when they combine Xanax with alcohol or another sedative.

What’s the difference between Xanax tolerance and Xanax dependence?

The difference between Xanax tolerance and Xanax dependence has to do with how the body reacts to the presence or absence of a specific drug.

With Xanax tolerance, certain cell receptors in the body that activate when the drug is present stop responding like they once did. Your body might clear Xanax faster, too. Scientists still don’t fully understand exactly why this happens in some people.

With Xanax dependence, if Xanax isn’t present or the dose is suddenly reduced, you might experience withdrawal. This means the body can only function normally when Xanax is present. It can happen with many drugs. In some cases, dependence can lead to addiction.

If your body is dependent on Xanax, it’s important to not abruptly stop taking it. Your doctor will put you on a schedule to gradually ease off the drug to avoid withdrawal symptoms. They can also recommend resources to support you.

Tolerance and dependence are different from addiction which is a more serious condition.

Can Xanax lose its effectiveness over time?

Studies have shown that as tolerance develops, Xanax actually becomes less effective and will stop treating those emotional disturbances in an effective manner. Individuals who start using Xanax in larger doses are more prone to becoming addicted sooner, but most can fall prey to dependency in a month or less even on small doses.


Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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