Question: I've been taking around 4-6mg of Xanax for about 3-5weeks give or take. im trying to stop and have 10mg Valium to help counter the Xanax as well as Valerian root. supplements and vitamins. Any ideas anything else to do? I exercise an extreme amount 5 days a week at least...aerobic and anaerobic, sweating alot of toxings out as well as low body fat. I went to a detox befoer and was give valium, vitamins, and pheobarbitual. Is it possible to get prescribed that right now? THANKS!!!

Dr. David Sack Says...:

It is more dangerous to detox from alprazolam (Xanax) than from heroin.  You feel miserable with both but convulsions and death can occur in healthy people trying to come off of sedative/hypnotic/anxiolytic drugs like Xanax.  Don’t try this on your own.  At Promises we try to avoid using benzodiazepines like diazepam (Valium) and chlordiazepoxide (Librium) to detox from short acting benzodiazepines like Xanax and Ativan because clients find it very difficult to come off the treatment.  Other strategies that have been studied and recommended (although not specifically approved by the FDA) include using carbamazepine (Tegretol) or phenobarbital.  Each of these strategies has advantages and disadvantages but all should be used only under strict medical supervision.

Question: hi dr.sack, my name is jackie, i have a question: i am on 1 mg. zanax a day and i am done, i am starting to withdraw and it is painful. i have blurred vision, headache, stomach nausea, dizziness, can't sleep, seeing things. 2 years ago i tried to withdraw and had hallucinations so bad i didn't even know who i was. what can i do to make these withdraws easier? my dr. is not going to give me any more medicine?

Dr. David Sack Says...:

Hi Jackie,

I would advise you get medical supervision for withdrawal from Xanax - a qualified detox program can make this much more comfortable for you and will improve your odds of success dramatically. It can also be dangerous to withdraw on your own.

Please know that withdrawal/detox is not recovery - you will need ongoing support such as a peer support group or cognitive behavioral therapy.  I recommend you consider either a 12-step program or SMART recovery to build a support network.

Question: I have been taking xanax for 3 months. I really need to stop, but the withdrawls are horrible. I figured since i was only taking them for such a short period of time, the withdrawls would be only a day or two. I lasted 3 days of hell and had to buy on the street. Please tell me how long this will last if i stop now.

Dr. David Sack Says...:

Withdrawing from Xanax on your own without medical supervision is extremely dangerous. It is one of the toughest withdrawals.  A medically supervised withdrawal will be much less painful because they can give you substitute drugs temporarily during the withdrawal to lessen the symptoms. I strongly urge you to do this with medical supervision for your own safety.  Please realize that withdrawal/detox alone is not treatment for addiction.  You will need ongoing support. Cognitive behavioral therapy can be effective in helping you stay clean by helping you develop strategies to deal with anxiety.  Also, if you have an underlying mood disorder, there may be a nonaddictive medication that can help you to lessen your risk of relapse on Xanax. A proper assessment will be important for your long-term success.

Question: i have beeen taking prescribed vicodin for 3 years about 15- 30 mg max a day. I actually only took 4 to 5 pills a day several times. I am now at a 2- 3 5 mg pill habit. I take to feel better. I already have a mood disorder and wonder if this is making me worse and is suboxodene? an answer to stop or is it better to slowly decrease my dose of vicodin?

Dr. David Sack Says...:

First, it is important for you to understand that trying to detox yourself from Vicodin is usually not an effective recovery plan.  If you have a mood disorder, are you being treated medically for that mood disorder?   If not, you are simply masking symptoms of your disorder with an opiate.  Your first goal should be to get a proper assessment of your mood disorder and an effective treatment plan.

Suboxone may be an appropriate treatment for your Vicoden dependency, but I believe Suboxone is most effective when used with a therapeutic program (day patient/outpatient or residential) that helps you develop behavioral/coping skills to deal with your mood disorder.  This program should have a psychiatrist who understands addiction and co-occurring mood disorders.  Mood disorders can generally be treated with non-addictive drugs, and that will give you a much higher quality of life than daily Vicodin use.

Question: i have a brother in law who h\is addicted to achoal and presc. pills and he has hit rock bottom and im afraid he is going to OD he really needs some help is there a law in oklahoma where his faimly can admit him forceably

Dr. David Sack Says...:

You would need to contact an attorney for legal rights in your state. In most states it is possible to do a 72-hour hold if someone is a danger to themselves or others, but nothing much beyond that. 

Have you considered hiring a professional Interventionist who is certified? The right interventionist can make a huge difference.  

Question: i have went off all my meds because i have lost my health ins. so i had no choice one of them being xanax. anyway i guess im in withdraw and today is day 9. i just want to know how long before i'll feel better. my main problem now is feeling anxiety and sleeplessness, cant even leave my house without feeling like i have to pass out. im already stressed cause of my financial problems.

Dr. David Sack Says...:

The time
course of Xanax withdrawal is variable but typically it peaks I the first week
to two weeks and then declines after that.  Xanax withdrawal is medically
dangerous and can be complicated by seizures, delirium (confusion, insomnia,
hallucinations), panic attacks and hypertensive crises. Xanax  and other
benzodiazepines should come with a warning, “ Don’t try stopping this on your
own at home.”  You may be past the worst but people can have seizures and
other complications even after 2 weeks.  Given your symptoms, getting a
consultation from an ER or urgent care is your best option.  The medications
most commonly used to treat benzodiazepine withdrawal are all available as
generics and therefore relatively inexpensive.

Question: I dont abuse xanax,but I do feel like im addicted,ive taken half of a 2mg pill twice a day for three years,ive tried tapering but im still sick,what else can I do the anxiety and panic attacks are worst,but worst I feel like I may have a seizure and thats what I am afraid of.

Dr. David Sack Says...:

Xanax (chemical name alprazolam) is a benzodiazepine drug.  Even though you may not be abuse the Xanax, your body has become physically dependent on it after three years of use.  The amount you’ve been taking is definitely high enough to cause dependency and abruptly stopping it can cause severe withdrawal that begins as anxiety and insomnia but often progresses to seizures or even delirium.  You should seek medical help to safely come off of Xanax.

Xanax is generally not considered a first-line treatment for panic disorder and should not be used by itself for this condition.  Other treatments such as selective serotonin reuptake inhibitors (Prozac (fluoxetine), Paxil (paroxetine), Citalopram to name a few) are more effective and have fewer side effects long term.  Cognitive behavioral therapy (CBT) is also very effective either alone or in combination with medications.

Question: My fiance is detoxing this week after his tappering plan. He is coming off of hydros for back pain. This is his first day sober (with God's help he will achieve the whole day) and he and I are excited but very aware some things will be going on this week that can make him act very unlike himself. What all can he expect? What all can I do/should I say or not say to best support him without putting myself/our relationship in accidental harm's way? He is nervous but ready to do this. It was entirely his decision to come and be honest with me about the physical addiction I didn't know he had and to get clean.

Dr. David Sack Says...:

Even with a gradual tapering most people will experience withdrawal symptoms in the few days after they stop an opiate drug and this can continue for s long as two weeks. Bone pain, anxiety, insomnia, restlessness, and abdominal discomfort are common.  The most medically dangerous withdrawal occurs with sedative hypnotic medications such as Xanax (alprazolam) or Ativan (lorazepam) which people often abuse along with opiates.  Seizures and delirium can occur and medical supervision is preferable to going it alone.  Even after someone has been successfully detoxed from opiates it is very common for them to experience intense cravings and to want to go out and use. 

Your fiance’s chances for success will improve immeasurably if he finds a knowledgeable physician to supervise his detox.

He should also consider seeking professional help since detox is just the first step to overcoming addiction.  He should also consider getting support by attending 12 Step meetings where he will meet others who have overcome their addictions

Question: In the city I am living in, we are in a psychiatric crisis. We cannot recruit and keep enough psychiatrists to meet the needs of the community. As a therapist I am faced with trying to find suitable help for someone while they are put on a waiting list for a psychiatrist. I have some nurse practitioners who are willing to help as long as the needs are not severe (psychosis, etc). What is your opinion on referring to medical professionals that are not psychiatrists just as a bridge to recovery and wellness while awaiting appropriate psychiatric care?

Dr. David Sack Says...:

There is a shortage of psychiatrists in many places as the specialty has not kept pace with demand.  Over the last twenty years, primary care physicians (GPs, internal medicine, ob-gyn) have stepped in to provide treatment for patients with a range of problems.  As a first line of treatment, this approach makes sense and is consistent with other medicine specialties.  Primary care physicians currently prescribe 70% of antidepressants.  If the first treatment fails, referral to a psychiatrist is the logical next step.  

Question: I've been addicted to Alprazolam for several years now. Two years ago I decided enough is enough and started to taper off. I started at a dosage of 4.5mg 3x a day. I am currently at a dosage of .5mg 3x a day. I find it incredibly difficult at this stage. Due to the low dosages involved, I have resorted to a water titration method to detox myself. I have started with 200ml of water. I use 2ml of ethyl alcohol to dissolve the alprazolam so that I can more uniformly distribute it in the water (I read it is insoluble in water alone). I plan to remove 2ml of the solution every day until the solution becomes just 200ml of water and no alprazolam. Does this seem effective? Is there anything I should know doing it with this method? Is that too fast of a taper? Basically, what is your opinion of the water titration method?

Dr. David Sack Says...:

Because Xanax has a short half life, many people will experience withdrawal symptoms when  they get down to the dose you describe.  Successful detox from Xanax nearly always requires that the Xanax be replaced with a longer half life medication that prevents the withdrawal symptoms from emerging.  Seizures are not unusual in coming off of Xanax even when it is done gradually as you have.  I strongly recommend that you find a physician knowledgeable about Xanax detox to help you succeed in the home stretch and avoid medical complications.