the Xanax episode: a critical conversation about the dangers of benzodiazepine abuse and addiction with Dr. Nzinga Harrison
Host: Brenda Zane, brenda@brendazane.com
Instagram: @the.stream.community
The Stream Community: private (not on Facebook) support community for moms of kids experimenting with or addicted to drugs or alcohol
Free ebook: “HINDSIGHT: 3 Things I Wish I Knew When My Son Was Addicted to Drugs, by Brenda Zane. Download here
Guest: Dr. Nzinga Harrison, Chief Medical Officer at Eleanor Health and podcast host of In Recovery
Show Resources:
Show Transcript:
SPEAKERS
Brenda Zane, Dr. Nzinga Harrison
Brenda 02:38
Hello and welcome back for another Hopestream episode and guess who I have on the show today? Dr. Nzinga Harrison, who joined me for the now infamous marijuana episode which is number 46. If you haven't listened you must do that. Dr. Harrison is back with me to talk about all things benzodiazepines. But most importantly, we are doing a deep dive on Xanax both prescription and illicit forms, which is unfortunately what most young people are taking today. I am just going to say that if your son or daughter is experimenting with pills, or if you know they're taking pills, you must, must listen to this whole episode. There are some truly life-changing implications from taking and being addicted to Xanax the Dr. Harrison shares that you need to know.
For some quick background, this amazing doctor is board certified in psychiatry and Addiction Medicine. She is the co founder and chief medical officer of Eleanor Health which offers comprehensive substance use disorder care. And they have locations in North Carolina, New Jersey, Massachusetts, Washington, Louisiana, Ohio, and they also have virtual support. So be sure to check out Eleanorhealth.com and I will put a link in the show notes as well. In addition to her medical career, Dr. Harrison also hosts her own podcast called In Recovery, which is hands down one of the best podcasts out there talking about all forms of addiction, not just drugs and alcohol. So check that out. And she's just an all-around rockstar. So with that, please listen to this incredibly, incredibly important episode about benzodiazepines and Xanax with Dr. Nzinga Harrison.
Brenda 04:32
Welcome back Dr. Nzinga Harrison to hopestream I'm just thrilled to have you back and I was telling you a few minutes ago we had a couple of requests after your marijuana episode, which I just called it the marijuana episode because it was so good. That's all I needed to call it. And listeners wanted to have a pocket sized version of you to carry around with them to talk to their teenagers. And then they said can you please do an episode on Xanax? So Here we are. So welcome back.
Dr. Harrison 05:02
Thank you so glad to be back. And just so that your listeners know a pocket-sized version of me comes with a full-size version of my appetite for sweets.
Brenda 05:15
what's your favorite sweet if you had to only pick one
Dr. Harrison 05:18
Oh my goodness. okay, let me see, Strawberry Shortcake, fresh strawberry whipped cream, super soft bunt cacke and now I'm like on a Fantasy Island, right?
Brenda 05:30
Oh, I know. And when strawberries are in season, they're so good.
Dr. Harrison 05:34
Oh, goodness,
Brenda Zane 05:35
Yum, yum. All right, well, we have so much to cover and so little time. So we'll just dive right into it. But I thought it would be helpful for you to just start us off with an understanding of what is a benzodiazepine, and why Xanax, in particular, seems to be the one that is kind of rising to everyone's awareness, and especially those of us with teenagers.
Dr. Harrison 06:01
So a benzodiazepine is quote unquote, a downer. So it's a sedative, and it's a group of medications. That includes Xanax, like you mentioned also Valium, Ativan and Klonopin, there are others, but those will be the most common, and what they do, there's a neurotransmitter in your brain called and throughout your body, called GABA. And GABA is basically the brakes. And so GABA decreases electrical activity decreases chemical activity throughout your brain in your body. And it's the exact same receptor that alcohol works on. So I always tell people, you can think of benzodiazepines as alcohol in tablet form.
To the second part of your question, why is Xanax in particular, so widely prescribed? There are a few reasons. So Xanax is one of the newest branded benzodiazepines. And so it's important that it's branded because then what you had was pharmaceutical reps, going around to doctors offices, explaining why Xanax is the best for anxiety, and that it's not dangerous and why you should use it. And so part of why it's so widely prescribed in US is because it had a sales engine behind it. Most recently, unlike the other benzodiazepines, which were older, their sales engine came before that.
And the other reason is, because of all the benzodiazepines, Xanax is the one we have that comes on the quickest. So you feel it the quickest, you hit the peak, the quickest. And it comes off the quickest. And that informs addiction in two ways. The faster you can feel a substance, the more addictive it is. But also the shorter the half life and the faster you fall off the cliff, when it gets out of your bloodstream, the worse the withdrawal symptoms. And so the faster the high, the more your brain is reinforced to chase that high. And the worst of withdrawal symptoms, the more your brain is reinforced to avoid those withdrawal symptoms. And so Xanax is the perfect storm for addiction because it comes on so fast. And it comes off so fast. It's reinforcing on both sides of that formula.
Brenda 08:35
Oh, yikes. That's interesting. So I imagine that was created on purpose, though, I mean, there must Is there a positive to that kind of half-life? Like I'm trying to imagine why that was created the way it is.
Dr. Harrison 08:49
Yeah, absolutely. And so it's it's not I at least I don't believe there's nefarious intent that says we're creating this to be the most addictive benzodiazepine that exists. But it is, you know, Xanax is like marketed for panic attacks. Panic attacks come on fast, and they disappear fast and so if you're having a panic attack and the panic attack is gonna peak usually within five to 10 minutes, then it doesn't quote-unquote help to have a medication that takes 30 minutes for you to feel the anti-anxiety effect. And so the faster it comes on, the more quote effective it is for panic disorder, which is true. The shorter half-life the thinking is like the shorter it's in your system or in your bloodstream, the less long term consequences you'll have, right so there's, there's thinking around manufacturing, a medication to perform like this, but unfortunately, this performance drives addiction and honestly like the dangerousness of Xanax withdrawal which kills people is really by that short half-life as well.
Brenda Zane 10:06
I didn't know that it was created for panic attacks because it seems like it's prescribed for just general anxiety or I was prescribed it when I couldn't sleep because my son was addicted to it, which is really ironic. You know, I'm going to the doctor saying my kid is addicted to drugs and I can't sleep and they hand me a prescription for Xanax. And like, I'm pretty sure I shouldn't have that in my house, because that just seems wrong. So I was doing some research and getting ready for this. And I read that and I just want to check this that in 1996, there were 8 million prescriptions written for Xanax and in 2017, over 25 million, is that right?
Dr. Harrison 10:48
Yeah, that is right. And thank you for pulling that statistic. Because this is like a huge education campaign that's going on for medical practitioners right now. It's like, Xanax is extremely dangerous. Do not prescribe it under any circumstances, it is not standard of care for anxiety, because that's how it came to be known. And so the pharmaceutical effort really was to primary care doctors, right? So there's not, they're very few you talk to a psychiatrist, like literally, I'm a psychiatrist. We literally hate Xanax. As soon as we see it, we're like, oh, goodness, this is the hardest benzo to get off of the hardest benzo to pull down the dose, it's like, everything about Xanax is the hardest.
But it's marketed to primary care, it works fast for anxiety, which helps people fall asleep. And they're not going to be hung over and groggy in the morning, which is true, it works great for panic disorder, the majority of which is taken care of by primary care doctors, not by psychiatrists, which is true. And the same way, like is literally the exact corollary for when these opioids came out. And it was like, you know, how the majority of your practice can't sleep? You know, how the majority of our practice has pain, and you haven't been able to help them with that. Here's something that helps, and it helps immediately, and it's safe. And that's how you get that's how you have that what did you just describe like a 4x 5x increase in annual prescriptions?
Brenda 12:23
Yes, that's fascinating. And I think this may be a tangent that we don't have time for, but with the level of anxiety that because that's just what I hear over and over and over, especially, you know, the listeners of this podcast are mostly parents of teenagers and young adults, that are feeling so much anxiety about the world, just for all kinds of reasons, social media, and you know, pandemics and things like that. And so it just seems like wow, maybe we're focusing on a very quick medical fix to something that doesn't necessarily need a pill. Do you know what I mean? Like, why so much anxiety is like, everybody has so much anxiety and we're just putting a prescription to it. Again, maybe a tangent that we don't have time for but it that's what just keeps striking me.
Dr. Harrison 13:16
That is not a tangent. And we need to take time for that because you and I will be elbowing each other for not enough room to stand on this soapbox, I guess.
Brenda 13:28
We'll just make a bigger box.
Dr. Harrison 13:30
We are so intolerant of anxiety and discomfort. And we live in a fix it with a pill society, even from the time like think about even just when you're little and you fall and you hurt yourself. And it's like, oh, let's take a Tylenol for the pain. Or you, you get a cough. And it's like, oh, let's take some cough syrup for the cough. Or you get a sore throat and you go to urgent care and then you're upset because they didn't prescribe an antibiotic. They said go home and rest and drink soup. And you're like, that's not what I came here for. I came here for an antibiotic, right? Like we're such a pill, fix it right now type of society.
When if, for example, mindfulness, and distress tolerance was part of our academic curriculum starting in preschool. And we could deal with anxiety and sit in anxiety and accept anxiety and be able to understand that anxiety is not in and of itself deadly. Right. And then there are definitely anxiety disorders. And so I want to carve out a special place for those that we have to think differently but the normal anxiety of life and how we could be approaching with connection and compassion and mindfulness, but that's not our orientation in this country. Our orientation is take a pill, fix it to make sure you can go to work to make sure you can go to school.
Brenda 15:15
And I remember my son coming home from his first treatment program, and he said, he know that he had done a lot of work. And he learned a lot. And he said, mama, how come no one ever taught me any of this? And I just thought, Oh, my gosh, that's so true. nobody teaches you how to deal with things that are stressful and anxiety. I mean, maybe I think now, maybe some schools are starting to, but it's definitely not the general, you know, path for education to say, okay, when you get into seventh grade and eighth grade, it's going to get really confusing, and it's kind of really stressful. And here's, here's a way that you could deal with that. Because the kids are gonna find these, you know, these drugs, when they don't have any anywhere else to, like you said, to sort of have that distress tolerance that is not destructive to their bodies.
Dr. Harrison 16:10
That's right. That's right. And like, just imagine if we valued coping skills as much as we value math,
Brenda 16:19
right?
Dr. Harrison 16:23
And the other side of that is that our kids are dealing with a lot. And I mean, like, there's so much just difficult childhood experiences that our kids are dealing with. And so you know, you have it stacked against them on that side. And then we're kind of our generation and generations before us raised without a tolerance for emotion. It's a double whammy. And of course, you find either you find Xanax or you find alcohol, or you find cigarettes, or you find another drug. And it works.
Brenda 16:57
Yeah. And well, especially when there's one designed specifically to work so well.
Dr. Harrison 17:03
Literally why it was created. Yes.
Brenda 17:05
And the other thing, I think that's hard for parents with Xanax and I say, Xanax a little bit generically, but I don't necessarily mean x. I know kids are also finding, you know, Valium, and stuff like that. But you don't smell it, because it doesn't smell like alcohol, you don't necessarily see the signs, I think a lot of parents can fairly easily tell when their kids are or have been had been smoking marijuana. But with a benzodiazepine, maybe it's a little harder to tell, and you just like your kid is fairly calm. Maybe that's this, this signal that, you know, they're taking something if they are kids who are anxious and have a lot of anxiety.
Dr. Harrison 17:48
That's exactly right. And so one of the things we're talking about adolescence, what we're always looking for is a change, right? So you know, you know who your child is, you know, how your child interacts with you, you know, how your child interacts with the outside world. And so when you see a change, because you're right, you can't smell it, you can't taste it, they're super small pills, so you're probably not going to be able to find it, right. And what happens is that when a kid first starts taking Xanax, and Xanax is probably not the first drug that a young person tries, like, it's probably in concert with other things. But when they first start, anxiety is going to get better. And you're going to notice your own relief. I like wow, my child seems like they're doing better. But ask yourself, have we made any intervention? Is this getting better? Because like, any change, you should be able to say, I think this is probably what's contributing to this change. This is the work we've been putting in this is how we've been doing things differently.
So like, if you see that that's the calm before the Xanax storm. Because Xanax turns into an addiction, which it does very quickly, because it comes on so fast, and it comes off so fast. So you actually, even before the addiction develops, you start getting those withdrawal symptoms in between doses, you get what we call, rebound anxiety in between doses because it comes off so fast. And then that drives the need to take the next pill, the calm before the storm is like oh, they seem they can tolerate things more. They're not as irritable. They're sleeping at night, also sleeping during the day. They just seem so calm, and then you'll be like they seem too calm the days even, out of it kind of zombie-ish. And then you'll start to see kind of like the behaviors that come around addiction, like oh, now we're finding more irritable, not you know, grades are slipping, not connected with the same friends. They were connected to. Not talking the way we used to talk, that's kind of like the progression that you will see with Xanax or other benzo's.
Brenda 20:07
Yeah, that is so good to recognize because I can see how that would be like, oh, wow, things are turning around. And parents are always so hopeful that things are going to self-correct. So that's really smart to say, okay, well, what else is going on that we've been doing to cause that positive change? And how long does it take? So are we talking like days or weeks or months, just maybe you can give us an idea of somebody starts taking and I'm going to add the caveat right now that for the moment, we're talking about real prescription level Xanax, then we will switch over to what's next. But let's say a kid is sneaking into his medicine cabinet, and getting actual real prescription Xanax and taking, you can tell us what a normal dose would be? What does that progression look like to the point where somebody is going to start feeling that dependence and those withdrawal symptoms?
Dr. Harrison 21:00
Yeah, so a normal dose, like if you get prescribed is probably going to be 0.5 milligrams. And it'll usually be prescribed between one and three times per day, as needed. Right, not as a standing dose, not like just take it three times a day,
Brenda 21:16
not like vitamins,
Dr. Harrison 21:17
not like vitamins, as needed is usually how it starts. And that will usually progress to oh, I know it was prescribed as needed, but I needed it twice every day. So then it's like, okay, well then just take it twice a day. And then it's like, well, with benzodiazepines, just like with alcohol, they're working on the same receptor. The more regularly you use it, then you develop a tolerance to it is the same for everything that we put on our bodies, but drugs specifically. And so then it's like, oh, I used to take it once a day. But then I started having anxiety later in the afternoon, so I started taking it twice a day. But then I couldn't go to sleep. So then I started taking it three times a day. But then I was taking .5mg three times a day, and it wasn't giving me the same effect. So now I'm taking one milligram three times a day instead of 0.5 milligrams, because Xanax comes on so quickly, and you develop tolerance to Xanax very quickly. And Xanax comes off so quickly. So you clear your bloodstream from it so quickly. And that causes the anxiety symptoms to rebound in between doses.
The time from starting Xanax to developing an addiction on Xanax varies based on a lot of different factors. But those factors can make it very short, as short as two weeks, as short as two weeks. And so think about, the more severe your anxiety is, will put you at higher risk because you take that first Xanax, and you experience a bigger sense of relief than a person that had mild anxiety, right? Like my anxiety was three, I took a Xanax, I was like, oh, I feel better. My anxiety was 10. If my anxiety like literally was suffocating me, I take a Xanax. And it brings my anxiety down immediately, the brain says we need that to survive. And so the more for an adolescent with very high anxiety or very high depression, or who doesn't sleep in that first day next puts them to sleep or, you know, chaos and strife in the home. Like the more that is the shorter the window to addiction to Xanax.
Brenda 23:36
Got it. And it is so amazing, like point five milligrams that just seems so tiny, that can have such a huge impact.
Dr. Harrison 23:45
Well, let me put that in context for you because we have this thing called benzodiazepine equivalence. So the longer the half-life, and the slower a benzodiazepine comes on, the less risk various for addiction there's risk for addiction with every single benzodiazepine. Before example, Klonopin comes on slow comes off slow, right? And so often, if I'm helping a person detox from Xanax, I will make the transition to a Klonopin or a Valium so that I can taper it with a slower kinder, gentler on off-ramp. But .5mg of Xanax like sounds so small, that's the equivalent of 10 to 20 milligrams of Valium. So it sounds small, but it's just because it's so potent. That's the equivalent of 25 milligrams to 50 milligrams of another benzodiazepine we use called librium. So don't be fooled to think that 0.5 is a small number. 0.5 milligrams of Xanax is a significant dose.
Brenda 24:56
It's like the little pods that you get of the laundry soap that you're like, can this little thing, clean all my laundry is like that is like the concentrated version it sounds like.
Dr. Harrison 25:05
That's exactly right. That's it.
Brenda 25:07
Holy cow. That is really scary. Okay, so I just want to make sure that people understand right now what we're talking about is legal prescription Xanax, which, if you have a teenager who's taking Xanax, there is probably a 99.9% chance that it is not legal, coming from a pharmacy, Xanax. And that is, that is a huge concern for a couple of reasons. One, it's probably got fentanyl in it, two, if it says that it's a one-milligram pill, it's probably not because really nobody's measuring that when they're producing fake Xanax pills. And you never know who what else is in there. Like you mentioned on the marijuana episode about, you don't know what's in there. You know, you got you're doing drug tests and finding all kinds of crazy stuff in these. So maybe we can talk about that a little bit and how so Xanax on its own sounds really dangerous. And then now we have this illicit Xanax that's in the market that kids are getting their hands on. So maybe we can just chat about that for a little bit.
Dr. Harrison 26:15
Extremely dangerous, because they can make these pills look exactly like the real Xanax and you put your finger right on it. First of all, it can be laced with anything. The most dangerous thing that is lacing everything these days is fentanyl. And benzodiazepines in and of themselves cause what we call respiratory depression. So they actually just like centrally in the brain, decrease the drive to breathe, opioids do the same thing. So that is the mechanism of opioid overdose death is that the opioids just in that part of your brain, suppress the drive to breathe and you just don't breathe. And then you died from just not breathing. And so when you add the respiratory depression of Xanax, which has it in and of itself as part of its own chemistry and physiology, to the even more potent respiratory depression of fentanyl, the combination of those two is the most deadly combination we have for accidental overdose.
Brenda 27:24
And often I know this from my son's experience, they're taking it with alcohol, and they've also been smoking some marijuana. So I think that's probably the, I was going to say trifecta, but it's four. So I don't know what that word is. But it's the marijuana, alcohol, Xanax, laced with fentanyl. Like that is just a death sentence.
Dr. Harrison 27:48
It's a death sentence. And to be clear, marijuana is not meaningfully contributing. So we can call it the trifecta or if you want to call it the quad factor too.
Brenda 28:00
Is that the word? quad-factor?
Dr. Harrison 28:02
No, I totally made that up.
Brenda 28:03
Okay. I'll go with it. You're a super smart doctor, I'll believe you.
Dr. Harrison 28:09
It is now official. But alcohol, remember I said benzodiazepines are alcohol and pill tablets? Yeah, alcohol suppresses respiratory drive. Xanax suppresses respiratory drive. fentanyl not only suppresses respiratory drive, but also has makes other anatomic changes that make it even harder to breathe. So it's making it harder to breathe at the same time. It's centrally in the brain suppressing the drive to breathe. And when we use Narcan to try to reverse that overdose Narcan doesn't work for Xanax and alcohol. Right? So like incredibly, incredibly dangerous and I know we kind of bifurcated our talk into like prescription Xanax, unless you are getting that Xanax directly from the pharmacy. Even if somebody says this is my prescription, and they show you the prescription vial and they're giving you pills out of it unless you got that Xanax directly from the pharmacy yourself. The chance that those are, let's say illegitimate,
Brenda 29:22
illegitimate, illicit...
Dr. Harrison 29:25
those are fake Xanax is extremely high because they're just so common on the street. And so a lot of our young people will like draw comfort, because their friend brings a vial and says like, oh, these are the Xanax that is a reused vial with some different pills that got put in that vial and we have no idea what's in those pills. That is playing Russian roulette.
Brenda 29:52
Exactly. And, for parents to know that your child doesn't have to be addicted to anything. To die of an overdose of fentanyl and Xanax because it could be the first pill they ever take. So I think there's also this misperception that oh, my kids not addicted, right? They're, they're fine. They're just they party here and there. But these parties that these kids go to which this just terrifies me, is there's a big bowl of pills in the middle of the table. And the game is to see how many you can take before you black out. So it's not that your son or daughter has to be an addict, let's say that it can be the very first time they ever take a pill and, and when their heart stops, that's it. That's the first and last pill that they can ever take. So that's really important.
Dr. Harrison 30:46
It's so important. And as a matter of fact, Brenda, the kids who are not addicted are somewhat at increased risk because of lack of tolerance. And so if your child has been using Xanax for months, and they go to a pill party, and they take 10 Xanax, they have a tolerance built up to Xanax, right, this other kid who's brand new to the party and has never taken Xanax before, 10 Xanax is a deadly dose for them.
Brenda 31:21
Yes.
Dr. Harrison 31:22
Oh, and let's not even add in fentanyl, right, fentanyl with zero opioid tolerance, like that kid is at really, really high risk,
Brenda 31:33
right? Or a kid who's just come out of treatment. A kid you know, a young adult who's just come out of incarceration. The same thing with the tolerance, I think is important to know.
Dr. Harrison 31:48
Exactly right. I actually just lost a childhood friend, three weeks ago now. He was discharged from jail and overdose the second week. So that's exactly right.
Brenda 32:02
I know that kids talk about and they have these Xanax bars. And what I was wondering is that actually a thing? Or are those just fake? Like, is there a real Xanax bar that you can get from a pharmacy? Because I see this all over? It's kind of in also like the rap culture and all over social media, these bars? what's the deal with Xanax bars?
Dr. Harrison 32:28
Yeah, so that's actually Yes, that is a real thing. So Xanax comes in different pill sizes, like all medications. So they come in 0.5 ones and twos. And the 0.5's are like little circular tablets. And the twos are shaped like a bar that has three different sections to it. And so when they say they're taking Xanax bars, that's like the two milligram size dose.
Brenda 32:58
That's like throwing 10 tide detergent pods in your washing machine? Like that is crazy.
Dr. Harrison 33:05
That is correct. So when they say they're taking bars, and like multiple bars, remember, I was telling you about the benzodiazepine equivalence ID and how potent these are. Two milligrams is a is a big dose of Xanax.
Brenda 33:23
That's huge
Dr. Harrison 33:25
Yeah, that's what they're referring to is the larger size tablet, 2 milligram.
Brenda 33:29
And so are, these are just super tactical questions. But I know parents want to know this. Do kids just take Xanax or can it be smoked or snorted or what's what's sort of the the use scenarios,
Dr. Harrison 33:45
all of the above, so typically, Xanax uses and this kind of follows the same trajectory for other drugs, you start with the least invasive method, and then as addiction grows, move to the more invasive method, and I'll describe why that's the case. So typically, Xanax use is going to start by just taking the pills, right? When you take the pills, it goes on your stomach, and then your liver clears out some of the dose that is called the first-pass effect. And it has to take a while to get in your bloodstream and get up to your brain and still Xanax comes on really fast. But that is the slowest high, that's the slowest intoxication is swallowing something.
Okay, then, as that addiction starts to build, and you need the intoxication effect to come on faster, you crush it, and you snort it. Because there are so many little blood vessels in your nose, and that delivers to your brain very fast. So that gets the intoxication peak even faster. And then as you develop more addiction, and these could probably go in either direction. You've already crushed it like you said, you're already smoking marijuana so you put it in your joint or in your blunt, and you smoke your Xanax as part of your marijuana. And your lungs are the most vascular, like the most number of blood vessels you have immediately distributes to the brain. Superfast high. This is why smoking cigarettes is so addictive with delivers to the brain so fast smoking anything. And then the next invasive is that IV, that's the fastest to get in the bloodstream is just to put it straight in with a needle. And so you crush it suspended in some water to make it a liquid, draw it up in syringe and inject it directly into the vein. And so Xanax is used in all of those ways, typically in that progression as addiction is getting worse.
Brenda 35:46
Okay, that's helpful to know. So if you're a parent, you're finding powdered that's a different sign potentially then if you're just finding pills, I wanted to go back to just reiterate that because Xanax is a benzodiazepine, not an opioid Narcan is not going to help if it's just Xanax.
Dr. Harrison 36:13
That's right. That's right. But so I don't want that message to be misconstrued as don't try your Narcan. Because the chance that even though we think it's quote, just Xanax, per all the conversation we had a minute ago with everything, like put the Narcan in, like error on the side of Narcan but if it doesn't work, then it's because it's Xanax, yeah.
Brenda 36:41
Okay, that makes sense. So even if somebody has Xanax that's mixed with fentanyl, the Narcan still can work. It's because it's working on the fentanyl.
Dr. Harrison 36:53
That's right.
Brenda 36:54
Okay, I just wanted to make sure that that that we cleared that up, so yeah, different classes. So because Xanax is a downer, and opioids I mean, is are somebody more susceptible? Do you think to moving from like, I'm 17, 16? I pop a couple Xanax at a party. I'm like, oh, that feels pretty good. Like I really like that. Do you think I'm more susceptible to move then to an opioid or to heroin because it's the same thing versus like a meth or cocaine, which to me, I'm speaking from absolutely zero personal experience. Because those are more like uppers. What do you think the path is there? Is there no path is just like people just do what they do.
Dr. Harrison 37:34
Yeah, you're exactly right, cocaine and amphetamine and methamphetamine are uppers. So we call them stimulants. Benzodiazepines are sedatives, opioids are in their own class, but they are downers right. Like they slow things down and treat anxiety. And so it's always interesting to me this language, it was a person's drug of choice. I say like, actually, the brain makes that choice because a person who has severe anxiety is more likely to get addicted to a Xanax or an opioid than a person, maybe with untreated ADHD. Because they're going to get their relief from a stimulant that pulls their thoughts together in a line where the person with anxiety may use a stimulant, and it makes the anxiety worse. And so like the brain is not going to choose that because it doesn't bring relief.
And so yes, I think there is unfortunately though, all of these drugs kind of like run together in in the street. And so sometimes it is starts with a benzodiazepine starts with Xanax, which is a lower bar, like I was saying, we all get trained into taking a pill to make us feel better from very little. And so taking Xanax is a very low bar, it's a pill, it's a prescription medication, a doctor wrote a prescription for it, that is a much lower bar to jump over. Then for example, heroin, right? So right, like the perceived is just is very different on those things. But sometimes, it will start with Xanax and progress to heroin. Sometimes they start all together. Sometimes a person will have an amphetamine addiction. And then they amphetamine is driving so much anxiety and paranoia that they use the Xanax to take the edge off of that. Sometimes they're intentionally using, you know, a cocktail to intensify. And so it can be hard to know. But there are definitely brains that get relief from sedatives and opioids, and there are definitely brains that get relief from stimulants. And so those are the risk factors for those brains, but there's everything in between.
Brenda 39:52
Okay, that makes sense, it kind of depends on who how you are as a person.
Dr. Harrison 39:58
Oh, I want to tweak your language, I want to tweak your language just a little bit there? Yeah, not who you are as a person so much as what your baseline brain chemistry is.
Brenda 40:10
Good distinction. Very good distinction. Yeah. It's not a personality default.
Dr. Harrison 40:16
Yes, ma'am, now you feel me.
Brenda 40:18
See, you're teaching me all kinds of things. That's awesome. Yeah, I know, I love that because it is language is so important. So, so important in this to avoid some of that shame, because it is really, really hard.
Dr. Harrison 40:35
Yep. And I mean, even like, I look at my own family history of addiction. And so the education that I've given my kids is based on our family history, your highest risk of addiction is to a stimulant. Hmm, okay. Right. Like if your brain was gonna choose, it's probably because I believe there's a significant amount of untreated ADHD and my family, also, right. And so that's like, ADHD is like a stimulant deficit. And so you spend your life kind of with anxiety coming from chaotic brain. And then you do that first line of coke, and everything clears up, and you're like, whoa, this is the sense of relief, I've been looking for my whole life. Whereas on the other side, tons of anxiety, definitely drives alcohol use disorders in my family also. And it's like, you didn't even realize you're suffering with anxiety until you took that first drink. And you're like, this is the relief I've been looking for. Right?
Brenda 41:38
So that's a good segue, actually, to having conversations with our kids, because so many parents, especially during COVID, have seen maybe it wasn't as apparent before, but now we are up close with everybody in our families. And they're seeing like, oh, my kid has got a lot of anxiety. And maybe we could talk about what does that look like? So if I'm a parent, and I'm seeing like, what would I be seeing that would tell me like kid has anxiety? And then I love how you said that, like, you're so specific with your kids about, you know, your brain chemistry might make you more prone to XYZ. Like how there's so many parents out there, like, oh my gosh, I know my kids taking Xanax, but in a way it's kind of helping them. So how do you have the conversation? And then what would be an alternative, especially for a young person? 15, 16, 17, who is genuinely feeling that anxiety, but the parents saying okay, we got to do something other than Xanax, because this clearly is not a good solution.
Dr. Harrison 42:45
So I think one of the more common ways, or maybe I'll say two of the more common ways that we see anxiety in adolescence is irritability. And so we think like, oh, you're just a pain in the you know what, and it's anxiety. Like, why is everything so difficult anxiety. Another way that we see anxiety a lot in adolescence is isolation. And so that can be difficult to tease apart, right? Because adolescents don't want to hang with their parents in general.
Brenda 43:17
Definitely not.
Dr. Harrison 43:20
But it goes back to this idea, like, if you see a change in your young person, and we know that adolescence is a critical time with so much going on biologically, electrically in the body psychologically in the peer system, and then COVID on everything else on top of that. And so I definitely looking for like new peaks, and irritability and new peaks and isolation are two big signs of anxiety and our young people in terms of having the conversation, I want everybody to start having the conversation about drugs with their kids at three years old. And people always think every time I say that people are like, you know what, I believed everything you said up until, like, exactly.
Brenda 44:08
If only we could rewind, but for anybody who's listening, who has three year old, listen up
Dr. Harrison 44:16
And it's not just “say no,” right? It's really it's, and it obviously varies by age. But so talking about adolescents, it's really like, listen, I know that it is at this point in time that drugs start to look attractive, they start to look attractive because the peer group and other people using this to look attractive because I know you're struggling with things because you know, there's a lot to struggle with. And so, if you have addiction in your family, like don't keep that a secret, right? Be like biologically our family history. My DNA that I gave to you has put you at risk, right and so this is how we mitigate the risk. And like, I talked to my kids and I say, this is the change that I see in you. Or do you see this change in yourself? This is what I think I'm seeing, always from like, I'm worried about you. And I'm not trying to stop you from experimenting and living your life because that's important. I am trying to, if at all possible, stop a tragic, awful illness from getting a hold of you. And so, if you're prescribed Xanax, so anxiety is always already an issue, my presumption is that you are not getting that from a psychiatrist. If you are, leave.
Brenda 45:42
Call Doctor Nzinga Harrison,
Dr. Harrison 45:47
That is not the recommendation, right? The recommendation for anxiety and adolescence is going to be therapy, if you have to do a medication and SSRI staying away from benzos as much as humanly possible. And so like, get a therapist, try to be working on what the what the social aspects of life and meaning and purpose and connectedness and compassion and acceptance, and a psychiatrist. So psychiatry is not easily accessible, I understand that. And so their psychiatric nurse practitioners, my recommendation is to see a psychiatric physician to do a full psychiatric evaluation. If you can see a psychologist that's even harder to get like a full psychological evaluation and have both of those pieces of data. So we can really put together a nice well-rounded plan for the young person. But Xanax, any benzodiazepine if you're on Xanax then at least like harm reduction, you know, as my thing, try to move to a longer-acting, try to move to an Attavan, try to move to a Klonopin. Really, though, you don't want it anywhere, at all, because it's just dangerous it just is.
Brenda 47:02
And if you are, so if your parent your you know, your kid is and you've opened the conversation, you're saying, okay, I listened to this podcast, we really need to get off of this. Let's deal with the anxiety. But from a medical standpoint, from a physiological standpoint, it doesn't sound like it would be a really good idea to just stop taking it. Whoa,
Dr. Harrison 47:22
what would somebody do? What would a parent Do you know, your kids taking it but they're, they're like, Okay, I'm willing to work with you here. What would they do? You have to get medical support. Okay? Xanax, withdrawal is one of his Xanax. Withdrawal is the deadliest benzodiazepine withdrawal that we have. And so not only do you get kind of like that peak and anxiety symptoms, but your blood pressure gets high, your heart rate gets high. For those who develop a complicated withdrawal syndrome. They develop the DT'S, where you start hallucinating, and get confused. And then Xanax often causes withdrawal, seizures, and withdrawal seizures can turn into coma and death. So cold turkey from Xanaz is not an option. Period.
Brenda 48:09
Does not sound like a good option.
Dr. Harrison 48:11
Is not an option, period. So you have to engage a medical professional. And this typically like benzodiazepine tapers, and discontinuation is the expertise of the psychiatrist. And not all psychiatrists, but definitely psychiatry like that is what our specialty is, or if you can find an addiction medicine doctor, then they will also have comfort in doing what it will be is a benzo conversion to one of those longer-acting benzodiazepines, and then a taper from there, whilst putting together all of those other interventions for anxiety that are not benzodiazepine.
Brenda 48:55
Right, because you don't want to just take away the drug and just leave like, okay, there you go, good luck with that.
Dr. Harrison 49:03
Good luck. Good luck with your anxiety, right.
Brenda 49:06
But that's really interesting to hear. So psychiatrist, because I know like in the medical profession, that all makes sense to all of you. But to those of us who are not, we're like, all these doctors names are so confusing. So you want a psychiatrist who can help you with the medication taper. So does that mean that you wouldn't necessarily have to like, I think parents always think I gotta send my kid off to some 30 day residential treatment program in Southern California by the beach, and they have yoga therapy. And, you know, maybe that is one way, but is it also something where you can work with the psychiatrists to taper the medication and still continue with your life?
Dr. Harrison 49:42
Mm hmm. That's exactly right. That's exactly right. So you do not always have to go away. So I ask people to think of it just like you think of diabetes, right? diabetes on a spectrum. Like sometimes your blood sugar is high, and you have to go to your boss primary care doctor, and they give you some medications and they make recommendations for exercise and nutrition. And your diabetes is stable, and you only have to see them every six months. But then sometimes your blood sugar gets out of whack. And for a little while, you have to go see your primary care doctor every couple of weeks as you're figuring out what it is. And then sometimes your blood sugar gets so bad that you have to go to the ER, and be in the ICU and stay in the hospital for a couple of weeks. But that is a very small part of diabetes, most of diabetes is outpatient taking care of it during real life, right.
And so we have this concept for addiction that like somehow you go away for 30 days to the beach, and you come back and everything's great. And it's like, no, no. Sometimes, yes. Sometimes addiction is that severe that you have to go to a residential rehab away? Yeah, most of addiction, you can provide that support in an outpatient way in a real life setting, if those supports are available in your community.
Brenda 51:11
Amazing. All right. I feel like I've just been to college or something. So much smarter now. And I hope all of the listeners feel the same way. So anything that we have left out about either Xanax in particular or benzodiazepines that people need to know?
Dr. Harrison 51:29
The big ones of just like very dangerous with Xanax being the absolute worst and no cold turkey. Right? Those are the big things I want people to know.
Brenda Zane 51:42
Right? Right. Okay, awesome. Well, we will put some resources to in the show notes. And this is just been so helpful. And I just want parents to listen to this to understand it is dangerous. It's not a you know, think of it as a drug, not a medication.
Dr. Harrison 51:59
That's exactly right. Thank you so much. Good to talk to you, Brenda.
Brenda 52:04
Thank you so much for listening. If you like to go to the show notes, you can always find those at BrendaZane.com/podcast. Each episode is listed there with full transcript, all of the resources that we mentioned, as well as a place to leave comments if you would like to do that.
You might also want to download my free ebook called HINDSIGHT: Three Things I Wish I Knew When My Son Was Addicted To Drugs. It is packed with information that I truly wish I had known back in the darker years with my son. And so I share it now in case it might be helpful to you in your journey. You can get that at Brendazane.com/hindsight, and I will put a link to both of these resources in the show notes as well. Thank you so much for listening. I'll meet you right back here next week.