Listening to Xanax

If you’ve struggled with severe anxiety, you’re probably familiar with benzodiazepines: Xanax, Ativan, Valium, and other “benzos.” Nearly all of my clients who have had panic attacks, and a hefty proportion of those who haven’t, say they’ve used them at some point.

Writing in New York magazine, Lisa Miller documents the rising popularity of Xanax, Ativan, Valium, and other benzodiazepines. She provides a brief history of these popular medications and attempts to situate their growing use within larger cultural shifts. She points to the usual culprits in our anxious times: Economic instability, fast-paced modern culture, vague and looming terrorist threats: 

If the nineties were the decade of Prozac, all hollow-eyed and depressed, then this is the era of Xanax, all jumpy and edgy and short of breath.

Miller’s essay is thoughtful and honest, part confessional, part trend piece. She writes at some journalistic remove, but she also relates her own experience using Ativan to cope with her mother’s death.  She makes a case for using Xanax, though she is overly skeptical toward the arguments against it.

Psychologists wish people wouldn’t take so many benzos and, especially, so much Xanax. “Surely it can’t be right that this level of pharmaceuticals makes sense,” says Hayes. Partly they say this out of professional obligation. Tone’s book refers to Xanax as “the crack [cocaine] of the benzodiazepines.” Its short half-life can mean disaster for people who use it daily: They crash as the drug is wearing off and immediately yearn for more. “The withdrawals are the worst (put me in the hospital),” reads a posting on a drug-rehab website. “Find something else to do like pot or beer.” Dr. Peter Breggin, who crusades against benzodiazepines, pointed out in an editorial in the Huffington Post after Whitney Houston died that even short-term use of Xanax can make people more anxious than they were before and that sporadic use can cause what he calls “medication spellbinding”: impaired judgment, loss of memory and self-control. “I have all these mixed feelings about psycho­pharmaceuticals,” says the friend who, like me, stole drugs from her deceased mother. “Messing with your brain chemistry isn’t something to be taken lightly.”
But the anti-benzo psychologists are also making a value judgment. They believe Americans would be better, and healthier, if they learned to manage their anxiety without pills. They believe people should feel their feelings.

Well...sort of.

Yes, many psychologists (myself included) generally do "wish people wouldn't take so many benzos." But it’s not out of professional obligation, nor a sense of what Miller calls "pharmacological Calvinism." Personally, I’m more pragmatist than Puritan. I don’t reflexively pathologize drug use, (despite having graduated from the D.A.R.E. program), and I don’t hesitate to refer clients to physicians when I think medication would be helpful. I’m not here to tell you, “Drugs are bad, m’kay?”

But deciding whether and how to use benzos (or any other drug, for that matter), is (ideally) a pragmatic, rational decision. You conduct a cost/benefit analysis of the benefits and drawbacks, and make your decision with an eye toward optimizing your long-term well-being.  (I’m not saying this is simple or easy, but it's what we do). In order to make a good decision, you have to have the facts. And the fact is that are there reasons to be wary of managing your anxiety with benzos.

Benzos—especially Xanax—can be habit-forming. Ending a dependency on Xanax can be very difficult, even under the close guidance of a physician. It involves going through a period of prolonged anxiety which, though (usually) not dangerous, can be very unpleasant.

If you're prone to panic attacks, benzos provide a short-term fix, but they often exacerbate and maintain panic disorder, which essentially is the fear of having panic attacks. For people with panic disorder, Xanax is not seen as a luxury, but as a requirement. It’s not, “I would really love a Xanax right now.” It's “if I don’t take a Xanax right now, I’m going to call an ambulance.”

But the biggest downsite to treating anxiety with benzos, rather than therapy, is the opportunity cost. Benzos can stop the anxiety (in the short term), but that's it. They can't treat the cause, and they can't change your basic relationship to it.

Sometimes this is okay. Sometimes we experience anxiety for reasons that are known, and clearly are well beyond are control. In those cases, taking Xanax might make sense, like closing your window to block out the sound of a car alarm in the street.

But sometimes, anxiety is worth listening to. Anxiety can be the dashboard “check engine” light that blinks on when you’re driving down a freeway. Sure, it might be nothing. But shouldn't you look into it?

In any given case, it’s hard to state categorically which it is. Determining our proper relationship with anxiety can be complicated business--which is why we have therapy. Therapy is NOT just for getting rid of anxiety (although it certainly can do that). It is a way to examine the conditions that give rise to it, and to consciously choose to change (or not change) them. 

Which is why I find myself frustrated when Miller writes, “I am suspicious of any cure that requires more effort and expense on my part and more hours away from my work and family.”

I completely sympathize with the sentiment. We’re all busy and tired. Who wants to spend time?

But, I mean, come on. When it comes to matters of emotional health and wellbeing, shouldn't you also be suspicious of cures that don't require time and effort?