Using Xanax to deal with anxiety and replace drinking?
January 20, 2017 12:32 AM   Subscribe

More details within, but my drinking got out of control due to anxiety and joblessness. My good friend noticed and suggested that I take Xanax. Great, I no longer drink, or if I do it is simply a beer. I take a very low dosage a day (.25mg or .5mg if I'm very stressed), and I do not get a "high" or anything from it. It makes me feel normal and I've been functioning great. I mentioned to my doctor about as to get my own prescription and he went into full on panic mode, further stating that he would not prescribe it to me and suggested I go to rehab. I am not abusing this, going to another doctor feels like doctor shopping, should I simply mention I have anxiety and would like to try some medications? I do not like lying to doctors, but I feel as if I actually figured this out on my own.

So basically I moved across the country to work in a very stressful, high paying job. I got burnt out as I am single, had a hard time meeting people (worked all the time). Furthermore the city this was in was very residential and anything resembling nightlife closed around 10PM due to volume so despite the occasional drink on the weekends I was not a big drinker.

I had no hobbies and felt as if I didn't know where I wanted to go with my career so decided to take 6 months off as I did save a lot of money in this sales job. As I was running errands and thought I'd get a quick bite to eat at this neighborhood bar and grill I hadn't been to. To my surprise, at 1PM it was completely packed. All sorts of retired or semi-retired middle age or older men with my background. I thought it was strange, but they were all in my boat of not having a job but being fortunate enough to not have to work. It was not a scene out of Barfly, and I quickly made friends for the first time in awhile (again, realize not all drunks and probably a majority aren't Barney Gumble types, but at first I sort of justified this).

Then it started going in at around noon after everyone was done with their golf game and sit there for 4 or 5 hours, drink as many beers in that time frame then maybe come back and watch whatever game is on TV. Hey, I'm not getting drunk, so its not that bad. And guess what all this anxiety I had is gone and I've replaced my job with socializing with friends.

I'm still a hypochondriac and began to worry that this everyday drinking was definitely not healthy even though I wasn't going through a handle every day. This lasted maybe 6 months, but I could tell my drinking was increasing which was where I got worrisome.

A friend suggested that I take his prescription of Xanax he doesn't use and told me he was supposed to take .5mg, but that I should start out with half that. It worked great, started reading again, getting things I put off together. I'm now down to half that (it has been two months), and was starting to worry I'd run out and it'd be great to have some around and that I don't drink anymore save for the single beer I had during a playoff game, which I did not finish. I thought he'd congratulate me on my healthier lifestyle, and I even said I know taking prescription medication like I was taking was not a great idea, but at the time was too ashamed to admit I was spending all day at the bar. This is where things went downhill:

1. He told me quitting cold turkey was a stupid idea and I should have gone to rehab. I assured him that I actually did count my drinks carefully as I was paranoid that my intake was increasing (it was). Furthermore I ordered beer as this bar was known to "heavy pour" and I didn't want to think I was getting 3 drinks when I was getting six, so I was trying to regulate it. In any case, I quit on my own and would not consider a single beer over two months a problem.

2. He refused to write be a prescription for Xanax and now believes I abuse it. I assured him there was no way that was possible as I only had a bottle from a friend and wouldn't know where to buy it off the street. I asked him if there were other options he considered safe, he gave me Prozac which does not help me. For the record, I did extensively look at all literature on Xanax and it is fairly well tolerated especially in low dosages and short time spans.

3. He suggested that since I am (in his opinion) of an addictive personality that I should check myself into in-patient rehab. I've never had any addiction issues before and really consider some bad life events that caused me depression and anxiety that I admittedly self-medicated but am making demonstrable progress in my life. I also asked several friends who went through similar bad situations and did go to rehab and they all told me I was fine, that they'd get their hands on anything they could, take it until it was out and definitely not nurse four beers but drink until there was nothing left to drink.

In any case, everything I've read indicates I was a short-term heavy drinker, which I'll admit but I am two months off of it and have no urge to go back. My Xanax use is also tapering and I feel like it actually cured anxiety problems and turned myself around.

So the question I have after all this, would it be wrong to seek a second opinion? Maybe leave the drinking part out of this for now, and taking Xanax and simply state I am having anxiety issues? I feel this is dishonest and drug seeking behavior, but I'm not trying to score pain medication or trying to get high. I simply feel normal on it, and when things get overwhelming it helps me not simply ignore the underlying problem but address it.

Sorry this was so long-winded, but was looking for advice of others who have gone through this or other people in the medical field, though I realize nothing here is medical advice. I just went in thinking I had made positive steps for my physical and mental health and was labeled a junkie. Which oddly, gave me more anxiety.
posted by anonymous to Health & Fitness (32 answers total) 2 users marked this as a favorite
would it be wrong to seek a second opinion?
IMHO, no, not at all, it is very, very rarely wrong to seek a second opinion.

Maybe leave the drinking part out of this for now, and taking Xanax and simply state I am having anxiety issues?
Yeah, I'd leave it out. It's usually better to be honest, but in this case, it seems like your actual situation is misleading, because it looks rather like other situations that provoke a certain reaction and people aren't differentiating easily enough. I think bringing it up is distracting from the main point, which is your (officially) untreated anxiety. It's a shame that we have to consider the optics of these things, but we do. However, if you've tried prozac without help, I would definitely mention that.

Sometimes when you already have an intended outcome with these medical situations, you have to gently guide things in your direction without outright saying you have an intended outcome, because doctors are (often rightfully) suspicious of people who have one, even though plenty of those people just happen to know what works for them already. Again, unfortunate optics.

oddly, gave me more anxiety.
I don't think it's odd at all! Don't feel bad about how you feel - I think your doctor is either being paranoid or has been burned by too many actual junkies to give you a fair shake here.
posted by gloriouslyincandescent at 1:24 AM on January 20, 2017 [10 favorites]

My Alprazolam (generic name) is prescribed by a psychiatric Nurse Practitioner who is also treating me for anxiety. If talking to your GP again doesn't help, you may want to look into a different practitioner.
posted by The Underpants Monster at 2:08 AM on January 20, 2017 [3 favorites]

I have used Xanax safely and legally on and off for about 5 years, for similar issues, and without any of the nightmares some people in the medical community are often perturbed about. Memail me if you like or ask the mods to facilitate?
posted by esto-again at 2:25 AM on January 20, 2017 [6 favorites]

IANAD. IANYD. IAJAMOTI. (I Am Just Another Mope On The Internets)

So I'm not a doc. But I've knocked around some, I've been in more than a few doctors offices, I've darkened the door of more than a few shrinks offices.

That doctor jumping up and down and proclaiming that you need rehab is, um, a bit over the top. IMO. He/she looked at you and didn't see you, saw instead the hundreds of other patients who are shopping for benzos, who have perhaps shopped him for benzos. It's got to be really frustrating for them. Still, it would have been nice had your doc actually seen the person standing in front of them, IE -- you.

Doctors are -- rightly, I think -- really paranoid about giving anyone a scrip for any drug in the benzodiazepine family. Xanax. Valium. Ativan. Klonopin. Probably 15 or 20 others, I'm not sure, though I'd bet that Wikipedia will tell you no problem. Benzos are really easy to get addicted to -- both physiologically and psychologically -- and they're a remarkably difficult addiction to kick. While they're all equally physiologically addictive, Xanax is the most psychologically addictive, because it hits your system so fast -- "Oh man, what a relief!" -- and they leave your system every bit as fast -- "Where's that damn bottle of pills!?! Aaaiiiiii !!!" So it's really a set-up for addiction. Klonopin is on the exact other end of the benzo family w/r/t half-life, it's in slower and out slower also.

So it's hard to get a doc to write you for them. You know the old saw: Lawyers go to law school and are taught to act like they're god; doctors go to medical school and are taught that they are god. You've got to stand straight and tell them head-on that you're not hustling them, that you need their help but that they are not god. They don't like that -- voice of experience -- but if a benzo is the only thing that will do the deal, that's what needs to be written.

But you don't know if benzos are the only drug that will do the deal for you. It's just that it's the only one you have experience with. I just did a search on your question; in it, the word "anxiety" appears 12 times, the word panic appears once. Panic and anxiety are different animals. To use benzos for anxiety is pretty much like hunting squirrels with an elephant gun. Sometimes anti-depressants work for anxiety (They never did anything for me w/r/t anxiety, and SSRIs in particular threw me deeper into the full-on panic I lived in for years.) for some people, it's possible that there are some out there that would work for you. There's a great anti-anxiety medication -- buspar, buspirone is the generic -- that is not at all addictive, has a tiny bit of an anti-depressant effect, and might knock the edge off your anxiety.

Honestly, going to another doc for what you're seeking isn't the right answer, not really. Find a shrink. A shrink will know the whole palette of anti-anxiety and/or anti-panic medications currently available, they'll know the correct dosages involved for you, they'll have an inside line on what anti-depressant might help you. They'll likely have more compassion than your doc, they'll be less prone to jumping up and down and barking and gesticulating wildly as you spin out your tale.

Anxiety sucks, panic really sucks. I hope you can find help.

Good luck.
posted by dancestoblue at 2:32 AM on January 20, 2017 [37 favorites]

Just an observation here. Many years ago I worked in addiction treatment and I've also been a mother and foster mother to teenagers who have gone through some drug-related issues. And I'm telling you that about the time I got to the 4th paragraph, I was starting to question your story. So many needless details—I couldn't help but wonder what you were trying to cover up.

I am NOT saying that's what you're doing and I do think your doctor way over-reacted, but I can also understand where he might be coming from.
posted by she's not there at 2:39 AM on January 20, 2017 [37 favorites]

And, of course, benzos can be helpful for some people. But the questionable reputation does not come from nothing.
posted by she's not there at 2:44 AM on January 20, 2017 [3 favorites]

I know taking prescription medication like I was taking was not a great idea

It is not just a bad idea. It's illegal. Going in to your doctor and telling them that you've been illegally using a substance and then asking them to give you more of it is virtually never going to go well. I'm not saying this to try to be judgmental. Giving away a whole bottle is pretty irresponsible on your friend's part, but that part's done. Going in to a doctor and telling them that you're abusing a controlled substance--and using it without a prescription is considered abuse per se, it doesn't matter how much--is not going to get you anywhere. But in general, you shouldn't be going to a doctor and telling them what to prescribe you. You should be going to a doctor and telling them you have these anxiety symptoms and asking them to help you come up with a plan to deal with your anxiety problem.

I've known heroin users who said they wouldn't take benzos because they're too hard to quit. I believe in benzos. I take benzos, but only extremely irregularly. Taking benzos daily is a fairly risky move and should not be done without a doctor's supervision, because you can absolutely build up a tolerance. What you're doing right now is probably not genuinely dangerous, but it's the way virtually everybody who winds up with a serious problem starts, and that's why they freak out. Everybody I've ever known with a problem started out self-medicating.

I agree with the "elephant gun" comparison above. Daily benzo use is last resort kind of territory, and the real problem here is that you've jumped straight to that, and yeah, it's concerning, especially since you're using it to replace another often-abused substance. I don't think you Have A Problem, I just think you're playing with fire and you should really take a few steps back and approach this through proper channels.
posted by Sequence at 2:44 AM on January 20, 2017 [52 favorites]

Something to be aware of is doctors are worried about liability. If one writes you a benzo prescription and you overdose on it (accidentally or on purpose) they can be liable. When a doctor hears you've been using benzos illegally, they will already be thinking that you might not take them as prescribed if they prescribe them to you. Furthermore, if you admit a history of substance abuse (and many will consider your brief period of drinking substance abuse, though some will not) they will be worried you won't take the benzos as prescribed.

I recommend seeing a therapist first, not just for your anxiety, but also if you get a referral from a therapist who has been seeing you for a while and who the prescribing MD knows is monitoring you on a more regular basis than they can, they might feel more comfortable prescribing a benzo if they ultimately decide that that is the appropriate medication. It will also be less likely to appear that you're just looking for a quick fix/self medicating. Though, as mentioned above, benzos are a drug of last resort for good reasons.
posted by Waiting for Pierce Inverarity at 4:05 AM on January 20, 2017 [3 favorites]

You should see a psychiatrist and not your GP internist about this.
posted by spitbull at 4:54 AM on January 20, 2017 [14 favorites]

I am a medical student and a person who uses benzos (that are prescribed to me) very infrequently for situational anxiety. Benzos are really not intended for regular use -- they are the drug of choice for situational anxiety (phobias, anxiety-inducing events), and for short-term use while waiting for another anxiety medication (like SSRIs) to take effect.
posted by i_am_a_fiesta at 5:46 AM on January 20, 2017 [8 favorites]

I think xanax is often perscribed as a temporary measure until anti anxiety meds (SSRIs) have a chance to start working or for a specific short term issue. If taken regularly, the dose needs to be consistently increased and you may get addicted.

With this in mind, maybe ask about anti anxiety meds and or talk therapy with xanax to help you get along until these longer term solutions can help you as well. So instead of I want xanax, start with I have anxiety! Good work in seeking the available options besides alcohol.
posted by Kalmya at 5:47 AM on January 20, 2017 [3 favorites]

I think your doc was slightly OTT with the inpatient stuff, and it sounds like he just ignored the context (I don't know about "addictive personality", since benzodiazepines are addictive, and I can see happy hour offering social connection as well as coping via booze at a rough time), but of course drinking to cope and then illegally taking someone else's drugs to cope is going to be flaggy! Come on, now.

I simply feel normal on it, and when things get overwhelming it helps me not simply ignore the underlying problem but address it.

Mmm, so I get this, all it does is take the edge right off. But that's why everyone likes benzodiazepines (who likes them), it's not that they're chasing some kind of high. (I took a very small dose of lorazepam for a little while recently to help with some anxiety issues myself, and I hear you, it just makes you feel normal.) The problem with them isn't moral (so much), I mean they used to be used for anxiety all the time, and no one's got an issue with other kinds of drugs for that condition, it's that they've since been found to be hugely addictive. (And newer info has found that they're correlated, in a dose-dependent way, with a threefold increased risk of death.)

Find another doctor, with a more nuanced view of the human condition, sure (maybe someone a bit older if your doc is young?) - but stay open to other ways of managing anxiety. Don't walk in with a preconceived notion of what the best way to deal with it might be. (Because it's probably not benzodiazepines.)
posted by cotton dress sock at 5:59 AM on January 20, 2017 [6 favorites]

You should seek a new doctor, probably a psychiatrist, and begin treatment for anxiety. A doctor will professionally evaluate your condition and work with you to prescribe the best treatment for your condition. There is no reason to shortcut this process if you are genuinely wanting to treat this disorder.
posted by slogger at 6:16 AM on January 20, 2017 [11 favorites]

I think you should go to a doctor or nurse practioner who specializes in this, and tell them the full story. A good one won't judge you or try to cart you off to rehab, but work with you to find you the right medication. It's not going to be Xanax, but that's a good thing. As others have said, it's not a drug that should be taken daily for extended periods of time. I'm seconding Buspar, a drug that I've been using for years and years with no side effects. It works great for anxiety.
posted by blackzinfandel at 6:49 AM on January 20, 2017 [3 favorites]

Start with your symptoms, and seek appropriate and effective treatment. If those problems are mental in origin, seek treatment from a mental health professional, and follow their lead.

Do not start with a substance, and seek justification or a backstory that leads to it. That is approaching the problem backwards.
posted by Dashy at 7:04 AM on January 20, 2017 [13 favorites]

Oh dear, it sounds like you really are anxious. In addition to good suggestions above, I think your feeling that you need benzos is your addictive brain waking up and stretching itself. It's practicing telling you that you need this specific substance-- alcohol, pills-- and that it will help your anxiety when in fact it worsens the cycle of anxiety. The doctor's suggestion of rehab was probably OTT but from his point of view he was doing you a favor.
posted by BibiRose at 7:25 AM on January 20, 2017 [3 favorites]

Your doctor sounds like they overreacted. That said, I agree with others who say that this story has a "grade my report card" feeling to it where you are working a little hard to justify the desired outcome that you are looking for.

Furthermore I ordered beer as this bar was known to "heavy pour"

This sort of thing doesn't matter, really. I know to the anxious mind (I am also anxious) it's important to include these details but to someone who is trying to manage your situation more generally the facts are

- drinker, concerned about drinking
- socially isolated
- takes friend's medication illegally
- now wants specific prescription for specific medication

It sounds like you need to start over with a different doctor and say "I have anxiety and it's affecting my life in these ways and I have been drinking to self-medicate and I'd like to try something else" Maybe talk about the things you have already tried which should include the standard stuff (limiting caffeine, working on sleep hygiene, getting exercise, eating better) as well as the non-standard stuff "A friend lent me some Xanax which was how I decided that I think I have an anxiety problem. I felt normal for the first time"

Your anxiety sounds situational which is good news since it's often the easiest to manage and deal with. But even though your first doctor sounds sort of awful (and some of that may have been filtered through your anxious mind) getting another professional opinion is probably going to serve you best in this situation.
posted by jessamyn at 7:45 AM on January 20, 2017 [13 favorites]

I would go to another doctor and tell them you have anxiety. I did that and had a 30 day "trial" of xanax pretty much forced on me by a doctor when I expressly told him I was looking for therapist recommendations and had no interest in drugs. It took me two different doctor visits to find someone who wasn't a pill pusher. Anyway, I live in Utah where we have the highest rate of prescription drug use. YMMV.
posted by Marinara at 8:15 AM on January 20, 2017

Your story didn't raise red flags of dishonesty or "oh my god this guy is on a REAL slippery slope." I recognize the detailed backstory as a symptom of anxiety. General anxiety, which is a close cousin of depression, which can happen in situations where you're stressed out and feeling isolated. It makes a lot of sense. I think your doctor overreacted. But probably, also, they just don't know you and they don't know your story.

So I would see another doctor and start with the facts as they are now: you feel anxious. You want relief from that discomfort. Are you interested in talk therapy, or meditation, or yoga, or better sleep hygiene, or anything else you can do without drugs? If you are, mention that. I've had success with SSRIs for general anxiety, and completely understand the feeling of "normal," finally. You're not bad or wrong or sketchy. But do look for help that's more specifically psych help, not general practitioner help. Good luck.
posted by witchen at 8:53 AM on January 20, 2017 [2 favorites]

(And newer info has found that they're correlated, in a dose-dependent way, with a threefold increased risk of death.)

That link is to a paywall, but I'm pretty sure that was in seniors, not the general adult population.

Your doctor is probably especially reluctant to prescribe benzos to you because you appear to have or be struggling with a drinking problem, and mixing benzos and booze is a really really fantastic way to kill yourself. I agree with the advice above to take the problem--not your preferred solution--to a new doctor and ask for help with the symptoms. Your Internet research is not serving you well if it's allowed you to persuade yourself that Xanax is relatively harmless. It's not.
posted by praemunire at 9:08 AM on January 20, 2017 [7 favorites]

Toxicologist here, not a physician.

So the question I have after all this, would it be wrong to seek a second opinion? Maybe leave the drinking part out of this for now, and taking Xanax and simply state I am having anxiety issues? I feel this is dishonest and drug seeking behavior, but I'm not trying to score pain medication or trying to get high. I simply feel normal on it, and when things get overwhelming it helps me not simply ignore the underlying problem but address it.

It's not wrong to seek a second opinion. Or a third. But be aware that drug seeking behavior is drug seeking behavior, even if it's benign, and not all physicians have the same threshold of concern about that. A commenter above notes that some physicians seem to throw Xanax at patients who have no interest in pharmaceutical treatments. So, if you desire it, seek it. But recognize: you're asking a physician for access to a specific controlled substance. To a physician, "I have anxiety issues, are there treatment options?" is not drug seeking, while "I have anxiety issues, unprescribed Xanax seems to help, can I get a prescription," is.

Without trying to sound alarmist, I zero in on statements like "I'm not trying to get high, I just use it to feel normal." It's a misconception that addiction manifests only in appetite for getting high. Addiction very commonly is tied to a sense of normalcy, and access to substances that keep one one the regular rather than off in limbo. In grad school, a lot of tox students learn about this with reference to coffee. How common is it for people to say, I can't survive the morning without my coffee, rather than, I can't wait to have a bunch of coffee and get so jacked up on caffeine that I can't think straight. Keep that in mind.

And lastly, Xanax is a treatment for anxiety in the short term, not the long term, and it is not a cure for your ills. As the FDA-mandated package insert reminds us, beyond about 6-8 weeks of use, the long term efficacy of Xanax hasn't been systematically evaluated. And yet, prescriptions and use continue well beyond 6-8 weeks for many people.

Be well.
posted by late afternoon dreaming hotel at 9:10 AM on January 20, 2017 [19 favorites]


It does seem like a slight overreaction on your doctor's part, but at the same time, I can see how this story would raise some red flags. Also, it's not uncommon for people to minimize their substance use when speaking to medical professionals/mental health professionals. So, if they here someone say, I have 3 drinks a day, the doctor may assume that the person is rounding down. I'm not saying that's what you're doing, but it wouldn't surprise me if your doctor is thinking that.

Also, the progression from difficult life circumstances -> drinking to deal with life circumstances -> taking other substances to deal with the drinking is a pretty common narrative among substance abusers.

On a personal level, I've been there, done that. It sounds like my drinking was heavier than yours, although I did get the benzos through a prescription (although the doctor's actions were pretty sketchy in retrospect). At first I used the benzos to minimize my drinking, but things kind of went downhill from there.

And as praemunire mentions, mixing benzos and alcohol is incredibly dangerous. Also, there's the fact that withdrawal from both substances can be brutal and even fatal in certain cases. (I'm not trying to alarm you; it sounds like you already know not to quit cold turkey, and all that, but I'm just pointing out that there are reasons for concern here.)

Anyway, yes, I would get a second opinion. A psychiatrist is probably your best bet. I would tell them about the drinking and how you drank to deal with anxiety. Personally, I would probably leave out the xanax all together. I also wouldn't go in and demand more xanax or other benzos. Just say that you're looking for something to ease the anxiety on a day to day basis, and be open to whatever they suggest. If you absolutely feel the need to mention xanax, it's probably in your best interest to downplay how much your friend gave you.

Of course, this is why doctors don't trust the amounts patients tell them, and it might be different if you have a pre-existing relationship with a doctor, but this story has a lot of red flags, no matter how you try to spin it.

Some doctors may freely hand out benzos, but they really are generally contraindicated for daily usage, although I know there are some exceptions. But most of the time, if you go in demanding benzos, you may well be labelled a drug seeker, especially when it sounds like you haven't even tried any of the non-benzo options.

(Honestly, I know it's not so uncommon for someone to give a couple xanax or whatever to a friend, but giving someone a whole prescription is pretty extreme and a very bad idea. Please don't accept prescription drugs from friends in the future.)
posted by litera scripta manet at 9:23 AM on January 20, 2017 [3 favorites]

Oops, sorry about that link! But nope, it wasn't seniors... Hope this link is better.

(It was a retrospective study analyzing the medical records of "34 727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69 418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years).
Results: Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription."

posted by cotton dress sock at 9:32 AM on January 20, 2017 [1 favorite]

This has veered plainly into people giving medical advice to someone who sounds very vulnerable in terms of ongoing addiction and drug seeking issues.

The GP is right- a Xanax prescription in the absence of meaningful engagement with addiction treatment in this situation would be extremely inappropriate.

Giving advice without the benefit of the full story, medical history, training etc is not only inappropriate but actually dangerous in this situation. I think this question shouldn't have been posted.
posted by Stephanie_Says at 9:58 AM on January 20, 2017 [7 favorites]

I'm saying this with deep concern, not chastise. What you did was extremely irresponsible. Short-term benzos are used for acute alcohol withdrawal symptoms such as seizures, under strict care from a medical professional. The fact that you thought transitioning from alcohol to xanax for long-term use was a good idea, nay, one that would be medically condoned shows that you really need to consult a doctor before you put a controlled substance in your body.

Some people use benzos, regularly, daily, for long-term for anxiety. A tolerance is built up quickly. It is very hard to taper off of them. There are many anxiolytic alternatives.

You are much better off bringing your problem to your doctor and letting their expertise guide you.
posted by pintapicasso at 9:58 AM on January 20, 2017 [5 favorites]

Many people here are telling you that it's no big deal, but I actually think that the daily use of a controlled substance without a prescription and without the supervision of a doctor is a pretty big red flag. Benzodiazepine addiction is particularly dangerous because the withdrawal syndrome can actually kill you, which is not the case of other addictive substances save for alcohol.

In my opinion, you are treading on a slippery slope here and it might be wise to consult another doctor. The fact that you are pretty explicitly seeking to exchange one addictive substance for another is concerning.

Also, there is a great deal of granularity between doing nothing and inpatient treatment, so that might be another reason to seek another opinion.

(source: I am a recovering polydrug addict well-acquainted with the compulsion to substitute one substance for another and pretending that I actually think it's meaningful harm-reduction. It is EASY to hit the methadone clinic every morning while patting oneself on the back for "getting clean.")

And P.S. Going to a physician and straight up asking for benzodiazepines is a good way to guarantee that said physician will NEVER, EVER prescribe them to you. That you added the detail of currently using a diverted prescription is absolutely what froke your doctor out.
posted by easy, lucky, free at 11:52 AM on January 20, 2017 [8 favorites]

IANAD etc. but I am familiar with the diagnostic criteria for problematic substance use disorder (aka addiction) and it feels like your doctor is misdiagnosing you a bit there. I echo the suggestions to find another doctor and talk about how to better address your anxiety, because if nothing else, this doctor isn't listening to you very well. Use of a controlled substance does not automatically equal addiction, nor does self-medication for anxiety symptoms.
posted by gingerbeer at 3:18 PM on January 20, 2017 [2 favorites]

I do not like lying to doctors, but I feel as if I actually figured this out on my own.

Also, this is like, pretty textbook "I have extensively rationalized my problematic relationship with the substance(s) in question" language. I didn't like lying to my doctor, either, which is why I went ahead and "figured out on my own" that if I did juuuust the tiniest smidge of methamphetamine, I could use less heroin, making me Less of a Heroin Addict, which is (obviously and incontrovertibly) good. Except these things don't really work that way.

You really need to speak honestly to a professional before this gets out of hand. I know that right now, you cannot fathom this trivial self-medicating becoming a huge, life destroying thing, but truly: you are walking a fine line.

Plus, you deserve to feel well and have your anxiety well-controlled in a way that is sustainable.
posted by easy, lucky, free at 8:45 PM on January 20, 2017 [1 favorite]

Although I believe you have already generally received good information and correct answers above from a knowledgeable crew of answerers, just a few general pieces of information to add relevant to your story that I thought might be useful and didn't see mentioned explicitly above (forgive me if I'm repeating someone):
- Benzos help a person quit alcohol because they are a treatment for alcohol withdrawal (really they are THE treatment for alcohol withdrawal). Your doctor may have freaked out in part because he thought you were trying to detox yourself from alcohol at home with illegal benzos, which is ill advised for reasons mentioned above, that is, the combination of these two substances or withdrawal from either one of them can be life threatening, and thus it is highly inadvisable to use them without a physician's oversight.
- In most places I've ever worked, and I work with a LOT of alcoholics, in order to qualify for detox you have to get significant symptoms of alcohol withdrawal. I mean, I am sure if you are a movie star then you can check in to a cash-pay detox for whatever reason you want to, but otherwise you have to meet criteria, it sounds unlikely you would have met them. That's all really water under the bridge, now, though.
- It takes drugs like Prozac a long time to work. They do not have the same properties as benzos do. A person can't just take one and feel different a half hour later. You have to take them for weeks in order to really determine whether they are helping you. Since these types of drugs are a lot less dangerous to patients than benzos, they are the first line treatments for anxiety. If a doctor who prescribes a med like this doesn't explain the expected timeline, patients may often end up self-discontinuing the medication thinking that it doesn't work, before it was expected to kick in.
posted by treehorn+bunny at 10:54 PM on January 20, 2017 [6 favorites]

Personally, I think what you've done is perfectly reasonable and constructive. Unfortunately, you definitely have to assume that no doctor will see it that way. You'd think that "I've been self-medicating in a way that was bad for me, but then I found a kind of medication that works much better and is legally prescribable, could you prescribe it?" might go over all right, but it really won't. For what it's worth, I had a similar experience; I've had persistent intractable insomnia all my life, and nothing at all had ever had the slightest effect on me until my mum was prescribed zopiclone (Ambien, I think?) and gave me a few to help me get some sleep during university exams. They turned out to be magical. Before that I was permanently sleep-deprived to the point of mild dementia, and had been desperate enough to try knocking myself out with alcohol etc, which didn't really help but was somewhat better than nothing. Zopiclone...just made me fall asleep. For the first time in my life, I could go to bed and go to sleep. My mum didn't like them or find them that effective, so I ended up with most of her script. When I went to the doctor to see if I could get a script of my own, I found that pitching it in a really specific way worked. Don't say you've been taking it regularly, and definitely don't mention the drinking. Say you've been having this problem, and maybe a family member gave you a couple of pills to get you through a specific crisis, and even though you weren't crazy about the idea of medication, you were desperate enough to try and they worked really well. Points to emphasize: you were reluctant to take meds, you don't like the idea of anything that might make you dopey, but these made you far more functional (translation: you're not looking to get high). A family member gave them to you, for a specific situation (translation: you didn't get them from a friend handing them out at a party, it's not a recreational situation, you're not looking to get high). It was only a couple of doses for a specific occasion, not something you've been doing regularly.
I know this seems stupid. Normally I would never say lie to a doctor, but in this case...essentially, a doctor will hear "had a drinking problem" and "xanax without prescription" and automatically assume that your problem is substance abuse. Just what gloriouslyincandescent said - the details of your situation are kind of misleading, and any doctor will interpret them in a counterproductive way, so what you have to do is kind of steer the conversation to hit or avoid particular alarm bells, in order to focus on what your problem actually is and what you need.
But also, do be ready to listen to them and give their suggestions a shot if they suggest something else, like SSRIs or CBT or something. Those things don't work for everyone, but they can be amazing for anxiety and they're worth trying as a longer-term solution.
posted by BlueNorther at 11:23 AM on January 21, 2017

Just to add on rereading- there are some very good answers here, especially gloriouslyincanddscent's and witchen's. It's not wrong or irresponsible to want to be prescribed something that's been really helpful to you in the short term. But it is a really good idea to look at other solutions for the long-term.
posted by BlueNorther at 11:37 AM on January 21, 2017

Congratulations on working to improve your life situation and for having made so much progress already. It seems like many posters are letting the legality of taking non-prescribed Xanax cloud their judgement of the relative harms of various courses of action. Not all drug use is drug abuse. Don't let your doctor shame you.

So you've enacted a self-imposed harm reduction approach to your drinking. Have you considered what your ultimate goal w.r.t. medical intervention is? If your goal is to maintain the status quo and simply take a pill every day, then a Xanax prescription might be a good solution. If your goal is to change the situation in your life that led to your patterns of behavior, then an indefinite prescription for an alcohol-surrogate won't solve the problem you're wanting to solve. The people who have said that benzos are hard to quit aren't joking. That feeling of normalcy you feel from them will only make it harder.

A good psychiatrist will understand both what medications are good for what conditions as well as what it feels like to have your experience altered by these medications. Please find a good psychiatrist. They often have much more nuanced views of these kinds of medications and how they relate to addiction/substance abuse. You must be honest with the doctor about your motivations, habits, and thoughts on the matter. Please find a doctor you trust and work with them to accomplish what you desire.
posted by GammaGoblin at 9:42 PM on January 22, 2017 [2 favorites]

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