When I first encountered people taking Xanax it was in the ER during my psychiatry residency. It seemed that every other person was addicted to Xanax, alcohol and street drugs. I even remember thinking that Xanax should be taken off the market I had such bad feelings towards it. Then I started seeing outpatients in my office that were already taking Xanax and never took it in larger doses than prescribed, never "lost" a prescription or ran out early and didn't throw a fit when I suggested cutting down on the medicine. Gradually I started to prescribe it in selected patients and found that for most people it helped them be more functional in their life. They could drive to work, go out in public and tolerate crowds. Nowdays I frequently prescribe it for panic patients.

The key issue is that it is not right for everyone. The patients that are likely to get addicted are those people with prior addictions, and those who have unrealistic expectations that a medication will take away *all* their anxiety. Usually it is obvious who these folks are; they are already taking other prescribed medicines or over-the-counter medicines (Benadryll, etc.) in large amounts or inappropriate ways. In that case it is the physician's responsibility to say "Hey, I think you have a problem and I'm not comfortable giving you any more."

Medication is a tool though, not a coping skill. I defiinitely agree with learning new techniques to handle anxiety. I go through the CBT model of panic with all my panic patients and encouage them to use it. Some of my patients with severe panic are able to talk themselves through the attack and overcome their fear of having one, which reduces the chances of having another one in the future. This is the best strategy because you never have to worry about running out of your medicine or leaving it at home in case of a panic attack. Unfortuately the majority of people I see are unwilling or unable to do the work CBT requires. But they are willing/able to take an occasional Xanax when a panic episode comes on.

As long as someone's use of Xanax is an attempt to deal with anxiety rather than escape it; I think Xanax should be thought of as another useful tool for anxiety.