Which Anxiety Medications Are Addictive? The Three With the Highest Misuse Liability, and the Ones That Are Not

“Are anxiety meds addictive?” has a short answer and a longer one. The short answer is that one class of anxiety medication, the benzodiazepines, carries the Food and Drug Administration’s strongest warning for exactly that risk, and the other classes do not. The longer answer is which benzodiazepines lead the list, why, how common misuse actually is, how to tell dependence from the anxiety the drug was treating, and what the alternatives are. This page gives both, with the source for each claim.

Dependence is the body’s adaptation to a drug, so that stopping it produces withdrawal; addiction is compulsive use despite harm. Benzodiazepines produce the first in most people who take them daily for weeks, and the second in a smaller group.

The National Institute on Drug Abuse draws the line plainly. Dependence results from physiological adaptation to chronic exposure, and a dependent person has unpleasant withdrawal symptoms on stopping abruptly; those symptoms can usually be managed medically or avoided by slowly tapering. Addiction involves other changes to brain circuitry and is distinguished by compulsive drug seeking and use despite negative consequences. Tolerance, needing more for the same effect, often accompanies dependence, and the institute notes that it makes it difficult for a physician to tell whether a patient is developing a drug problem or has a medical need for a higher dose.

The distinction matters because most people who become dependent on a benzodiazepine did nothing wrong. They took it as prescribed for longer than the label intended, and the label itself says that is enough. A 2016 pharmacy review put it this way: benzodiazepines have low abuse potential in most of the general population, and a subset, especially people with a history of a substance use disorder, is at elevated risk; misuse happens most often in combination with opioids and alcohol.

Source: What classes of prescription drugs are commonly misused?, Misuse of Prescription Drugs Research Report, National Institute on Drug Abuse.

About 30.6 million American adults, 12.6 percent, used a benzodiazepine in a year, and 5.3 million of them misused one. Misuse accounted for about 17 percent of all use and was highest among adults aged 18 to 25.

Those figures come from a University of Michigan analysis of the 2015 and 2016 National Survey on Drug Use and Health, published in Psychiatric Services. Two details from it are worth more than the headline numbers. Misuse without a prescription was the most common type, and a friend or relative was the most common source, which means the pills causing the problem usually came from somebody’s legitimate prescription. And misuse of prescription opioids or stimulants was strongly associated with benzodiazepine misuse, which is the same pattern the DEA and the pharmacy review describe: the danger is concentrated where benzodiazepines meet other drugs.

Adults over 50, meanwhile, were more likely than younger adults to take a benzodiazepine more often than prescribed or to use it for sleep, which is the quieter form of dependence.

Source: Benzodiazepine Use and Misuse Among Adults in the United States, Maust et al., Psychiatric Services, 2019.

SSRIs and SNRIs, buspirone, hydroxyzine and beta blockers do not cause addiction. SSRIs and SNRIs can cause discontinuation symptoms when stopped abruptly, which is a different thing, and buspirone does not even share the benzodiazepines’ mechanism.

The antidepressants, sertraline, escitalopram, fluoxetine and the SNRIs such as venlafaxine, are the first-line long-term treatment for anxiety disorders, and they carry no boxed warning for abuse or addiction. What they do have is a discontinuation syndrome, dizziness, nausea, flu-like symptoms and electric-shock sensations after stopping suddenly, which resolves in one to two weeks and is prevented by tapering. The Effexor withdrawal and Prozac pages explain it; it is not addiction and does not involve craving.

Buspirone is the clearest contrast. Its prescribing information states that it is not a controlled substance, that there is no direct evidence it causes physical dependence or drug-seeking behavior, and that it does not exhibit cross-tolerance with benzodiazepines and other sedatives, so it will not block the withdrawal syndrome from those drugs, and it advises withdrawing patients from a benzodiazepine gradually before starting it. In other words, it works on a different system, produces no benzodiazepine-type dependence, and cannot be used as a bridge off one.

Hydroxyzine is an antihistamine that the National Library of Medicine lists for anxiety and tension as well as itching, and beta blockers such as propranolol blunt the physical symptoms of anxiety without acting on the brain’s reward system at all. None of these is a benzodiazepine, and none appears in the misuse data above.

Source: Buspirone hydrochloride tablets prescribing information, DailyMed, National Library of Medicine; Hydroxyzine, MedlinePlus Drug Information.

Briarwood runs medically supervised benzodiazepine detox in Austin and Houston: a switch to a long-acting benzodiazepine at an equivalent dose, then a stepwise taper under nursing observation. The anxiety that is still there underneath is treated alongside.

The stay is longer than an alcohol detox because the taper cannot be rushed, and the benzodiazepine detox page sets out how it runs and how long it usually takes. The medications used in benzodiazepine detox page covers the drugs.

What makes the difference afterward is that the anxiety the benzodiazepine was prescribed for does not go away when the benzodiazepine does, so the clinical team’s job during the stay includes arranging what treats it next: a prescriber for a non-addictive medication, therapy, and the step after detox. The anxiety and addiction page describes that side of the care, and cost and insurance covers what a stay costs with and without coverage. Admissions is answered at every hour, and the first call is the right place to ask whether what you are taking, and how much, needs a bed or a prescriber.