Anxiety Medication Misuse and Benzodiazepine Dependence: Therapy on Long Island That Works Alongside Your Doctor
For Nassau County adults whose “as needed” prescription became every day, and for the physicians, psychiatrists, and employee assistance programs looking for a psychologist to partner on benzodiazepine dependence therapy.
It started with a real reason. A panic attack at work. A father’s illness. A divorce that made sleep impossible. Your doctor prescribed Xanax, Ativan, or Klonopin, and for a few weeks it helped a great deal. Nobody expected it to still be in your medicine cabinet five years later.
Now it’s part of your day. You take it on a schedule, not just when you need it. You’ve noticed the dose that used to work doesn’t quite do it anymore. You get anxious when the bottle runs low, and more anxious when you picture going without it. Maybe you’ve added a glass of wine to stretch the effect, or taken a pill from someone else’s prescription when yours ran out.
None of this makes you a bad patient or a weak person, and it’s exactly what benzodiazepine dependence therapy on Long Island is designed to address. Benzodiazepines create physical dependence with regular use, even when taken exactly as prescribed. What they don’t do, over the long run, is treat the anxiety underneath, and in many cases they end up making it worse.
Contact Long Island Psychology to talk confidentially about your medication and your anxiety. We work with your prescriber, never around them.
What Anxiety Medication Misuse Looks Like
“Misuse” sounds dramatic, and most of the people we see don’t fit the stereotype. The term covers a spectrum, and many people land somewhere on it without realizing:
- Taking a benzodiazepine more often, or in higher doses, than prescribed.
- Using an “as needed” medication daily, including on calm days, to prevent anxiety rather than treat it.
- Combining a benzodiazepine with alcohol, cannabis, sleep medication, or opioids.
- Taking pills from a friend’s or family member’s prescription.
- Getting prescriptions from more than one doctor, or refilling early.
- Using the medication to cope with emotions it wasn’t prescribed for, such as sadness, boredom, or loneliness.
- Feeling unable to stop even though you want to.
Dependence and misuse overlap but aren’t identical. Someone can take the prescribed dose faithfully and still be physically dependent. Someone else can be misusing a medication without yet being dependent. Both deserve attention, and both respond to thoughtful, coordinated care.
Why Benzodiazepines Can Make Anxiety Worse Over Time
Benzodiazepines work by boosting the brain’s main calming system. They act quickly, which is why they feel so effective. With regular use, the brain adjusts by turning down its own calming signals, so that between doses the nervous system runs hot. The result is rebound anxiety: waking at 4 a.m. with a pounding heart, feeling edgy by mid-afternoon, needing the next dose sooner.
To the person experiencing it, rebound anxiety feels identical to the original disorder getting worse. That’s one of the cruelest features of dependence. The medication appears to be the only thing holding the anxiety back, when a meaningful share of what you’re feeling is the medication wearing off.
There’s also a psychological cost. Anxiety improves when people learn, through experience, that feared situations and sensations are survivable. A fast-acting sedative interrupts that learning. The panic never gets the chance to crest and fall on its own, so the belief that it’s unbearable stays intact.
In the way we think about anxiety at Long Island Psychology, the pill has been doing the same job worry does: trying to hold back a reality that feels intolerable. Worry gives us the illusion of control over things we can’t control; the pill makes those things stop mattering for a few hours. Neither one helps you accept and live with uncertainty, and that acceptance is where lasting relief comes from.
Signs Your Anxiety Medication Has Become a Problem
- You feel anxious when you think about running out.
- You need more than you used to for the same effect.
- Your anxiety is worse first thing in the morning or as a dose wears off.
- You’ve tried to cut back and felt shaky, sleepless, or panicky.
- You’ve mixed your medication with alcohol, even occasionally.
- People close to you have noticed memory lapses, slurred speech, or fogginess.
- You’ve been less than candid with a doctor about how much you’re taking.
- The thought of having no medication available (on a trip, say) triggers real fear.
Common Paths Into Dependence
The Crisis Prescription That Stayed
A benzodiazepine prescribed during a crisis, such as a death, a medical scare, or a divorce, with the expectation it would be short term. The crisis passed; the prescription didn’t.
The Panic Safety Net
People with panic disorder often carry a pill “just in case.” Knowing it’s there becomes its own form of avoidance, and the fear of panicking without it can grow into agoraphobia-like restrictions: no long drives on the Northern State, no crowded trains into Penn Station without the bottle in a pocket.
The Sleep Solution
A benzodiazepine or a sleep medication like zolpidem taken nightly for insomnia. Over time, sleep without it becomes impossible, and the worry about sleep becomes its own source of anxiety.
The Double Sedative
A pill for the daytime, wine for the evening, or both together at night. The combination deepens dependence on each and carries serious medical risk, including dangerous sedation and slowed breathing.
What This Looks Like in a Session
A composite, with details changed. A 52-year-old attorney from Garden City, the mother of two teenagers, is referred by her internist, who has grown uneasy about continuing to refill her lorazepam. It was first prescribed seven years ago, the spring her father was dying at a hospital in Mineola. She takes it every night now and on bad days at lunch as well. Most evenings there’s also a glass or two of wine.
In our early sessions she talks quickly and precisely about everything that might go wrong: her son’s grades, a new managing partner she’s sure is reviewing her billables, a mole her dermatologist wants to watch. When I ask what would happen if she stopped anticipating problems, she looks almost alarmed. “Then I’d be the one who didn’t see it coming.”
With her written permission, we coordinate with her internist and a psychiatrist, who design a slow taper. None of it is rushed, and none of it is abrupt. Our sessions focus on her conviction that constant vigilance protects her family; we test her predictions against what actually happens, and practice sitting with not knowing. Grief for her father, which she never really had time to feel, surfaces midway through and becomes a large part of the work. The taper takes about five months. By the end, she sleeps without the pill most nights and has cut the wine to weekends. She describes her worry as “still there, but not running the calendar anymore.”
What Changes
Before
- The medication feels like the only thing holding anxiety back
- Anxiety spikes as each dose wears off
- Running low on your prescription feels like an emergency
- Panic still feels unbearable
After
- You have skills that work without a pill
- Anxiety is steadier through the day
- Medication decisions happen calmly, with your doctor
- Panic has been faced, and it passed
How We Treat Anxiety Medication Misuse and Dependence
Medical Coordination Comes First
Benzodiazepine withdrawal can be dangerous, including the risk of seizures, and it should never be done abruptly or alone. We don’t make medication decisions. With your permission, we coordinate closely with your prescribing physician or psychiatrist, who manages any taper, while we treat the anxiety that the medication has been covering.
CBT With Exposure and Response Prevention
CBT is one of the best-supported long-term treatments for anxiety disorders. For panic, phobias, and obsessive-compulsive patterns, CBT uses exposure and response prevention. Step by step, without the pill in your pocket as backup, you let feared sensations and situations run their course. Your nervous system collects its own evidence that they end. We usually time this work alongside the taper so the skills are in place as the dose comes down.
Motivational Interviewing and Motivational Enhancement Therapy
Ambivalence about reducing a medication that feels essential is completely normal. Motivational interviewing helps you explore your own reasons for change, and motivational enhancement therapy adds structured feedback so the decision is informed and yours.
Acceptance and Commitment Therapy (ACT) With Mindfulness
Mindfulness, a core component of ACT, builds the capacity to notice rising anxiety without immediately reaching to shut it off. During a taper, that capacity is invaluable.
Relapse Prevention
We plan for the high-risk moments (a work crisis, a flight, a medical appointment) when reaching for an old prescription or a drink would be most tempting.
Psychodynamic Therapy
What was the medication protecting you from feeling? Psychodynamic work often uncovers unprocessed grief, old family patterns, or a long history of having to stay in control.
Dynamic Experiential Learning (DEL)
DEL, Dr. Shulman’s experiential approach, helps people feel directly that anxious states can be tolerated, which is exactly what a fast-acting sedative prevents them from learning.
Positive Psychology
As the medication takes up less space, we help you build steadier sources of calm and satisfaction: sleep routines, movement, relationships, and meaningful activity.
For Physicians, Psychiatrists, and EAPs
We welcome referrals from primary care physicians, psychiatrists, and employee assistance programs across Long Island. When a patient is tapering a benzodiazepine or showing signs of misuse, adding structured psychotherapy can make the taper more tolerable and reduce the chance that anxiety drives a return to the medication or to alcohol. With the patient’s consent, we provide regular updates, coordinate on timing, and flag concerns promptly. Contact us to discuss a referral.
What to Expect in Your First Session
We’ll talk about your anxiety history, your medication history, and anything else you’re using, including alcohol. With your permission, we’ll get your prescriber’s contact information so care can be coordinated. You won’t be asked to change anything that day. You will leave with a clearer understanding of how your medication and your anxiety have been interacting.
Contact us to schedule a first appointment.
Frequently Asked Questions
Can I stop my benzodiazepine on my own?
Please don’t. Stopping abruptly after regular use can cause severe withdrawal, including seizures. Any taper should be supervised by your prescriber.
Is it dangerous to drink while taking Xanax, Ativan, or Klonopin?
Yes. Both depress the central nervous system, and together they can cause dangerous sedation and slowed breathing.
I take my medication exactly as prescribed. Can I still be dependent?
Yes. Physical dependence can develop with regular use at prescribed doses. Dependence isn’t a moral failing, and it’s something your prescriber and therapist can help with.
Why does my anxiety feel worse even though I’m on medication?
Regular use can cause rebound anxiety as each dose wears off. Part of what feels like worsening anxiety may be that rebound.
Are there anxiety treatments that don’t cause dependence?
Yes. CBT is highly effective for anxiety disorders, and physicians have other medication options for long-term treatment. Your prescriber can discuss those.
How long does a benzodiazepine taper take?
It depends on the specific medication and dose (and on how long you’ve been taking it). Tapers often take months, and slower is usually better. Your prescriber sets the pace.
Do you prescribe or manage medications?
No. Our psychologists don’t prescribe. We work in close coordination with physicians and psychiatrists.
Can my doctor refer me directly?
Yes. We welcome physician and EAP referrals, and with your consent we’ll keep your doctor updated.
What if I’ve been getting pills from more than one source?
Please tell us. We’re not here to judge or report you; knowing the real picture helps us keep you safe.
Can I do this work by telehealth?
Yes, and working professionals often prefer it. We see patients by telehealth anywhere in New York State.
Where are your offices?
In Garden City, we’re on Franklin Avenue, within walking distance of the LIRR station and the Cathedral of the Incarnation. Our Rockville Centre office is a few minutes from Mercy Hospital. We also see patients from Great Neck, Manhasset, and Port Washington by telehealth.
How does payment work?
We don’t bill insurance directly; you pay per session and receive a superbill for out-of-network claims. Here’s how to check your benefits.
Further Reading From Our Blog:
Our article The Pill That Stopped Working: When Benzodiazepines Start Making Anxiety Worse walks through the research on why these medications can lose their effect, including the FDA’s boxed warning. If you’re in early recovery from alcohol as well, Why Sobriety Can Feel Worse Before It Feels Better may help.
Getting Help in Nassau County
Depending on an anxiety medication isn’t a character flaw, and it isn’t permanent. With coordinated medical care and the right therapy, most people can reduce or stop safely and come out with anxiety that is more manageable than before.
Contact us today. Long Island Psychology serves patients in Garden City, Rockville Centre, Great Neck, Manhasset, Syosset, and throughout Nassau County, with telehealth statewide. For related reading, see our co-occurring anxiety and addiction approach, self-medicating anxiety, managing anxiety in early recovery, our drug addiction therapy, and our generalized anxiety disorder therapy, or view our full list of locations served.
