As is always the way when it comes to medical matters, the first step is diagnosis. The patient consults his or her regular doctor and, if a specialist’s opinion is required, there will be a referral to a psychologist. The patient is the primary source of information about symptoms — most of the symptoms will be obvious physical behavior including increased heart rate, faster breathing, sweating, etc. shaded by subjective factors offering an insight into what has triggered worries of this level of intensity. In deciding whether this is a true case of anxiety disorder, the anxiety must have become persistent and significantly affect the quality of life. A key factor is whether there is a genuine and continuing reason for the anxiety. If the anxiety is not completely rational, it will be considered a disorder. However, the diagnosis and subsequent decisions of treatment can be complicated if there are social or physical contributions to the anxiety state. If the person is going through a long-running divorce or finds the work environment stressful, it may be necessary to resolve those problems first. Only then can the doctor see whether the anxiety is sufficiently irrational to justify treatment as a disorder. Similarly, if there are serious health problems including alcoholism and substance abuse, it will be necessary to treat those conditions. It may well be that, as the health issues are resolved, the anxieties reduce.

If the patient has been through previous treatment, it will be very important to review exactly what happened and, if possible, decide why that treatment was not successful. It would be a waste of everyone’s time to repeat what was done before. Then comes the decision on finding a balance between medication and psychotherapy. The pressure from the health insurance industry is to find the cheapest solution. Experience has shown the premium rates rising fast and, to maintain profitability as the number of people carrying insurance falls, treatment options costing the least are encouraged. Doctors, the clinics and hospitals are also coming under financial pressure. A lot of time and space is required to provide one-to-one psychotherapy. This forces the for-profit medical profession to prefer medication. Why is this a bad outcome?

All the research shows therapy and counseling as significantly more effective than the use of drugs. Indeed, the only effect of a drug like xanax is to help the patient feel comfortably numb. Anti-anxiety drugs do not solve the underlying problems causing the anxiety. Their only purpose is to help keep the anxiety under control. But without the necessary therapy, patients have nowhere else to run and hide. They are effectively pushed down the route of dependence on drugs to live the rest of their lives with some peace. While this is great for the pharmaceutical industry because it now has millions of customers depending on its drugs, it is completely against the interests of the patients. They have the continuing cost of the drugs as a drain on the family budget, and the threat of withdrawal symptoms adding to their psychological difficulties if they attempt to stop. This is not to say that xanax is in any way a bad drug or that people should not take it. But it was only designed for short-term use. Potentially taking it for years is not in the patients’ interests.