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Anxiety disorders are common, and medication is often used to manage symptoms. However, some anti-anxiety drugs, especially benzodiazepines (like alprazolam, which is Xanax, or diazepam, which is Valium, carry a high risk of dependence. This has led patients and providers to seek non-addictive anxiety medications that can relieve anxiety without the same pitfalls.
- Medications like Xanax or Valium are effective for anxiety but are habit-forming, so they are no longer recommended first-line for long-term treatment.
- Several medication classes (SSRIs, SNRIs, buspirone, beta-blockers, hydroxyzine) can treat anxiety without abuse potential, making them suitable for chronic use.
- Combining medication with therapy and lifestyle changes yields the best results. This is especially important for people in addiction recovery, as anxiety and substance use disorders often co-occur.
Understanding addiction risk in anxiety medications
The most notable anxiety medications with addiction risk are the benzodiazepines. These provide quick relief but cause tolerance and physical dependence with long-term use. Because of this, they are not recommended as first-line treatments for chronic anxiety. [1]
Other older sedatives (like barbiturates) are potentially even more dangerous and are rarely used for anxiety. [2] In contrast, most modern anxiety medications (such as antidepressants and buspirone) do not produce euphoria or cravings and thus have minimal abuse potential. The myth that “all anxiety meds are addictive” is simply not true—many effective treatments carry no significant risk of addiction.
Evidence-based non-addictive anxiety medication options
Multiple classes of medications can alleviate anxiety with little risk of misuse.
1. SSRIs and SNRIs
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line medications for generalized anxiety disorder, panic disorder, social anxiety, and related conditions. [3]
Examples of SSRIs include sertraline and escitalopram, and examples of SNRIs are venlafaxine and duloxetine. These drugs boost levels of neurotransmitters (like serotonin) to improve mood and reduce anxiety. They are not addictive and are safe for long-term use. The main drawback is a delayed onset of benefit, as it typically takes 2–6 weeks before significant relief is felt. SSRIs are often the first-line treatment. If an SSRI is ineffective by itself, an SNRI may be the next step.
SSRIs/SNRIs can cause side effects (like nausea, insomnia, or sexual dysfunction), but their overall safety profile is favorable, especially compared to benzodiazepines.
2. Buspirone (BuSpar)
Buspirone is a unique anti-anxiety medication primarily used for generalized anxiety disorder (GAD). It is often chosen if SSRIs are ineffective or poorly tolerated. Buspirone is notable for having no risk of physical dependence or withdrawal. [4] Unlike benzodiazepines, it does not affect GABA receptors or cause significant sedation.
Studies show that buspirone can be as effective as a benzodiazepine for GAD, especially when given sufficient time to work. [4] However, it typically has a slow onset; taking it daily for 2–4 weeks is usually necessary for full effect. Buspirone is best for chronic anxiety (especially persistent worry) rather than acute panic. Its side effects are generally mild (like dizziness or headache).
3. Beta-blockers
Beta-blockers (e.g., propranolol and atenolol) are heart medications that are sometimes used off-label to manage the physical symptoms of anxiety. [5]
By blocking adrenaline, beta-blockers can reduce shakiness, rapid heartbeat, and tremors. Beta-blockers are not addictive and can be helpful in short-term or situational anxiety (for instance, taking propranolol before a public speaking event to ease performance anxiety). [6]
However, research indicates that beta-blockers may not significantly improve overall anxiety disorders in clinical trials. [6] They treat the bodily effects of anxiety without addressing the mental aspects. Thus, beta-blockers are usually an adjunct tool, rather than a primary treatment for chronic anxiety.
4. Hydroxyzine (Vistaril)
Hydroxyzine is a sedating antihistamine that is occasionally prescribed for anxiety or insomnia. It is not habit-forming. Clinical evidence shows that hydroxyzine is more effective than placebo for generalized anxiety disorder and may have similar short-term efficacy to benzodiazepines. [7]
This makes it a potential alternative for acute anxiety relief. On the downside, hydroxyzine commonly causes drowsiness, dry mouth, and other anticholinergic side effects. [1]
People can also develop tolerance to its sedative effects over time. For these reasons, hydroxyzine is usually considered a second-line or “as-needed” option for anxiety, rather than a daily long-term treatment.
5. Other medications: Gabapentin, Pregabalin, Diphenhydramine
Other non-addictive medications are used in some instances.
Pregabalin (Lyrica) and gabapentin (Neurontin)
Pregabalin and gabapentin are medications used primarily to treat neuropathic pain, yet they also have anxiolytic properties. They can help reduce anxiety (especially the physical symptoms of tension). For example, studies show that pregabalin is effective in reducing anxiety in GAD (with a relatively rapid onset of benefit).
These drugs often cause side effects (like dizziness and fatigue), and there is some potential for misuse. Pregabalin and gabapentin are classified as Schedule V controlled substances in the US. [1] These medications are typically reserved for treatment-resistant anxiety or as add-ons to first-line therapy.
Diphenhydramine (Benadryl)
An over-the-counter antihistamine with sedating effects, diphenhydramine can temporarily calm anxiety and help with sleep. Diphenhydramine is not addictive, but its strong sedative effects and short duration of action make it impractical for regular use in anxiety management. It is sometimes taken for occasional relief but is not a primary anxiety treatment.
Comparing non-addictive medications vs. benzodiazepines
Benzodiazepines provide rapid relief (often within an hour) but carry significant risks. In contrast, non-addictive medications work more slowly but are safer for long-term use. For example, a benzodiazepine can quickly quell a panic attack but may lead to tolerance and dependence. In contrast, an SSRI or buspirone might take a few weeks to build up its effects, yet it can reduce anxiety consistently without risk of addiction. [4]
While SSRIs, SNRIs, buspirone, and similar drugs are preferred for the daily management of anxiety disorders, benzodiazepines are best reserved for short-term or acute situations. Moreover, non-addictive meds generally have milder side effects and do not impair cognition or alertness to the extent that benzodiazepines can.
Other treatment and management options for anxiety
Medication is only one part of effective anxiety management. Therapy is a cornerstone—particularly cognitive-behavioral therapy (CBT), which has a strong evidence base for anxiety disorders. [9]
Regular exercise also has proven benefits, as physical activity reduces anxiety levels and improves mood. [10]
Additionally, practicing relaxation techniques (such as deep breathing exercises, mindfulness meditation, or yoga), maintaining good sleep habits, and avoiding excessive caffeine or alcohol can help control anxiety. Many patients find that combining these approaches with medication yields the best results for long-term anxiety relief. [11]
Dual diagnosis treatment and considerations for people in recovery
Anxiety frequently co-occurs with substance use disorders. [12] Some people with anxiety may even try to self-medicate with alcohol or drugs, which increases the risk of developing an addiction. [13]
For someone in recovery from addiction, it’s crucial to manage anxiety without jeopardizing sobriety. That means, if possible, avoiding benzodiazepines and other habit-forming tranquilizers in favor of non-addictive treatments.
SSRIs or buspirone, for example, can treat an anxiety disorder without triggering a relapse. Integrated dual diagnosis programs address anxiety and substance use disorder together, leading to better outcomes.
By prioritizing non-addictive medication and therapy, people in recovery can relieve their anxiety symptoms while safeguarding their sobriety. This strategy allows patients to manage anxiety effectively as they maintain long-term recovery and improve their overall quality of life as well.
