Anxiety and the abuse of medication

When “just to take the edge off” becomes the new dependency

Anxiety is one of the most common reasons people walk into a doctor’s office asking for help, and one of the most common reasons people end up quietly dependent on medication they never planned to abuse. It rarely starts with a party story. It starts with someone who cannot sleep, cannot switch their mind off, cannot stop the dread, and cannot keep doing life at the pace it demands. They are not trying to get high. They are trying to feel normal.

That is why this topic hits such a nerve. Because the person with medication abuse does not match the stereotype. They might be a parent. A professional. A student. A high functioning adult who looks fine from the outside. They can be the person who gives everyone advice, holds the household together, and still has a secret drawer, a secret script, a secret panic, and a growing fear that they cannot cope without pills.

In South Africa, where stress is a national background noise and mental health support is uneven, it is easy for a short term prescription to become a long term coping system. Then the coping system turns on you.

Relief is fast and the brain remembers

When anxiety is severe, it feels like a threat inside your body. Tight chest, racing heart, nausea, shaking, spiralling thoughts, dread that arrives without reason and refuses to leave. A medication that quiets that down can feel like a miracle. Within an hour, the body settles. The mind slows. The person can breathe again.

That relief is powerful, not only emotionally but neurologically. The brain learns quickly, this is how we stop the alarm. It is not morality. It is conditioning. If someone takes a pill and feels relief, they will want that relief again, especially when anxiety returns the next day, or later that night, or during the next crisis.

For many people, the medication is appropriate at first. The problem begins when it becomes the only tool, the only plan, and the only way the person knows how to get through a bad moment.

The prescription pipeline

Medication misuse often grows out of a very ordinary pattern. A person is prescribed something for anxiety or sleep, often “as needed.” At first they use it occasionally. Then life keeps lifing. Work pressure, relationship strain, financial stress, family conflict, grief, burnout. The person uses it more often because they are not coping. They start taking it before meetings, before social events, before bed, before difficult conversations. The pill stops being emergency support and becomes routine.

Then tolerance can develop. One pill does not feel like enough. The person takes one and still feels anxious, so they take another. They justify it because they are “not abusing,” they are using it for anxiety, which sounds responsible. They may not even notice that “as needed” has quietly turned into “every day.”

Once dependence is in place, stopping is no longer simply a choice. The body reacts. Rebound anxiety hits. Sleep collapses. The person feels worse than before they started, and that convinces them they need the medication, when in reality they may be feeling withdrawal or rebound symptoms. That confusion keeps the loop going.

The warning signs people ignore

Medication abuse hides behind respectability. Nobody raises an eyebrow at a blister pack. Nobody thinks “addict” when the label has a pharmacy name on it. Families miss it until behaviour changes.

Some warning signs are practical. Running out early. Getting anxious about supply. Keeping backup pills “just in case.” Visiting multiple doctors. Avoiding conversations about how much is being taken. Being defensive when questioned. Mixing medication with alcohol to sleep or “calm down.” Taking it before normal stressors that should be manageable.

Other warning signs are emotional. Increased irritability. Flatness. Mood swings. Memory lapses. A kind of emotional distance where the person is present but not fully there. They may look calmer, but they are less engaged, less warm, less connected, and the household feels it.

The biggest sign is fear. If the idea of not having the medication triggers panic, you are no longer dealing with simple anxiety treatment. You are dealing with dependency.

Anxiety becomes the perfect excuse

Anxiety is real. That is what makes this so tricky. People can have genuine anxiety and also abuse medication. Families often get paralysed because they do not want to be cruel. They do not want to accuse someone of abuse when that person is visibly struggling. They also do not want to take away the one thing that seems to help.

This is where the conversation needs to be adult and honest. Relief is not the same as recovery. If the only plan is pills, then the person has not built any capacity to handle stress, discomfort, panic, or sleeplessness without chemical support. That means anxiety stays in charge. The medication becomes a temporary mute button, and the moment it wears off, the panic returns stronger, because the person has learned to fear the panic even more.

So yes, anxiety is real, and medication can be part of treatment, but using medication as a daily emotional crutch without building coping skills is how people end up trapped.

Anxiety care without building a second problem

A proper plan usually has multiple parts. There is the medical piece, safe management of medication, honest disclosure of what is being taken, and a realistic tapering plan when dependency exists. There is the psychological piece, therapy that targets anxious thinking, panic cycles, avoidance behaviour, and nervous system regulation. There is the lifestyle piece, sleep structure, routine, exercise, nutrition, and reducing stimulants and alcohol that keep anxiety fuelled.

Most importantly, there is the accountability piece. People who have started abusing medication often need external structure, not because they are bad, but because anxiety and dependency make people rationalise. A person can mean well and still lie to themselves when panic hits.

Families may need guidance too, because families either become police or they become enablers. Neither helps. The aim is boundaries with support, not chaos with lectures.

The conversation South Africa needs to have

A lot of people in South Africa are living with high stress, poor sleep, and constant pressure. That does not mean everyone will abuse medication. It does mean the conditions are perfect for quiet dependence, especially when therapy feels inaccessible, waiting lists are long, and people are expected to just cope.

The answer is not to shame people for needing help. The answer is to stop pretending that a pill is a complete mental health plan. Anxiety deserves real treatment. Medication may be part of it. Medication misuse is a separate risk that needs to be addressed early, before it becomes a second crisis.

If you recognise yourself in this, do not wait until you are running out early, lying about supply, or panicking at the thought of stopping. Talk to a professional and be honest about what is happening. The earlier you tackle it, the safer and simpler it tends to be.

If you are a family member watching it, do not get hypnotised by the respectability of a prescription. Watch the patterns, the secrecy, the dependency, and the emotional cost. You are not being harsh by naming it. You are being realistic, and realism is often what saves people.