Drug Story: “On Xanax and Anxiety”

Host: Thomas Goetz
Guest Voices: Martha McPhee, Dr. Andrew Saxon
Date: February 3, 2026

Episode Overview

This episode of Drug Story dives into the cultural, medical, and personal story of Xanax (alprazolam), examining how it became both a medical lifeline and a source of risk in modern society. Through the lens of Martha McPhee’s long-term use, psychiatry’s evolving approach, and a dose of drug history, host Thomas Goetz asks: what happens when we use drugs to fix our mental and emotional challenges—specifically, anxiety? The episode blends personal narrative, expert insight, and cultural analysis to chart the evolution of anxiety as a diagnosis and Xanax as its pharmaceutical companion and cautionary tale.

Key Discussion Points & Insights

1. Martha’s Story: The Personal Cost of Tranquility

• First Panic Attack (00:07–01:05):
  Martha recounts her terrifying first panic attack in New York, feeling like she was dying, desperate to escape and fearing for her children’s safety.

  • “I started racing like I needed to get out of my skin and run away.” — Martha McPhee (00:13)

• Discovery & Escalation of Xanax Use (01:05–02:30):
  After her doctor prescribed Xanax, it soothed her panic quickly. At first, usage was rare—a “tiny bite” at night for sleep—but her dependency escalated over time.

  • “It calmed me right down...I just slowly started using it.” — Martha McPhee (01:32)

• Attempts to Quit: Rebound Anxiety (03:21–04:16):
  A new doctor linked her mounting anxiety to “rebound anxiety”—withdrawal-like symptoms from long-term Xanax. Both her therapist and medical doctor insisted she stop.

  • “That anxiety doesn’t go away when you take the Xanax. It’s stored, and then it comes back...with a vengeance.” — Martha McPhee (03:30)

• Going Cold Turkey (04:16–04:39):
  Against medical advice, Martha quit abruptly, experiencing turbulent withdrawal but ultimately feeling calmer and more centered off the drug.

  • “I was bouncing off the walls. It was awful, right?” — Martha McPhee (04:30)
  • “My sisters...say, oh, my God, you’re a different person. You’re so much calmer.” — Martha McPhee (04:43)

2. Anxiety: From Evolutionary Response to Medical Condition

The Nature and History of Anxiety

• Evolutionary Role of Anxiety (11:45–12:56):
  Dr. Saxon explains anxiety as a vital survival mechanism rooted in “fight or flight”—helpful in the face of danger but problematic when misapplied in modern life.

  • “If you had an anxiety reaction...you were prepared either to run away from the danger or confront the danger to your fullest capacity.” — Dr. Andrew Saxon (11:45)
  • “Much of our anxiety in modern life has to do with things where we don’t need a fight or flight response.” — Dr. Saxon (12:25)

• Anxiety in Culture and Diagnosis (13:10–17:00):
  Anxiety as a modern epidemic is a recurring theme in literature and culture, but ancient Greeks and Babylonians recognized and tried to treat it too. Cognitive Behavioral Therapy (CBT), modeled in part on Stoic philosophy, becomes a key treatment.

  • “There’s a difference between a state of anxiety and a trait of anxiety...as a trait...anxiety could be understood as a sickness or a disease.” — Seneca, paraphrased by Thomas Goetz (16:35)

• Medicalization: Arrival in the DSM (17:20–18:10):
  Anxiety is classified as a psychiatric condition in 1952’s first DSM, spurring a search for treatments as societal stress increased post-WWII.

The Drug Evolution

• Tranquilizers: Miltown & Barbiturates (18:30–21:40):
  Initial “miracle” anti-anxiety drugs worked rapidly but proved addictive and dangerous, with mounting deaths among celebrities and everyday users.
  • “It worked too well...a new kind of overdose victim was showing up in hospitals.” — Thomas Goetz (20:33)

3. The Benzodiazepine Era and Xanax’s Rise

Valium: The First Blockbuster Benzo

• Valium’s Success & Problems (24:22–26:05):
  Marketed as “Mother’s Little Helper,” Valium’s popularity soared, especially among women. Its effectiveness brought dependency and significant side effects.

Xanax: Targeted, Timed, and Culturally Entrenched

• Xanax Launch and Strategy (27:07–28:47):
  Upjohn’s calculated approach—targeting doctors, emphasizing clinical anxiety, and minimizing side effect narrative—resulted in rapid Xanax adoption.

  • “It was perfectly timed to address what seemed like a growing epidemic of anxiety.” — Thomas Goetz (28:12)

• From Medical Use to Cultural Touchstone (29:25–29:52):
  Xanax outpaces its rivals to become a cultural icon, name-checked in everything from The Sopranos to rap songs, cementing its place in the zeitgeist.

Immediate Effects, Immediate Risks

• The Euphoria Trap (30:13–31:22):
  Dr. Saxon describes how Xanax’s fast-acting, euphoria-inducing properties make it especially prone to overuse and abuse.
  • “Alprazolam...gets into the brain very quickly and causes an effect very quickly and tends to be more euphorogenic than many of the other benzodiazepines.” — Dr. Saxon (30:44)

4. Side Effects and the Dark Side of Xanax

Two Paths to Abuse

• Recreational Abuse (32:15–34:22):
  Used as a party drug, Xanax suppresses risk perception, encouraging dangerous behavior and repeated dosing. Overdoses skyrocket, especially when mixed with opioids or in counterfeit forms laced with fentanyl.

  • “More people went to ERs for non medical use of benzodiazepines than...for prescription opioids.” — Thomas Goetz (34:10)

• Silent, Prescribed Dependency (34:22–36:21):
  Many, like Martha, follow their prescription, not realizing the long-term risk of physical dependence. Official guidelines for short-term use were routinely ignored.

  • “Half of patients who were prescribed benzodiazepines took them for two months or longer.” — Thomas Goetz (35:11)

The Problem of Withdrawal

• Overlapping Symptoms (36:21–37:47): Withdrawal from benzos mimics anxiety, making it nearly impossible to tell where the disorder ends and withdrawal begins; tapering off is notoriously hard.
  • “The withdrawal symptoms and the symptoms of an anxiety disorder...overlap...they might misinterpret the withdrawal as just a return of their anxiety disorder.” — Dr. Saxon (36:21)

Changing Medical Consensus

• The Black Box Warning (37:47–39:29):
  Since 2020, all benzodiazepines must carry strong warnings about addiction and dangers. Modern guidelines overwhelmingly recommend against their use for chronic anxiety, favoring therapy or SSRIs.

• Shifting Prescribing Patterns (39:29–41:39):
  Psychiatry has curbed benzo use, but general practitioners—seeing more patients—lagged behind. The best treatment, per Dr. Saxon, is psychotherapy: skills to manage anxiety rather than masking it with medication.

  • “The best treatment that you can get for an anxiety disorder...developing skills to help handle and manage anxiety symptoms.” — Dr. Saxon (41:25)

5. Finding Peace Without a Pill

• Living Mindfully (42:07–43:10):
  Martha now prioritizes conscious living and practical coping: diet, reading, and mindfulness over medication.

  • “Be conscious, be conscious...I do like to think about that advice from him, to be and live consciously.” — Martha McPhee (42:10)
  • “It’s not easy. But it’s a lot better than taking Xanax.” — Martha McPhee (43:03)

• Tranquility Has a Cost (43:10):
  Goetz’s closing thought: if a drug seems magical in its effect, there’s likely a hidden cost. True tranquility can’t always be delivered by a pill.

Notable Quotes & Memorable Moments

| Timestamp | Speaker | Quote | |-----------|----------------------|---------------------------------------------------------------------------------------------------| | 00:13 | Martha McPhee | “I started racing like I needed to get out of my skin and run away.” | | 03:30 | Martha McPhee | “That anxiety doesn’t go away when you take the Xanax. It’s stored, and then it comes back...” | | 06:56 | Dr. Andrew Saxon | “It does feel like a miracle cure.” | | 08:25 | Dr. Andrew Saxon | “What seems like a victory...is a false victory because in the long run, we haven’t solved it.” | | 13:35 | Thomas Goetz | “Anxiety...is almost like an immune response. It’s a physiological reaction that we need to stay alive. And just like our immune system can work against us, anxiety can also turn on us.” | | 30:44 | Dr. Andrew Saxon | “Alprazolam...gets into the brain very quickly...and tends to be more euphorogenic.” | | 36:21 | Dr. Andrew Saxon | “There’s a big overlap between the withdrawal symptoms and the symptoms of an anxiety disorder...”| | 41:25 | Dr. Andrew Saxon | “The best treatment...is psychotherapy treatments...you’re developing skills to help handle and manage the anxiety symptoms.” | | 42:10 | Martha McPhee | “Be conscious, be conscious...to be and live consciously.” | | 43:10 | Thomas Goetz | “If a pill seems like magic...maybe it’s too good to be true. Everything has a catch.” |

Key Segment Timestamps

• Martha’s first panic attack & start of Xanax: 00:07–02:30
• Historical origins of anxiety as diagnosis: 11:45–18:00
• Rise & risks of tranquilizers/barbiturates: 18:30–23:06
• Benzodiazepines – Valium to Xanax: 24:22–29:32
• Xanax’s unique risks (euphoria, abuse): 30:13–31:22
• Recreational & prescribed dependency dangers: 32:15–36:21
• Withdrawal, black box warnings, new guidelines: 36:21–39:29
• Psychotherapy; mindful living advice: 41:39–43:10

Tone and Style

Thomas Goetz’s tone is investigative but compassionate—balancing historical narrative, scientific explanation, and empathy for those who struggle with anxiety. Expert voices lend authority and personal stories (especially Martha’s) keep the episode grounded and human. Humor and pop culture references lighten the mood without diminishing the topic’s seriousness.

Summary

This episode artfully traces how anxiety—once a universal and often beneficial emotion—evolved into a target for medical treatment, especially through drugs like Xanax. Listeners track the arc from ancient coping methods and mid-20th-century drug booms through to today’s double threat of recreational and “legal” prescription abuse. The show warns that while pills like Xanax can feel miraculous, tranquility often comes with lasting costs—and that sometimes, learning to live consciously may be the healthiest prescription.

If you or someone you know needs help with mental health or substance use, dial 988 in the US for support anytime.