Two problems, one careful approach

This page covers two kinds of work that look different but need the same skills. One is treating addiction. The other is de-prescribing: reviewing the medications you take, deciding which ones still earn their place, and tapering the ones that do not. Both require patience, honesty, and a plan that goes at your pace.

Addiction is a medical condition

Addiction involves lasting changes in the brain circuits for reward, stress, and self-control. Researchers at the National Institute on Drug Abuse describe it as a treatable brain disorder in which recovery is expected, not exceptional (Volkow et al., 2016). It is not a moral failing, and you do not have to hit bottom before you deserve help.

I treat alcohol, cannabis, stimulant, and sedative use, and I look closely at what sits underneath it. Anxiety, trauma, ADHD, depression, bipolar disorder, and chronic pain are often part of the story, and treating one without the other rarely holds. I have worked as a psychiatrist in residential programs for adolescents and young women with serious mental illness, addiction, and trauma, so I am used to both problems arriving together. I have also published on cannabinoid hyperemesis syndrome, a serious condition seen with heavy long-term cannabis use.

For alcohol use disorder, medication works and is underused. A systematic review and meta-analysis found that naltrexone and acamprosate both reduced the return to drinking compared with placebo (Jonas et al., 2014). For opioid use disorder, medication treatment with buprenorphine or methadone is the standard of care and sharply reduces overdose risk; I will help you get started on it or connected to a program that can.

I do not ask you to promise abstinence in the first visit. We start with what is happening, what you want, and what is safe.

What de-prescribing means

De-prescribing is a structured process: review everything you take, work out what each medication was started for, check whether it is still helping, and then reduce or stop the ones that are not, one change at a time, while watching for a return of symptoms or withdrawal (Scott et al., 2015). It is not a campaign against medication. Some people need their medication for a long time, and I will say so plainly. The point is that every drug on your list should have a reason to be there.

People reach me in a few common ways. For example, they are on five medications and cannot say what three of them are for; they have taken a benzodiazepine or sleep medication for years; they have been on an antidepressant for a decade and wonder if they still need it; or side effects have piled up faster than benefits.

Benzodiazepines and sleep medications

Benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin), and sleep drugs such as zolpidem (Ambien), cause physical dependence in many people who take them exactly as prescribed. That is not the same as addiction, and it is not a character problem. In 2020 the FDA required boxed warnings covering abuse, misuse, addiction, physical dependence, and withdrawal for the whole class.

Stopping suddenly can be dangerous, including seizures, so please do not cut these on your own. A 2025 joint guideline from ten medical societies advises against abrupt discontinuation in people who are likely physically dependent, calls for an individualized taper with ongoing monitoring, and generally suggests starting with small reductions of around 5 to 10 percent of the dose (Brunner et al., 2025). For people who have taken these medications for a long time, a taper can take many months and sometimes more than a year. That is normal, not a sign that something is going wrong.

Antidepressants and other psychiatric medications

The science on stopping antidepressants is still developing, and experts disagree about how common and how long-lasting withdrawal symptoms are. Most agree that stopping abruptly after long-term use is rarely a good idea, that withdrawal and relapse can feel alike, and that slower tapers are a reasonable thing to try. A 2019 paper in The Lancet Psychiatry proposed tapering in progressively smaller steps rather than fixed cuts, so the dose drops less as it gets lower (Horowitz & Taylor, 2019). I use that idea as a guide, not a rule, and adjust to how you are doing.

The same careful approach applies to antipsychotics, mood stabilizers, stimulants, gabapentinoids, and combinations that have grown over the years.

What the process looks like

1. A long first visit to build a complete medication history: every drug, dose, start date, why it was started, and what happened.

2. A look at the diagnosis, because sometimes the medication list is a record of a diagnosis that was never quite right.

3. A written plan with the order of changes, the pace, and what we will watch for.

4. Changes one at a time, with check-ins between steps, so we can tell what is causing what.

5. Coordination with your other prescribers and your pharmacy, so no one undoes the plan by accident.

I will not take away a medication that is keeping you well just to shorten the list.