I am a psychiatrist and I do work in an inpatient psychiatrist hospital and I never prescribe either xanax (alprazolam) or valium (diazepam). As others mentioned above, alprazolam is highly addictive and, I find, causes more hurt than help. Diazepam is an OK long-term benzo, but there are cleaner, better ones.
I only prescribe benzodiazepines for two reasons:
1) the patient is at acute risk for withdrawal from and alcohol or benzo addiction. If this is the case, I use ativan (lorazepam) or librium (chlordiazepoxide). I prefer the latter.
2) very short-term treatment for agitation or anxiety. I use it in acute settings as a temporary measure until the other meds (anti-depressants, mood stabilizers, anti-psychotics, etc kick in). in this case I use the short-acting ativan (lorazepam) on a “as needed” basis usually in 0.5 to 1 mg increments up to 6–8total mg per day OR I use the longer acting Klonapin (clonazepam) usually no more than 1–3mg per day.
I HATE discharging people on these meds because they are so addictive. I will never discharge someone with lorazepam (unless they have a flight or something) and I will rarely, begrudgingly discharge someone on clonazepam provided I know the outpatient psychiatrist they will follow up with and can have a conversation about my reasoning with him/her.
If I admit someone who regularly takes a benzodiazepine as an outpatient, I wont continue it and I wont discharge them with it. I think it’s bad clinical practice to prescribe alprazolam ever. I can understand the justification for diazepam, but I think clonazepam is better because it’s longer acting and easier to dose. Nonetheless, I think these meds require extreme caution and cannot be taken lightly.