anxiety and substance abuse

For all of us, life involves elements of worry, stress and fear. These emotional states are natural, even beneficial, when they occur in the right circumstances. However, anxiety disorders have become so prevalent in the United States that they now represent the most common type of psychiatric illness in the country. The Anxiety and Depression Association of America reports that roughly 18 percent of American adults suffer from some form of anxiety; however, only about 33 percent are being adequately treated. Anxiety often goes hand in hand with other forms of mental illness, such as:

  • Major depression
  • Eating disorders
  • Attention deficit hyperactivity disorder (ADHD)
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Substance use disorders

Substance abuse is more prevalent in people with anxiety disorders than in the population as a whole. Drugs and alcohol may initially be used to soothe the incessant worry and physical agitation of anxiety; however, over time, substance abuse only makes anxiety symptoms worse, resulting in a destructive cycle of addiction. Substance abuse also increases the risk of negative consequences like hospitalization, accidental injury, self-isolation and suicidal ideation.

Treating individuals with a dual diagnosis of anxiety and substance abuse requires an integrated treatment plan that targets both of these challenging conditions.

Types of Anxiety Disorders

Anxiety takes many forms. The most prevalent of these conditions is generalized anxiety disorder (GAD). Brown University estimates that about 5 percent of the population suffers from GAD, with females twice as likely to have the disorder as males. GAD is characterized by a constant state of worry or dread for at least six months. People with GAD may be worried about their health one minute and anxious about their children’s future the next. Most of these concerns are either greatly exaggerated or completely unfounded.

Anxiety affects the body as well as the mind. In addition to the constant psychological tension of GAD, the individual may experience physical symptoms such as:

  • Dry mouth
  • Sweating
  • Rapid pulse
  • Rapid, shallow breathing
  • Upset stomach
  • Diarrhea
  • Tremors
  • Fatigue
  • Insomnia
  • Jumpiness
  • Poor appetite

Drugs and alcohol can intensify the physical effects of GAD — such as shakiness, rapid heart rate, nausea and fatigue — making it even harder to function at work or maintain a healthy home life. WebMD notes that many people with GAD meet the criteria for depression, substance abuse, and additional anxiety disorders, including:

Social anxiety disorder

The debilitating fear of being humiliated or embarrassed in public situations

Panic disorder

A condition marked by intense, recurrent episodes of crippling fear, which can become a source of anxiety in themselves

Post-traumatic stress disorder (PTSD)

A disorder resulting from severe, unresolved terror or violence in the past

Obsessive-compulsive disorder

A condition characterized by intrusive, irrational thoughts combined with repetitive, ritualistic behavior that can’t be controlled

Specific phobias

Intense, debilitating fear of certain objects, animals or situations, such as enclosed spaces (claustrophobia), public settings (agoraphobia) or spiders (arachnophobia). These fears may have a distant basis in reality; however, they are exaggerated to the point that they interfere with the individual’s daily activities.

Certain forms of anxiety, such as panic disorder and PTSD, can generate such intense, overpowering fear that they resemble the signs of a heart attack or stroke.

Although the effects of anxiety are usually not life-threatening, symptoms like chest pain, shortness of breath, and sensations of choking can feel like a medical emergency.

Exploring the Roots of Anxiety

The roots of anxiety are deep and complex, arising from neurological, genetic and environmental sources. Clinical studies of close relatives and twins have shown that anxiety disorders frequently run in families. Certain disorders (PTSD, specific phobias, or social anxiety disorder) may be triggered by traumatic situations such as:

  • Physical, verbal or sexual abuse in childhood
  • Military combat
  • Sexual assault
  • Acts of terrorism
  • Witnessing violence

Not everyone who experiences trauma will develop an anxiety disorder. However, exposure to extreme stress, combined with a genetic or neurological predisposition to anxiety, may increase the likelihood of a psychiatric illness. Anxiety has been linked to imbalances in the neurotransmitter GABA (gamma-aminobutyric acid), a brain chemical that regulates stress levels and promotes rest and sleep. According to the NAMI Advocate, a publication of the National Alliance on Mental Illness, low levels of GABA may contribute to a number of psychiatric disorders, including anxiety, depression, bipolar disorder and schizophrenia. In people who suffer from anxiety, a GABA deficiency may cause psychological tension, agitation, sleeplessness and other symptoms of the disorder.

Anxiety and Addiction

Anxiety and substance abuse are often so closely intertwined that it’s hard to tell where one disorder ends and the other begins. Statistics published in Alcohol Research and Health reflect the high rates of substance abuse among individuals with anxiety disorders. Out of the individuals who responded to nationwide surveys:

  • 16.5 percent of respondents with any type of anxiety disorder also abused either alcohol or drugs
  • 39 percent of respondents with panic disorder abused drugs or alcohol
  • 27.45 percent of individuals with generalized anxiety disorder reported substance abuse
  • 11 percent of respondents with social anxiety disorder reported substance abuse

Learn More

Advances in Psychiatric Treatment notes that alcohol is one of the most common drugs of abuse among people with anxiety because it acts quickly to relieve symptoms. An alcoholic beverage can reduce edginess and irritability, ease tremors, and numb feelings of panic or fear. However, the chronic use of alcohol and other central nervous system depressants can exacerbate anxiety. In fact, many of the effects of withdrawing from alcohol, benzodiazepines and barbiturates are identical to the symptoms of anxiety disorders:

  • Restlessness
  • A sense of dread
  • Shakiness
  • Sweating
  • Elevated blood pressure
  • Delusional thinking

In order to tell the difference between an anxiety disorder and drug or alcohol abuse, the clinician must ask questions like the following:

  • When did anxiety symptoms begin?
  • When did substance abuse begin?
  • When and how does the patient use drugs or alcohol?
  • What makes anxiety symptoms better?
  • What makes anxiety worse?

Therapists use face-to-face interviews, standardized psychiatric questionnaires, and rating scales like the Beck Anxiety Inventory to gather data about a patient’s history of addictive behavior and mental illness. In order to treat both anxiety and substance abuse, these co-occurring conditions must be addressed at the same time. Through intensive psychotherapy, behavioral modification, and psychiatric medications, both disorders can be effectively resolved.

Is Anxiety Treatable?

There is no single drug or treatment that “cures” anxiety, but this debilitating disorder can be controlled successfully with the right combination of therapies. In addition to conventional approaches like individual psychotherapy, group counseling, and anti-anxiety medication, alternative and complementary treatments offer a host of benefits. Here are a few of the most effective traditional and holistic treatment modalities:

Behavioral modification therapies. Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have proven to be successful at helping people with anxiety disorders manage intrusive, disabling thoughts. A review of research studies published in Dialogues in Clinical Neuroscience showed that cognitive behavioral therapy, which focuses on helping the patient consciously change destructive thoughts and behaviors, is effective at treating all of the major anxiety disorders. Anti-anxiety medication. When taken correctly under a doctor’s supervision, psychiatric medication can be a valuable tool for controlling the symptoms of anxiety. Drugs in the benzodiazepine family, like alprazolam (Xanax) and lorazepam (Ativan) have been used successfully on a short-term or as-needed basis to prevent panic attacks and promote sleep. However, because these drugs have a potential for abuse, many clinicians now prescribe antidepressants in the SSRI (selective serotonin reuptake inhibitor) category, such as fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro). SSRIs are especially useful for individuals who suffer from co-occurring anxiety and depression. Another non-addictive anxiolytic drug, buspirone, is often prescribed to patients with a history of substance abuse. Family counseling. The effects of anxiety are never limited to a single individual. The spouses, parents, and partners of people with anxiety disorders can also benefit from intensive therapy and support. Stress reduction therapies. Yoga, martial arts, guided meditation, massage, and acupuncture can help promote a profound sense of relaxation by focusing scattered thoughts and releasing physical tension. For individuals recovering from substance abuse and anxiety disorders, these therapies can also facilitate the detox process, cleansing the system of harmful chemicals.

Dual Diagnosis Recovery

girl-reading-outside Recovering from an anxiety disorder combined with substance abuse could be one of the greatest challenges you’ll ever face. Integrated dual diagnosis treatment plans provide the support and resources you need to overcome these difficult disorders and lead a healthier, more satisfying life. Dual diagnosis rehab facilities offer comprehensive psychiatric care for patients struggling with mental illness and addiction. In addition to the traditional and alternative methods applied to the general treatment of anxiety, dual diagnosis recovery programs a full range of rehab services, including:

  • Medically supervised detoxification
  • Medication management for psychiatric and anti-addiction drugs
  • Individual and group addiction therapy based on 12-step principles
  • Behavioral modification training to develop and hone coping skills
  • Family and couples addiction counseling
  • Relapse prevention classes
  • Relaxation and recreational therapies
  • Aftercare services

The dual diagnosis treatment plans at Futures are tailored to the needs of the individual client. From the assessment phase throughout the stages of recovery, we provide treatment that reflects each client’s personal history and future goals. For more information about our exclusive recovery services in Palm Beach County, Florida, call our toll-free number and start the healing process today.

Some services listed may not be included in our core program. An admissions counselor will be able to provide you a complete list of core services. Information provided for educational purposes. Premium services or programs may be arranged through your therapist or case manager.

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