Anxiety is a big word, covering a wide variety of conditions and symptoms that affect millions of people. While the concept of anxiety is universally understood, the mechanics and implications of the medical state can surprise people, in addition to the connection between anxiety and drug addiction. Recovery is always possible, but part of treatment comes from grasping the full scope of anxiety and what it means when it comes to substance abuse.
Anxiety and Anxiety Disorders
For example, the commonly accepted definition of anxiety is a feeling of worry or dread, especially with regards to an imminent event, or an event where the outcome is not known (such as an exam, a job interview, or even the conclusion of a marquee sports game). Medically speaking, however, anxiety can mean a number of different mental health conditions gathered under the umbrella term of anxiety disorders. While they do cause people to experience worry, dread, or stress, the key point with these anxiety disorders being mental health conditions is that the person experiencing the symptoms is often rendered helpless to prevent the onset of the symptoms and cannot control the symptoms once they have taken effect.
The issue is exacerbated when the individual’s life suffers because of the debilitating effects of the anxiety. People who experience anxious moments, but who do not have anxiety disorders, will be able to go about their day when the crisis passes; people with anxiety disorders cannot stop the effects of their anxiety disrupting their everyday life. Professional, social, familial, and academic obligations will be interrupted and damaged by the sense of panic, stress, and foreboding that comes as a part of the condition. A person with this kind of anxiety loses sleep, cannot focus on hobbies, cannot relax, and cannot cope with even small problems.
Expecting those with anxiety disorders to simply “get over” their fears is futile, because what they are feeling isn’t merely a passing discomfort. It is persistent; it cannot be abated by admonishing or comforting them.
Different Types of Anxiety
Anxiety disorder is not a simple case of overreacting, either; Medical News Today writes that one of the defining characteristics of anxiety disorder is that the reaction has to be disproportionate to the trigger, meaning that the anxiety-laden response greatly outweighs the real scope of the situation. Even a relatively miniscule provocation might throw the individual into a panic attack that cannot be controlled.
Anxiety disorder comes in many forms. Generalized anxiety disorder is a very common presentation, where people excessively fret and stress over everyday topics, such as their relationships, financial situations, health, or even having anxiety itself. These worries occur even if there is no tangible reason for them to feel this way (i.e., the relationship is secure, finances are good, and they have no health concerns).
Then there is panic disorder, where individuals are gripped by such fear and tension that they have difficulty breathing, tremble uncontrollably, and feel nauseated. According to the American Psychiatric Association, this is a serious form of anxiety disorder that affects 1 in 75 people.
Social Anxiety Disorder
The National Institute of Health estimates that approximately 15 million people have social anxiety disorder, a paralyzing fear of being judged by other people or embarrassing oneself in a public setting. Individuals who have social anxiety disorder will go to great lengths to limit their interactions with others, perhaps even eschewing opportunities to make friends or business contacts, or go on dates. As with anxiety in general, this is not simple shyness; those with social anxiety disorder cannot simply “get over” their discomfort, and forcing them into a public situation, or one where they have to interact with another individual, can be traumatizing and debilitating for them.
People can start to feel the onset of social anxiety disorder even weeks before they are due to meet with another person, or they might experience panic disorder-like symptoms if they believe they are being judged or watched by others in a large setting. Again, as with anxiety overall, there may be no basis for this assumption, but the anxiety disorder will be relentless nonetheless.
Obsessive-compulsive disorder (OCD) is another very common presentation of anxiety disorder. Affecting around 2.2 million people (or 1 percent of the population), OCD causes its sufferers to experience obsessive thoughts about personal safety or wellbeing that can only be allayed by carrying out compulsive, repetitive actions. These thoughts can be intrusive, interfering with daily life and obligations; the actions can take hours to perform or repeat, often causing significant inconvenience and disruptions to individuals and the world around them. Typical presentations of obsessive-compulsive disorder might include washing hands for hours after shaking hands with a stranger, or losing hours’ worth of sleep at night due to checking and rechecking every point of entry into a home.
As with anxiety disorders in general, trying to interrupt individuals when they are having an episode of OCD, or assuming that their behavior is trivial and controllable, might cause a panic attack.
Post-Traumatic Stress Disorder
One of the most infamous forms of an anxiety disorder is post-traumatic stress disorder. Here, people who have suffered an event that grievously threatened their lives or sense of personal safety experience recurring memories of the event, in the form of nightmares and intrusive flashbacks. They become incredibly sensitive to anything that might trigger a recollection – a soldier might hear a firework and be convinced that it is an improvised explosive device, or a rape victim might be too scared to enter into a romantic or sexual relationship – and, as a result, their daily lives are affected.
PTSD can disrupt sleep patterns, make social engagements a source of anxiety, and can lead to the breakup of relationships. As with other anxiety orders, telling a person with post-traumatic stress disorder that their trauma is in the past, and that the effects are all in their head and nothing to worry about, can make the problem significantly worse.
Signs of an Anxiety Attack
Anxiety disorders are all different in their own ways, but the signs of an attack in progress are shared, in terms of physical symptoms and mental and emotional symptoms.
- Pervasive dread
- Inability to socialize, relax, or enjoy the company of others
- Rapid heartbeat
- Nausea or vomiting
- Difficulty breathing
- Tense, rigid muscles
Anxiety and Drug Addiction
All of these symptoms can make a susceptible person turn to drugs or alcohol to cope with the stress of anxiety, especially if personal concerns are not taken seriously by friends or family. It is entirely possible that the sufferers themselves are unaware that what they have is far more than a simple case of nerves. Thus, they take drugs and alcohol to make themselves feel better; and then, when the symptoms persist, they consume even more drugs and alcohol, in part because they are futilely chasing confidence and assuredness, but also because the chemical substances have started to change the brain’s functioning.
Drugs work by targeting the centers of the brain that produce the chemicals that lead to a person feeling pleasure, rewarded, or anticipation of rewards. It is the same mechanism of action behind addictive behaviors that do not involve drugs, like gambling or a food addiction. With chemical substances, however, the neurotransmitters responsible for the sensations of reward and pleasure are made to artificially flood the brain, creating an incredibly strong response that immediately hooks the individual. Those taking a drug, whether recreational or prescription, feel an intense burst of euphoria that is unlike anything they have normally or naturally experienced before.
The Cycle of Drugs and Anxiety
For someone with an anxiety disorder, this euphoria can seem like the complete opposite of the stress, dread, and fear they have become accustomed to. But it doesn’t last, as the body breaks down the drugs, and the dopamine is reabsorbed by the brain. So the person takes another hit, as much as to recapture that blissful euphoria, but also because the person instinctively remembers how good it felt to take those drugs or drink alcohol, and wants that feeling again.
Psychology Today calls it a “cycle of self-medication and rebound anxiety,” a process of deepening both the addiction and the symptoms of anxiety disorder. In a vicious form of catch-22 – the same drugs that bring momentary relief (whether prescription drugs, illegal drugs, or simply caffeine) can also cause anxiety.
The Anxiety and Depression Association of America quotes a doctor as saying that social anxiety disorder “frequently travels in the company” of alcohol or drug abuse, as people with social anxiety disorder might try to make use of alcohol or cocaine’s reputation as a “social lubricant.” However, the anxiety robs these people of the perspective of knowing when too much is too much (or that cocaine is dangerous in any amount), or even that they have an anxiety disorder that needs treatment and therapy, not drugs and alcohol to get over their fear of talking to people.
Factors for Anxiety
What can lead to a person developing an anxiety disorder? Mayo Clinic explains that as with other mental health issues, there is no one singular cause, but rather a combination of conditions that, if aligned just right, make a person more susceptible and prone to developing an anxiety disorder.
For example, genetics could play such a role.
A person with a family history of mental health and/or substance abuse disorders is likely to inherit the likelihood of growing up with an anxiety disorder, although it should be understood that having a family member with an anxiety disorder does not guarantee that an individual will also have the disorder.
But other factors can influence the probability. Growing up in a stressful environment (for example, a household where fighting and arguing are common) or experiencing a traumatic event in childhood (such as physical/sexual assault or a home invasion) could combine with pre-existing risk factors to lead to the cultivation of a general feeling of stress. If the stress is left untreated, it could grow and fester until it becomes impossible to live with, culminating in the kind of anxiety disorder that drives a person to substance abuse.
Women and Anxiety
Gender, too, can make a difference. Women are twice as likely to have an anxiety disorder as men, and women are more likely to develop anxiety disorders earlier in their lives than men are. This may be due to variations in brain chemistry between the genders; estrogen and progesterone hormones give women a stronger flight-or-fight response, but the response stays activated for longer than it does in men, leading to the side effect of a heightened reaction to stressful stimuli that manifests in anxiety disorders.
Similarly, women are twice as likely as men to develop post-traumatic stress disorder even though, according to the American Psychological Association, men experience more traumatic events than women. Furthermore, women tend to have stronger symptoms of PTSD than men.
For such women, their PTSD is a risk factor that itself may contribute to the development of a substance abuse disorder. Women who have PTSD are two or three times more likely than men to start drinking or abusing drugs, according to the Alcohol Research & Health Journal. This becomes significantly more likely if the women were the victims of sexual or physical abuse during their youth.
Helping a Person with Anxiety and Drug Addiction
Helping someone with the co-occurring disorders of anxiety and drug addiction can start by recognizing the warning signs of the problem. If behavior or personality changes, if the person starts losing interest in hobbies, or if the person insists on consuming drugs and alcohol even as the visible consequences start mounting up, then the person is in need of an intervention. A person who is also suffering from an anxiety disorder should not even begin to experiment with drugs, since chemical substances can easily (and powerfully) upset the already-compromised chemical imbalances in the brain.
The first step to break the addiction is detox, which is a process of gradually weaning individuals off their physical dependence on substances. Detox is a difficult stage of treatment, so it should not be attempted at home. Instead, a treatment facility provides a safe, clean space, with doctors and medical staff on hand, to help as the body relearns how to function without drugs or alcohol.
Detox often causes distressing withdrawal symptoms, many of which are similar to the signs of anxiety mentioned above (muscle discomfort, trembling, rapid heartbeat, etc.). To make sure that the client is as safe as possible during the process, a doctor might prescribe selective serotonin reuptake inhibitors, a kind of anti-anxiety medication that keeps the brain from reabsorbing the serotonin neurotransmitter. Serotonin relays electrical signals from the areas of the brain that are responsible for the regulation of mood and social behavior, among many other functions; preventing its reabsorption leaves the individual with a much better mood, which can help with anxiety.
Examples of selective serotonin reuptake inhibitors include:
- Fluoxetine (sold under the brand name Prozac)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
Therapy for Anxiety and Drug Addiction
Medical detox usually lasts a little more than a week, although the length of the process depends on some of the risk factors mentioned above, including the nature of the anxiety disorder at play and how extensive the drug addiction is. When ready, clients can start a course of therapy to help them understand, cope, and overcome the underlying issues behind their anxiety and drug abuse.
The American Psychological Association explains that licensed psychologists will use a methodology called Cognitive Behavioral Therapy (or CBT) to help their clients identify and learn from the sources of their anxiety. It is only through therapy (like CBT, although there are other approaches) that clients can make tangible strides towards restoring a sense of balance and stable mental health to their lives. Simply walking away from treatment after detox is ineffective (and might even prove more harmful).
CBT works as the psychologist and client work together to come up with techniques to control (or even eliminate) the behaviors that arise from anxiety. These techniques could be as innocuously basic as deep breathing and counting to 10 when the person feels the onset of a pounding heartbeat or shallow breathing. To people without anxiety disorder, the idea of breathing slowly might be obvious; but those who struggle with the disorder need the intervention of a trained mental health care professional to learn how to take control of their lives, one step at a time.
The same way that CBT teaches clients how their thoughts lead to the symptoms of anxiety disorders (and how those thoughts can be anticipated and prepared for) can be applied to treating substance abuse. As people become more aware of their thoughts and feelings, it can lead to a greater acknowledgement of the danger of taking drugs and alcohol (especially with a pre-existing anxiety disorder) and how better ways of acting on their thoughts and feelings can lead to more positive outcomes.