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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.
For example, the commonly accepted concept of anxiety involves feelings 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).
In terms of a medical diagnosis, however, anxiety can mean a number of different mental health conditions gathered under the umbrella term of anxiety disorders.1
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 affected person is significantly negatively impacted by their symptoms and is often powerless to prevent or control the symptoms once they have taken effect.
An individual’s daily life may become markedly compromised because of the debilitating effects of 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 might lose sleep and be unable to focus on hobbies, relax, or cope with even small problems.2
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.
Anxiety disorder comes in many forms. Generalized anxiety disorder is a common presentation, where people excessively fret and stress over everyday issues, 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).3
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 Anxiety and Depression Association of America, this is a serious form of anxiety disorder that affects 2-3% of the US population in any given year, and is twice as common in women as in men.4
The National Institute of Mental Health has pointed to past estimates of roughly 12% of U.S. adults having social anxiety disorder—a potentially paralyzing fear of being judged by other people or embarrassing oneself in a public setting—at some point in their lives. Individuals who have social anxiety disorder may 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.5
People may start to feel the impact of social anxiety disorder even weeks before they are due to meet with another person, or they might experience panic 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.
While the different anxiety disorders are diagnosed based on somewhat different sets of diagnostic criteria, some general signs and symptoms common to anxiety disorders include:2
The Anxiety and Depression Association of America 7 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 to help make them feel more comfortable and less inhibited in social settings.
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. And, 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. 6
Gender can make a difference. Women are twice as likely 8 to have an anxiety disorder as men, and women are more likely to develop anxiety disorders earlier in their lives than men are.
These differences may be due to variations in estrogen- and progesterone-mediated brain chemistry between the genders and the development of a relatively stronger and more persistent flight-or-fight response.
Helping someone with the co-occurring disorders of anxiety and drug addiction can start by recognizing some of the warning signs and symptoms 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 adverse consequences start to mount, treatment may be beneficial.
In cases of significant substance dependence, the first part of recovery may be a medical detox. Some acute withdrawal syndromes are particularly unpleasant and, potentially risky, so this step 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 can cause distressing symptoms, many of which can be related to anxiety. To make sure that the client is as safe and comfortable as possible during the process, a doctor might administer stabilizing medications (e.g., opioid agonists, benzodiazepines, when applicable) during the withdrawal management period.
As such medications may be intended only for short-term use (i.e., during detox), and underlying anxiety is likely to continue to be an issue, other anxiety management medications may need to be initiated—such as selective serotonin re-uptake inhibitors (SSRI) or selective norepinephrine re-uptake inhibitors (SNRI). These medications have little to no abuse liability but affect the brain chemistry in a way that helps to manage anxiety in the longer-term.12
Examples of SSRIs include:
Examples of SNRIs include:
Benzodiazepines, such as Xanax and Valium, are sometimes prescribed for anxiety, but these drugs have the potential for abuse and dependence, and many doctors do not want to prescribe them for this reason. 12 In addition to medications, non-pharmacologic measures may also be instituted for better management of anxiety.
Medical detox may last, on average, for several days to weeks, although the length of the process depends on some of the factors mentioned above, including the nature of the anxiety disorder at play and how extensive the drug addiction is. After successful detox and withdrawal management, patients may transition into a longer-term course of rehabilitation and 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.13
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 how better ways of acting on their thoughts and feelings can lead to more positive outcomes.
To facilitate this, the client’s family might be part of treatment, as having a good network of trusted and loved ones to fall back on is a huge part of preventing relapse. Group therapy and aftercare support also play important roles in helping the client learn from others who have been in the same situation, who have changed their lives to adapt to the reality of being newly sober and taken control of their anxiety disorders for the first time in their lives. Aftercare support can mean a 12-Step support group for the drug addiction, a support group for the anxiety disorder (such as Emotions Anonymous), or participation in healthy activities, like exercise, yoga, cooking therapy, art therapy, and music therapy.
Psychotherapy may take several months to complete, and aftercare support can be a lifelong commitment. With so many treatment options available, recovery is within reach for those suffering from anxiety and substance abuse.