Anxiety and Substance Use Disorders
What is Anxiety?
Anxiety is an emotion that produces feelings of tension, worry, and even physical changes such as increased blood pressure.5 We all need some degree of anxiety to respond appropriately to everyday life circumstances. However, if ongoing anxiety interrupts your daily routine and interferes with work, school, other activities, and relationships, you may have an anxiety disorder.5
Anxiety disorders are treatable and can be effectively managed by working with your doctor who can help you choose a treatment that is right for you.1 Therapy helps people learn what anxiety is, what triggers their anxiety, why anxiety affects them in certain ways, and how to change the response. Although it may be difficult to seek help at first, understanding the symptoms of anxiety may help give you confidence in seeking professional advice. The goal of therapy is to improve your overall health and free yourself from the debilitating thoughts and restrictions that come from having an anxiety disorder.
Common Symptoms of Anxiety
Mental disorders, like anxiety, involve changes in thinking, mood, and/or behavior. These changes can affect how you relate to others and how you make choices.6 The different types of anxiety disorders include generalized anxiety, substance/medication-induced anxiety, social anxiety, phobias, and panic disorder.
The following symptoms are associated with generalized anxiety disorders:7
- Excessive anxiety and worry, occurring more days than not for at least 6 months
- Difficulty controlling the worry
- Anxiety and worry that are associated with 3 (or more) of the following 6 symptoms (Note: Only 1 item is required in children)
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless or unsatisfying sleep)
- Anxiety, worry, or physical symptoms causing significant problems in social, work, or other important areas of everyday life
- Anxiety that is not caused by medication side effects or other substances, or a medical condition (e.g., hyperthyroidism)
- Anxiety that is not related to having another mental disorder
These symptoms may negatively affect a person’s life, especially if they begin to avoid certain situations to avoid anxiety.7 In someone with an anxiety disorder, physical signs may become amplified such as sweating, trembling, dizziness, or a rapid heartbeat, making it difficult to effectively engage with others.7
How Are Anxiety and Substance Use Disorders Related?
Anxiety disorders (ADs) co-occur with substance use disorders (SUDs) at a high rate2 and some studies indicate that one disorder may develop due to the other.2 Anxious people might attempt to use an addictive substance or self-medicate to “calm the nerves” rather than going to a doctor to be evaluated for their anxiety. The risk associated with this pattern of coping is that it can lead to more anxiety, addiction, or other medical complications.
There are other reasons why SUDs and mental health issues may occur together. Environmental influences, hereditary traits, and genetic similarities in people with both addiction and anxiety occur in 30% to 68% of those studied.9 Common personality traits that influence risk-taking, addiction, and addiction-related characteristics also contribute to co-occurring disorders. These characteristics include behavioral inhibition (being self-conscious and unable to relax), anxiety sensitivity (hypersensitive), increased startle reaction, and dysfunctional emotional processing.9
People who have a mental health disorder and are untreated, undertreated, or misdiagnosed are at increased risk for misusing, abusing, or becoming dependent on a substance.2 The intense need to “cover-up” feelings and manage unpleasant symptoms of anxiety contributes to resorting to quick fixes. Alcohol, prescription drugs, and illicit drugs can be easily accessible and are often taken to cope in situations that cause anxiety although this is a dangerous combination.
There are addiction risks to certain approved treatment medications for both anxiety disorders and the treatment of SUD. Medications that are classified as scheduled drugs have addictive qualities, meaning, if the substance is misused, overly used, or abused it has the potential to make a person gain tolerance and dependence on that substance. Medications such as benzodiazepines are effective in treating generalized anxiety; however, their use is controversial because of the high abuse potential.10
Physicians, nurse practitioners, and other prescribing professionals of scheduled medications often screen for substance use disorder routinely while prescribing these drug therapies. People who have been taking scheduled medicines for even a short period (e.g., weeks) have the potential to gain a tolerance, which can lead to abuse and dependence. In addition, medications like benzodiazepines (e.g., Ativan or valium) pose a risk to others when diverted or misused. It is important to keep these types of medication in a safe place where no one else can access them.
Commonly Prescribed Drugs for Anxiety
Anxiety disorders are commonly treated with “anti-anxiety” medications to help reduce symptoms such as panic attacks or extreme fear or worry.8 Generalized anxiety disorder is most often treated with a common class of anti-anxiety medication called benzodiazepines. If a person is diagnosed with a panic disorder or social phobia, the first line of medication is usually a selective serotonin reuptake inhibitor (SSRI) or another antidepressant.8
Medication therapy varies based on a person’s diagnosis, other prescribed medications the person may be taking, and other medical conditions.
Benzodiazepines used to treat anxiety disorders include the following:8
Benzodiazepines should be taken exactly as prescribed. The most common side effects from taking benzodiazepines are drowsiness and dizziness. However, other possible side effects include: 8
- Blurred vision
Notify your provider if any of the following symptoms become severe and/or persistent:8
- Problems with coordination
- Difficulty thinking or recalling things
- Increased saliva production
- Muscle or joint pain
- Frequent urination
- Blurred vision
- Change in sex drive or ability
Other medications that are effective in treating anxiety include beta-blockers and buspirone. These medications help control symptoms such as sweating, rapid heart rate, and trembling that are brought on by anxiety or panic episodes. Beta-blockers (e.g., Propranolol, atenolol) are often prescribed to treat short-term symptoms and are often ordered as needed, meaning you only take them when you think you need to.7 Buspirone (e.g., BuSpar) is for longer-term therapy and must be taken daily to work properly.8
Benzodiazepines need to be taken with caution as they have potential risks for addiction. Tolerance, dependence, and withdrawal need to be evaluated frequently to screen for risk of developing a substance use disorder.
Substance Use Treatment for People with Anxiety
Long-term, effective treatment for those who have an addiction and a mental health disorder is often referred to as treatment for a dual diagnosis, or more recently called treatment for co-occurring disorders.10 (p1) Evidence reveals that the best way to treat the co-occurring disorders is through an integrated treatment model.10 An integrated treatment plan includes both psychotherapy (e.g., talk therapy) and pharmacotherapy (medication therapy) to address the complex needs of co-occurring disorders.10
Clinicians are trained to understand the person’s history leading up to their substance use and mental health symptoms. The treatment team needs to determine whether the substance use led to the mental health condition or the mental health condition lead to substance abuse10
Anxiety disorders that co-occur with a substance use disorder can be a challenge to diagnose, because of the potential for substance intoxication or withdrawal to induce symptoms of anxiety.10 The complex nature of co-occurring disorders are best treated simultaneously by addiction specialists and mental health professionals (e.g., social worker, addiction counselor, psychologist, psychiatrist) who communicate as a team and care for the individual together.
Elements of integrated treatment to help decrease both anxiety symptoms and risk of relapse include:10
- Behavioral treatments such as cognitive-behavioral treatment (CBT), a type of effective psychosocial treatment.
- Medication therapy (e.g., antianxiety, antidepressants).
- Combining CBT and medications.
Cognitive-behavioral therapy is based on 3 core principles:11
- Psychological problems are based, in part, on unhelpful ways of thinking.
- Anxiety problems are based, in part, on learned patterns of unhelpful behavior.
- People suffering from anxiety disorders (or other mental health disorders) can learn better ways to cope, to relieve the symptoms causing distress, to effectively live.
Research indicates that integrated treatment has proven effective in treating substance use disorders by increasing abstinent days and decreasing symptoms of anxiety.10
Is Integrated Treatment Right for Me?
If you have a diagnosis of a mental health disorder and are struggling with substance abuse, integrated treatment will likely benefit you. When talking with your healthcare provider it is important to share your medical and mental health history as best as possible. The more information you provide the more it will help you, your physician, and the treatment team to make the right plan for your treatment.
Integrated Treatment Options for Anxiety and Addiction
When you are ready to get help you should look for a rehab center that has an integrated treatment program that can treat both addiction and anxiety at the same time. Integrated treatment providers work with experts in medicine, addiction, behavioral, and mental health. These programs incorporate multiple therapies to meet your comprehensive needs in treating co-occurring disorders.American Addiction Centers is a leading provider of integrated treatment programs at various locations throughout the United States. We are positioned to help you every step of the way in receiving treatment for your co-occurring disorder. We specialize in the following advanced therapies:12
American Addiction Centers Desert Hope Las Vegas Treatment Center has an expansive list of specialty therapies to help reduce stress and foster well-being. To complement their comprehensive integrative treatment plans these holistic approaches are offered:13
- Animal therapy
For more information about treatment at Desert Hope, or any American Addiction Centers’ location, call our confidential substance abuse helpline to speak with our team.
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