Anxiety and Addiction
Anxiety is a feeling that a person experiences as a reaction to stress, which may have a useful purpose. When someone is experiencing anxiety, heart rate and blood pressure increase, body temperature goes up, and some of the naturally occurring chemicals in the brain are either stimulated or suppressed. A person goes into a state of being hyperalert and focused, muscles tense up, and senses are often sharpened. Sometimes, people may experience a state of hyperarousal when a situation doesn’t warrant it or after the danger or stressful situation has passed, however.
Anxiety disorders are some of the most common mental health disorders in the United States. The Anxiety and Depression Association of America (ADAA) reports that more than 40 million American adults (aged 18 and older) suffer from an anxiety disorder. The National Institute on Mental Illness (NIMH) publishes that this equates to over 18 percent of the adult population and that in almost a quarter of those affected, the disorder is classified as “severe.” Anxiety disorders cause a person to feel fear or perpetual worry and can interfere with daily life, making it difficult to sleep, concentrate, and eat. Fatigue, restlessness, feelings of being on edge, tension, sweating, headaches, gastrointestinal upset, and tremors are common side effects of anxiety disorders.
Addiction is a brain disease that over 20 million Americans (aged 12 and older) battled in 2013, the National Survey on Drug Use and Health (NSDUH) publishes. Impacting behaviors, emotions, physical health, social interactions, and more, addiction often accompanies mental health disorders like anxiety. Someone suffering from an anxiety disorder is 2-3 times more likely to also battle an alcohol use disorder (AUD), and around six times more likely than the general population to also suffer from a drug use disorder, Psychiatric Times warns.
ADAA postulates that individuals battling anxiety or mood disorders also suffer from substance use disorders about 20 percent of the time. There are many reasons that these two disorders co-occur at such high rates. Similar parts of the brain may be involved in the onset of both addiction and anxiety, and both disorders may have genetic or environmental factors related to their onset.
Drug and alcohol abuse can increase anxiety symptoms in the long run, even though they may seem to temporarily quell them. Substance abuse may be a method of trying to decrease anxiety, as alcohol and drugs like cannabis, opioids, and benzodiazepines all decrease some of the hyperactive functions of the central nervous system that anxiety can cause. In addition, substances can increase pleasure by altering brain chemistry. Psychiatric Times publishes that anxiety disorders generally come first (three-quarters of the time) in the case of co-occurring substance use disorders (SUDs), further indicating a connection between anxiety symptoms and substance abuse as a coping method.
Types of Anxiety Disorders
There are several types of anxiety disorders, which co-occur with addiction at variable rates. Below are some examples of common anxiety disorders and their connection to addiction:
Generalized anxiety disorder (GAD)
- GAD affects more than 3 percent of the American adult population, and women have double the risk of developing the disorder, according to ADAA.
- Individuals may spend hours upon hours each day worrying excessively, causing extreme fatigue, muscle tension, headaches, insomnia, and stomach upset.
- The risk factor of those with GAD also having a co-occurring AUD is close to three times that of the general public, while the risk for a co-occurring drug use disorder is 9-10 times the rate of the general population without GAD.
- Central nervous system depressant substances, like alcohol, opioids (both heroin and prescription pain relievers), marijuana, and benzodiazepines, may be desired substances of abuse as they can blunt anxiety symptoms by increasing the presence of GABA (gamma-aminobutyric acid) in the brain. GABA has sedative effects, thus reducing the stress response.
Post-traumatic stress disorder (PTSD)
- Close to 8 percent of the adult population in the United States is likely to suffer from PTSD at some point in their lifetime, the US Department of Veterans Affairs (VA) reports, with women having double the risk of developing the disorder than men.
- PTSD typically occurs after a person goes through a traumatic or life-threatening event. Individuals may then experience flashbacks, difficulties sleeping, a desire to avoid anything associated with the event, memory issues surrounding the trauma, and intrusive thoughts.
- Around 20 percent of veterans suffering from PTSD also battle an SUD, according to the VA.
- Alcohol and central nervous system depressant drugs are common substances of abuse in individuals suffering from PTSD. Between 26 and 35 percent of individuals battling PTSD also suffer from simultaneous drug use and dependence, the National Institute on Drug Abuse (NIDA) publishes.
- Affecting twice as many women as men, close to 7 percent of the US population suffers from panic disorder, according to ADAA.
- Panic attacks may occur suddenly and without warning, causing physical symptoms like chest pain, upset stomach, heart palpitations, and difficulties drawing a deep breath. Individuals may go to extreme lengths to avoid triggering a panic attack.
- Alcohol dependence and addiction commonly co-occur with panic disorder at rates between 14 and 25 percent, the Primary Care Companion to the Journal of Clinical Psychiatry
- Alcohol may exacerbate panic disorder symptoms and even trigger panic episodes, especially in those dependent on the substance, and alcohol abuse may cause symptoms of panic disorder to present, ADAA
Social anxiety disorder
- Around 15 million adults in the United States suffer from social anxiety disorder, ADAA reports, and men and women suffer from the disorder at equal rates.
- Intense and unreasonable fear of social situations that interferes with normal functioning and often causes avoidance of social situations, panic attacks, and intense anxiety signify social anxiety disorder.
- Alcohol is a common substance of abuse for those suffering from social anxiety disorder, as it can lower inhibitions and reduce fear of humiliation while increasing talkativeness and self-assuredness.
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes that one-fifth of those battling social anxiety disorder also suffer from an AUD.
- A phobia is an irrational fear of something, like an object or situation, causing panic, anxiety, and avoidance of it.
- Close to 9 percent of American adults suffer from some kind of phobia, ADAA reports.
- Specific phobias may include fear of small places (claustrophobia) and fear of public spaces and being alone in them (agoraphobia), among many others.
- Individuals with a specific phobia are at an approximate 2-3 times greater risk for also suffering from an AUD and 3-4 times as likely to suffer from drug dependence and addiction, Psychiatric Times
Addiction and Anxiety: A Dangerous Combination
Substance abuse can make a person feel happy, less anxious, and carefree; as a result, it can seem to be helpful in reducing symptoms of an anxiety disorder. Unfortunately, when drugs or alcohol are regularly abused, the changes in brain chemistry may have the exact opposite of these desired effects when the substance wears off. Dependence on drugs and/or alcohol often comes with both physical and psychological symptoms, including drug cravings and uncomfortable side effects.
Anxiety symptoms are worsened during drug withdrawal, and individuals may become addicted to these substances, as they may no longer be able to control their drug use. Rebound anxiety can be more intense during withdrawal than the initial symptoms of the anxiety disorder in the first place. Treatment compliance can therefore be difficult, and medications used to treat anxiety disorders may be rendered ineffective due to adverse interactions with substances of abuse. Relapse rates may be higher for those with co-occurring anxiety disorders than for those without. In order to successfully manage anxiety symptoms, drug use needs to be curtailed and abstinence sustained.
Managing Both Anxiety and Addiction
Since anxiety disorder symptoms are exacerbated by drug and/or alcohol withdrawal, medical detox under the watchful eye of highly trained medical and mental health professionals is an important first step in treating these co-occurring disorders. Medical detox can provide a safe and secure place where individuals can receive professional care. Symptoms of both withdrawal and anxiety can be managed through pharmacological and supportive methods while physical balance is restored. Individuals are then able to move on to a residential or outpatient treatment program.
A thorough assessment at intake is a helpful tool for substance abuse providers to use to find out what level and type of treatment program may be optimal for the individual. In most cases, a combination of medication and therapeutic techniques is helpful. Behavioral therapies use both group and individual sessions to identify potential stressors and teach clients how to handle them successfully.
Different types of anxiety disorders may benefit from various therapeutic and supportive methods. Integrated treatment plans that manage both the anxiety and addiction at the same time can aid in long-term recovery from both disorders.
The American Psychiatric Association reports that complementary techniques can be useful in helping to manage stress and anxiety levels as well. Methods like mindfulness meditation, yoga, massage therapy, a healthy diet plan, and fitness programs are often combined with traditional treatment methods for a balanced and well-rounded approach.