Anxiety and substance abuse. How does it happen? A glass of wine with dinner or a few drinks at a party is considered moderate alcohol consumption, and it’s not a cause for concern for most people. But if you have an anxiety disorder, you may find that it makes your anxiety symptoms worse.
Also, individuals who have an anxiety disorder are two to three times more likely to have an alcohol or substance use disorder at some time in your life than the general population. Those who suffer from anxiety and substance abuse should find help immediately.
Anxiety and Substance Abuse
About 20% of Americans with anxiety or a mood disorder such as depression also have an alcohol or other substance use disorder (SUD). And about 20% of people with a SUD also have an anxiety or mood disorder.
Many national surveys have found that about half of the people who suffer a mental illness during their lives will also experience a substance use disorder, and vice versa. Generalized anxiety disorder (GAD) frequently overlaps with other behavioral problems such as depression, other anxiety disorders, and substance use disorder.
When you have a substance use problem and a mental health condition, it is called a co-occurring disorder, comorbid condition, or dual diagnosis. The disorders occur either at the same time or one right after the other.
Which Comes First? Anxiety or Substance Abuse?
Substance abuse and mental health disorders are closely connected.
Although some substance abuse can cause extended psychotic reactions, one doesn’t directly cause the other. However:
- Alcohol and drugs are used to self-medicate the symptoms of mental health issues. People abuse alcohol or drugs to relieve the symptoms of an undiagnosed mental disorder. Although the exact way an individual develops co-occurring anxiety and substance use disorders is not clear, self-medicating is believed to play an important role. It often gives temporary relief of an uncomfortable emotion or sensation, and that reinforces its use.
- Alcohol and drug abuse can raise the underlying risk for mental disorders. Mental disorders are caused by a combination of genetics, environment, and other outside factors. If you have a risk for a mental disorder, abusing alcohol, illegal, or prescription drugs might push you over the line. There is evidence that some abusers of marijuana have a heightened risk for psychosis. Those who abuse opioid painkillers have a higher risk of depression.
- Alcohol and drug abuse can worsen the symptoms of a mental health disorder. Substance abuse can sharply increase the symptoms of mental illness or even trigger new ones. Abusing alcohol or drugs can interact with medications such as antidepressants, mood stabilizers, and anti-anxiety pills. This renders them less effective at managing mental health symptoms.
Most people with a SUD or anxiety disorder have one without the other, but having both becomes a dangerous cycle. The symptoms of one can make the symptoms of the other worse.
Social Anxiety Disorder (SAD)
The co-occurrence of substance abuse (especially alcohol abuse) is common among people with a social anxiety disorder. People with this disorder claim that alcohol helps ease their social anxiety. In reality, it often makes it worse. Alcohol use disorder (AUD) usually develops after the beginning of this disorder.
Generalized Anxiety Disorder (GAD)
People with GAD are anxious about major life issues as well as minor day-to-day stresses. GAD is known to overlap with other anxiety disorders and substance disorders. Individuals with GAD use substances to avoid constant worrying.
Posttraumatic Stress Disorder (PTSD)
Substance abuse and PTSD often occur together. People suffering from PTSD often use alcohol or drugs to try to ease their anxiety, but substance use can increase their symptoms. Mental health professionals treat PTSD and substance abuse together because PTSD symptoms can cause a SUD relapse.
Alcohol or drugs frequently cause panic attacks. Having panic disorder is a risk for relapse among those with a substance use disorder. Alcohol abuse commonly starts before or at the same time as panic disorder symptoms.
Decades of research have shown that anxiety disorders and substance use disorders co-occur at higher rates than would be expected by chance alone. Anxiety and SUDs are among the most frequent psychiatric problems in the U.S.
Regardless of the way the comorbidity between anxiety and substance use disorders integrate, the pathways together lead to mutual maintenance where each disorder bolsters the other. The mutual maintenance of the comorbidity has shown that anxiety disorders are related to increased severity of lifetime AUD.
And the presence of a SUD can affect the course of anxiety disorders. A 12-year study revealed that the presence of a SUD is associated with a decreased recovery rate and increased probability or a recurrence of general anxiety disorder. It also heightened the risk of suicide in patients with panic disorder compared to patients with panic disorder and no SUD.
Risks of Comorbidity
Risk factors for future SUD in people with anxiety disorders are:
- Any use of drugs or alcohol to cope with anxiety
- Positive family history
- Any binge drinking
- Younger age
- Any type of anxiety or mood disorder
Drug Use, Mental Disorder, and Youth
There are few studies on comorbidity among adolescents, but research shows that adolescents with SUDs also have high rates of co-occurring mental illness. More than 60% of adolescents in substance use disorder treatment programs also meet the diagnostic benchmark for another mental illness.
Although drug use and addiction can occur at any time in your life, drug use usually starts in adolescence. Coincidentally, this is also when the first signs of mental illness commonly appear. From about the ages of 18 to 25 years, people with co-occurring disorders need integrated support and treatment to help them get through the stressful changes in education, work, and relationships during those years.
Having a mental disorder in childhood or adolescence can increase the risk of later drug use and a SUD. This shows that better diagnosis of youth mental illness might help reduce the comorbidity. Other research shows that youth develop inward disorders like depression and anxiety before developing SUDs.
General Warning Signs of a Dual Diagnosis
It is difficult to diagnose a SUD and a co-occurring mental health disorder. It often takes time to figure out what might be a mental issue and what might be a drug or alcohol problem.
Signs and symptoms also change depending on the mental health problem and the type of drug being used.
There are some general warning signs that you may have a comorbid disorder:
- Do you use alcohol or drugs to help deal with unpleasant memories or feelings, to control pain, intensify your moods, face frightening situations, or to stay focused on tasks?
- Are you noticing a relationship between your substance use and your mental health? Do you get depressed when you drink, for example?
- Has someone in your family had either a mental disorder or alcohol or drug abuse?
- Do you feel depressed or anxious even when sober?
- Do you have unresolved trauma or a history of abuse?
- Have you been treated previously for either your addiction or your mental health problem? Did the substance abuse treatment fail because of the complications from your mental health issue or vice versa?
The Complication of Denial
Denial is common in substance abuse, and it often complicates a dual diagnosis.
It’s difficult for an individual to admit how dependent he is on alcohol or drugs, or how much they are affecting his life. It frequently occurs in mental disorders too. Symptoms of depression or anxiety can be frightening, so they are often ignored with the hope that they will go away.
Some people are ashamed or afraid of being seen as weak if they admit they have a problem. But substance abuse and mental health issues can happen to anyone, and admitting you have a problem is the first step to solving it.
Treatment for Substance Abuse and Anxiety
The best treatment for co-occurring disorders is a consolidated approach.
This means the substance abuse problem and the anxiety disorder are treated simultaneously. Which disorder came first doesn’t matter. Long-term recovery depends on getting treatment for both disorders at the same time and by the same treatment provider or team.
Treatment for your mental health problem may include:
- Individual or group counseling
- Lifestyle changes
- Peer support
Treatment for your SUD may include:
- Withdrawal symptom management
- Behavioral therapy
- Peer support groups
Some of the complicating factors to having both conditions are:
- The greater risk of other health problems
- More pronounced withdrawal symptoms when the abused substance is stopped
- Higher incidence of relapse.
Combining Medication, Psychotherapy and Behavioral Therapy for Treatment
Also called “talk therapy” is needed to help the person understand why he became a substance abuser and what the underlying problem is. Therapy with a therapist and support group therapy can be helpful in both substance abuse recovery and managing anxiety.
Cognitive Behavioral Therapy (CBT)
CBT has shown to be effective in the treatment of many anxiety disorders. It can be considered as an effective alternative to drug treatment. Or it can be used along with drug treatment and psychotherapy.
According to Michael Otto, Ph.D., of Harvard University, a combination of medication and CBT may provide the best patient outcomes. When using medications in combination with CBT, it’s important not to use the medication on an as-needed basis. Patients need to learn to use CBT strategies to control breakthrough anxiety.
Cognitive-behavioral therapy targets dysfunctional chains of thoughts, feelings, and behaviors. The therapy is focused on learning other ways of responding. Interventions involve breaking the anxiety experience into understandable parts and providing a model for change.
The use of non-medical treatments should be emphasized in people with SUDs. They become used to responding to any anxiety with the use of a pill. It’s important to teach coping strategies.
However, the idea of combining the programs used in the treatment of both disorders to create a treatment tailored to the specific person has received attention in recent years. An optimal pharmacological medium for treating a dually diagnosed person would be one with low abuse potential. It needs to be safe in overdose or if taken with a substance of abuse.
Selective Serotonin reuptake inhibitors (SSRIs) have shown to be effective in the treatment of many anxiety disorders.
If the person has a severe long-term SUD, then detoxification may be necessary. Withdrawal symptoms can be very painful, physically, and emotionally, occasionally leading to psychosis. It’s best to do this under medical supervision.
How to Help Yourself to Help Your Loved One
Helping someone you care about with substance use and a mental health disorder can be a rocky road. Resistance is common, and the path to recovery can be long.
You need to learn to accept what you can do and what you can’t do. You can’t force someone to remain sober, and you can’t make them take their medication or go to appointments.
These are some of the things you can do to make sure you don’t lose yourself in the process:
- Make positive choices for yourself- Don’t let their moods affect you.
- Encourage your loved one-Keep a positive outlook for both of you.
- Seek support-Make sure you get the emotional support you need to cope.
- Set boundaries-Be realistic about the amount of care you are able to provide without feeling overwhelmed. Don’t let the co-occurring disorders take over your life too.
- Educate yourself-Learn all you can about the mental health problem as well as substance abuse treatment and recovery.
- Be patient-Recovery doesn’t happen overnight. It is an ongoing process, and relapse is common, but you can get through it together.
You Can Get Through It!
Other people have done it and you can as well. You are a unique person so you will require a unique treatment program. But you are not so unique that you can’t do it. At Daylight Recovery Services, we have a dedicated, professional staff. They will be able to get you through this complicated condition and on your way to a healthy future.
You should give yourself the chance to be free of that weight you’re carrying around. Our addiction specialists are available 24 hours a day. If you need help, have questions, or just need contact with someone who understands, contact us here.