Anxiety is a natural stress response; your body enters this state to turn on the “flight or fight” response to urge protection when it senses danger. Addiction and anxiety is a common dual diagnosis and can become severe if left untreated. Even though anxiety is a natural part of life, if it becomes prolonged, all-consuming, and interferes with everyday life, it is considered to be a mental health disorder.
When anxiety co-occurs with substance abuse, both conditions can be exacerbated. While anxiety may lead to excessive use of substances, substance abuse is known to cause anxiety. Both conditions should be treated simultaneously for a successful recovery.
What Is An Anxiety Disorder?
It’s normal to go through moments where you feel stressed, nervous, or worried. Anxiety is a natural reaction to human emotion and life’s many challenges. Natural anxiety will come when necessary and cease when it’s no longer needed. When you have an anxiety disorder, these feelings are experienced for a long time with no reason for them.
Being in a constant state of fear or panic can be debilitating, and often keeps individuals from doing the things they love. It can keep you from interacting with friends and family, excelling in your career, and in extreme cases cause physical disabilities and severe fatigue.
Symptoms Of Anxiety
The physical or psychological symptoms of an anxiety disorder differ from person to person, but some common characteristics include:
- Chronic feelings of worry, fear, and distress
- Extreme fatigue
- Feelings that you are dying or extremely ill
- Feeling like you need to avoid triggers
- Increased heartbeat
The severity of anxiety symptoms will manifest differently from person to person. Commonly, mental health conditions have similar diagnostic criteria to one another. In other words, sometimes other symptoms can resemble anxiety, which is why it can not be left untreated. Professional help is necessary for people who have or believe they may be struggling with an anxiety disorder or other forms of mental illness.
If you have been evaluated by a physician and there is no medical or physical reason for these symptoms (meaning you are in good health) you are likely suffering from an anxiety disorder.
Types Of Anxiety Disorders
Anxiety disorders involve more than temporary worry or fear. For people who experience this kind of mental illness, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.
Over 40 million adults in the United States (19.1%) suffer from an anxiety disorder. Meanwhile, approximately 7% of children aged 3-17 experience issues with anxiety each year. Most people develop symptoms before the age of 21. Oftentimes, individuals with an anxiety disorder also develop a substance use disorder (SUD). This is called a dual diagnosis or co-occurring disorder.
There are several types of anxiety disorders, including generalized anxiety disorder, post-traumatic stress disorder, panic disorder, social anxiety disorder, and various phobia-related disorders. The five major types of anxiety disorders are:
A generalized anxiety disorder (GAD) is characterized by a continuous feeling of fear or anxiety that might interfere with day-to-day activities. It is not the same as occasionally worrying or feeling anxious as a result of demanding life situations. For months or perhaps years, people with GAD endure regular episodes of anxiety for months, sometimes years.
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How Does Anxiety Cause Substance Abuse?
Anxiety commonly co-occurs with substance abuse. Since the effects of anxiety can cause severe emotional and physical difficulties, many people find that substances temporarily relieve some of the negative effects. Although they occur independently and should be treated as such, having both can create a vicious cycle and hinder the ability to overcome one another.
In the case of a general anxiety disorder (GAD), using drugs and alcohol can lower the severity of the everyday side effects. Many people cope with substances to ease their physical symptoms like body tension and calm their overactive emotions. They become dependent on substances and lose their ability to naturally calm themselves down.
In cases of social anxiety, it’s common to use alcohol to feel more comfortable participating in social events, but this creates a deeper fear of socializing while sober. Alcohol abuse is a common repercussion of this coping mechanism.
Panic disorder is another form of anxiety disorder that co-occurs with substance abuse. The fear of experiencing a panic attack can cause individuals to abuse drugs and alcohol to prevent them. Regardless of the type of anxiety, someone suffers from, substance abuse is only a band-aid and will not only worsen anxiety over time but create comorbidity that needs attention and proper treatment to overcome.
Which Comes First, Anxiety or Substance Abuse?
Anxiety and substance abuse are two of the most prevalent behavioral and mental health disorders and often co-occur with one another. In cases of a dual diagnosis, it can be difficult to pinpoint which condition came first and led to the development of the other. The National Epidemiologic Survey on Alcohol and Related Conditions found that those with an Anxiety disorder are 15% more likely to develop a substance abuse disorder.
When anxiety disorders co-occur with substance abuse, oftentimes it is a way of self-managing the symptoms. The attempt to control my physical and emotional symptoms is an example of anxiety-causing substance abuse disorder.
On the other hand, alcohol and substance abuse changes the way the body produces hormones, cognitive function, and nervous system regulation. These unnatural changes can make the body believe it’s in danger and ignite the “flight or fight” response. Since those with a substance addiction are constantly putting dangerous chemicals in the body, this anxiety/ stress response will be chronic, constant, and fit the criteria of an anxiety disorder.
Typically when these co-occurring conditions develop, treatment of substance abuse will lower the occurrence of anxiety. In most cases of dual diagnosis, whichever condition came first is the focus of treatment, but both need attention and a rehabilitation program.
Co-Occurring Disorders: The Relationship Between Anxiety Disorders and Substance Abuse
There are many reasons why these specific mental health conditions occur, and why each influences one another. The development of a dual diagnosis can stem from a variety of different risk factors, including:
- Coping Mechanisms: The strong relationship between addiction and anxiety is commonly due to individuals attempting to control their negative symptoms on their own instead of receiving proper treatment.
- Genetics: There is strong evidence that substance abuse and anxiety are both genetically predisposed, meaning that if it already runs in your family, you are more susceptible to developing one or both of these mental health conditions. Since they co-occur so frequently, even if only one is in your family, you may develop the other later in life.
- Side Effects of Addiction/Withdrawal: The symptoms of withdrawal and heavy substance abuse can closely resemble those of anxiety disorder. If experienced long enough, the body can adapt and believe this state to be a normal one and leading to the development of chronic generalized anxiety.
Diagnosing Anxiety and Substance Abuse
The first step in recovery is understanding what conditions you are experiencing, how and why they co-occur, and making sure to receive an official diagnosis from a medical professional. It’s important to see an experienced physician to conduct a full evaluation of your symptoms to properly identify the conditions and come to the conclusion of a dual diagnosis. When both of these conditions co-occur, treating only one will not make for successful rehabilitation.
There are several ways doctors and therapists can identify these coexisting conditions and create a treatment plan from the perspective of not one condition, but both simultaneously.
The processes of diagnosing will likely include the following:
- Lab Tests
- Physical Examination
- Psychological Examination
During these evaluations, the patient will work one on one with experienced professionals to understand the severity and specific characteristics of his or her anxiety disorder, as well as, any underlying contributing factors such as substance abuse. They will also attempt to uncover which condition came first and led to the other, so the patterns of development can be better understood.
There are different types of anxiety and types of addictions that can all fall under the category of co-occurring, so it’s important, to be honest with your treatment team about your drug abuse, thoughts, and experiences that led you to seek help.
Treatment for Anxiety and Addiction
Treatment for anxiety disorders and substance use disorders will include a combination of treatment programs and therapies aimed at addressing both the mental and physical side effects of these co-occurring conditions. Treatment will look different for each case, but common options for treatment for co-occurring disorders such as anxiety and addiction typically include:
Prescription medications for anxiety such as benzodiazepines are not always used, especially if there is a concern for addiction after substance abuse, however, they have proven successful in a large percentage of patients.
If medical staff finds that anxiety was the condition that led to the development of addiction, oftentimes anti-anxiety medication is used. Antidepressants including SSRIs and Tricyclics are designed to help the brain’s chemistry function at its normal levels. Some patients have only been prescribed them for a short time while others will find more success staying on them long-term.
Counseling sessions with a psychiatrist or therapist will help address both your mental illness and substance addiction, and aid in discovering the root causes of their development. Unresolved childhood trauma, insecurities, genetics, and effects from past experiences can be major factors in the development of both conditions. Talking with a professional will enable you to learn how to accept and let go of whatever experiences are triggering your anxiety and substance abuse.
Holistic treatments have been proven to be effective in helping people with anxiety disorders and substance use disorders. These alternative methods teach individuals how to cope with everyday symptoms of anxiety, stressors, and triggers. Yoga and meditation offer tools of relaxation and mindfulness, and acupuncture or massage therapy can lessen the tension that has manifested as a result of chronic stress.
Treatment For Anxiety and Addiction At Discovery Institute
Here at the Discovery Institute, we provide comprehensive services designed to address all aspects of the disease of addiction and mental health, from initial assessment and detox to therapies and support groups, and thorough aftercare. Our patients are offered multiple evidence-based approaches, each having been shown clinically to fight addiction and co-occurring anxiety from a variety of angles.
Upon discharge, individuals will have the tools and confidence they need to maintain sobriety and regain control of their lives. Contact us anytime to start your journey!
Dr. Joseph Ranieri D.O. earned his BS in Pharmacy at Temple University School of Pharmacy in 1981 and His Doctorate Degree in Osteopathic Medicine at the Philadelphia College of Osteopathic Medicine in 1991. He is Board Certified by the American Board of Family Medicine and a Diplomate of the American Board of Preventive Medicine Addiction Certification. Dr. Ranieri has lectured extensively to physicians, nurses, counselors and laypeople about the Disease of Addiction throughout New Jersey and Pennsylvania since 2012.