Anxiety disorders are some of the most commonly diagnosed mental health disorders, likely to occur during the lifetimes of approximately 28.8 percent of the population, according to a study in Psychiatric Times. Addiction, or substance use disorders, also have a high lifetime prevalence, occurring in about 14.6 percent of adults.
Frequently, these conditions occur together, which can pose a challenge for treatment professionals. Without treating both issues together, the person suffering from these co-occurring conditions is more likely to relapse into either condition than a person who is dealing with just one alone. For this reason, it is important to understand the value of obtaining integrated treatment for anxiety disorder and substance abuse when they occur together.
Understanding Anxiety Disorders
In general, anxiety is defined as a type of mood disorder that results in uncontrollable worry, fear, or panic. The Anxiety and Depression Association of America defines anxiety as persistent, excessive, and unrealistic worry. This can involve various levels of worry or fear, from persistent worry or apprehension to absolute terror, depending on the type of disorder, the source of the anxiety, and the person’s particular level of illness.
Anxiety is based in the body’s natural response to stress, also known as the fight-or-flight response, as described in an informative article on Psych Central. This is a normal hormonal and neural response to stress that heightens a person’s attention and increases reaction time to help deal with threats.
For a person with an anxiety disorder, this system is malfunctioning in some way, causing the person to have fight-or-flight reactions to situations that would not typically cause such a reaction.
Types of Anxiety Disorders
The types of anxiety disorders vary based on the source of and reason for the anxiety. Where a person without the disorder might occasionally worry about these things when directly confronted by them, a person with an anxiety disorder may worry about them all the time, even when there’s no actual threat. Some types of
- Generalized anxiety disorder: excessive worry about general, everyday concerns
- Panic disorder: occurrence of spontaneous panic attacks with no apparent cause
- Agoraphobia: fear of being in public places or other places where a panic attack may occur
- Social anxiety: extreme self-consciousness or fear when around other people
- Specific phobias: unreasonable fears of specific items or events, such as heights or spiders
Depression can often occur with anxiety, as can related conditions such as post-traumatic stress disorder or obsessive-compulsive disorder.
According to the DSM-5, OCD, PTSD, and acute stress disorder are no longer included as an anxiety disorder.
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While anxiety disorders cannot be cured, they can be managed effectively with professional treatment. The main treatment for anxiety is therapy aimed at helping the person recognize the behavioral patterns or experiences that result in an anxiety response. Once the triggers are recognized, the person can learn behaviors to help moderate that response.
Another aspect of anxiety treatment is medication that can decrease the occurrence of anxiety symptoms. Medications can help manage the hormonal or neural malfunctions that result in the feelings of worry, panic, and fear.
Many medications used for treating anxiety have side effects. It is important to work with the certified prescribing professional and follow medication instructions exactly to get the most benefit from the medications
Anxiety and Addiction
Anxiety and addiction occur together frequently; in fact, up to 27 percent of people suffering from substance use disorders also suffer from post-traumatic stress disorder and the anxiety that goes along with that disorder, according to research in the Journal of Substance Abuse Treatment.
There are many factors that contribute to the co-occurrence of anxiety and addiction. These include:
- Family history of mental illness and substance abuse
- Self-medication for anxiety disorders
- Degree of anxiety disorder or substance abuse
- Type of substance of abuse
Sometimes anxiety is not a separate, co-occurring disorder, but a result of addiction instead. While this can be difficult to diagnose, experienced medical and psychiatric professionals can help determine when anxiety is a disorder that will need special treatment integrated with the substance abuse treatment.
Cause and Effect
The relationship between anxiety and addiction is complex. For example, some studies have shown that while anxiety rarely comes before addiction, it often comes after, making it seem that anxiety is often a symptom of the substance use disorder rather than a true co-occurring disorder.
On the other hand, some anxiety disorders are strongly correlated with substance abuse. For example, general anxiety disorder has been shown to correspond with individuals having a higher number of addiction diagnoses.
Another contributor to the co-occurrence of addiction and anxiety disorders is the idea of self-medication. Sometimes, a person with an anxiety disorder may decide to take illicit drugs, use alcohol, or misuse prescription drugs to reduce feelings of anxiety. Self-medication can lead directly to a substance use disorder over time.
Medications and Addiction
Misuse of prescription medications can be a particular risk for substance use disorder in people with anxiety disorders. The reason for this is that a number of the medications prescribed for anxiety disorders, like alprazolam or diazepam (Xanax or Valium), can be extremely addictive if misused. Known as benzodiazepines, or benzos, these medications and others like them can cause changes in the brain’s hormone pathways that may result in addiction.
According to the Journal of Clinical Psychiatry, even low-dose benzos can cause these changes and lead to addiction if they’re taken for too long or at higher levels than prescribed. For this reason, it’s important for people taking anti-anxiety medications to follow their doctors’ instructions exactly and not misuse the medications.
Medical support for anxiety is a part of treatment, but with a co-occurring substance use disorder, it important to avoid medications for treatment that may encourage or exacerbate the addiction problem. According to a review in Psychiatric Annals, research into medications that can help with both conditions is ongoing, and some medications that have less addictive potential can help.
Treating Anxiety and Addiction Together
When a person is dealing with an anxiety disorder in combination with substance abuse, it can be frightening to think about trying to get treatment. As described in an article from Psychology Today, if the substance abuse is discontinued, the anxiety can become worse for a time, which makes the person want to return to the substance for relief. However, because of the nature of the substance use and the development of tolerance to the substance, it takes more and more of the substance to keep the feelings of anxiety, fear, and panic under control.
Because of this heightened risk of relapse to substance use, it is important to provide integrated treatment of both the anxiety and the substance use disorder. The first step is to provide medically managed and supervised detox. This is especially important for people who are using benzos or alcohol, as withdrawal from these substances can be dangerous. In addition, medically assisted detox integrated with support for anxiety symptoms can ensure that the temptation to return to substance use is minimized and managed throughout the process.
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Therapy for Anxiety and Addiction
For co-occurring anxiety and addiction, detox is best undertaken as part of a continuum of care in an inpatient treatment program, so therapies emphasize integrated treatment for both conditions. These therapies include a variety of psychological counseling and practical education sessions designed to help the person learn to manage the symptoms of anxiety and the desire to self-medicate or otherwise abuse substances at the same time.
A type of therapy that has been shown in various research to help with both anxiety and addiction is Cognitive Behavioral Therapy, or CBT. As described in a research review in Psychiatric Times, CBT is more likely to help people manage these co-occurring disorders than mutual self-help group therapy such as 12-Step programs.
In contrast, CBT sessions can help a person begin to understand and recognize the causes of anxiety and how they can trigger substance use. The person then uses this understanding to develop strategies that help manage anxiety and subsequently decrease the need to self-medicate. With practice, this can help the person manage both conditions after therapy is complete.
Long-term Management of Anxiety and Substance Use Disorders
After treatment, a person who is dealing with both substance abuse and an anxiety disorder may be fearful about returning to daily life and being able to manage both conditions alone. To help with this, the person can enter an aftercare program that includes treatment and support, such as:
- Contingency Management, which provides rewards for proven maintenance of both conditions
- Individual or group therapy, to keep up skills learned in rehab
- Family therapy, often started in rehab to help family members provide motivation and support
- Group support or therapies, as appropriate
With continued support and self-confidence, the person can maintain recovery in the long-term, maintaining sobriety while still managing anxiety symptoms.