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By Tim L | 09 February, 2020 Published in Guides
2

Nervousness and anxiety are normal and healthy reactions to stressful or distressing situations and periods in our life, but there are some people who find that anxiety overcomes them entirely.

This, too, is fairly normal; affecting roughly 40 million adults in the USA alone, anxiety disorders are some of the most common mental health issues in the world today [1].

Ranging from panic disorder to consistent, lower-level anxiety, anxiety is a complex thing which varies from person to person; as a result, it’s hard to study and codify.

One thing we do know, however, is that there is a strong link between addiction, whether that be alcoholism or drug addiction, and anxiety disorders.

What Is Anxiety?

According to the APA (American Association of Psychology), an anxiety disorder is characterised by feelings of tension, fear, worry, and nervousness when such feelings are not warranted by a person’s surroundings and situations [2].

People with an anxiety disorder experience mental and physical symptoms which can range from low-level nervousness and sweating to distressing violent or sexual intrusive thoughts and panic attacks [3].

While we know what causes situational anxiety in day to day life, there is no definitive explanation for what causes anxiety disorders.

Potential causes can be:

  • Brain chemistry and genetic factors
  • Environmental stresses
  • Trauma
  • Medical factors
  • Substance abuse

For those struggling with addiction of some kind, anxiety can become a real and recurring problem which only adds to the difficulties of recovery.[4]

Anxiety and Addiction

For those struggling with addiction of any kind, anxiety can be a constant companion.

The physiological rollercoaster that alcohol and narcotics put our bodies ends, as you may know, with a process of withdrawal.

The same biological processes which cause our bodies to display physical withdrawal symptoms like sweating, shaking, and nausea, can also cause mental symptoms like anxiety, depression, and intense feelings of guilt.

These are short-term effects, however; it’s the more lasting effects of heavy drinking and substance abuse on mental health that professionals are worried about these days.

Alcohol and Anxiety

The link between alcohol addiction and mental health issues are many, but most have not been fully explored.

Nonetheless, healthcare professionals and experts agree that there is a clear link between alcohol abuse and anxiety disorders.

Recent research into the effects of alcohol abuse and mental health has shown that consistent, heavy drinking not only makes short-term anxiety more likely, but it can also rewire our brains to make them less able to cope with stress in the future [5].

In fact, a range of studies done on mice found that chronic alcohol exposure reacted to stimuli in similar ways to people with PTSD [6] .

In short, alcohol abuse can contribute to the development of a clinical anxiety disorder amongst those who had not previously suffered from such issues.

For those who already have an anxiety or panic disorder, alcohol can exacerbate existing symptoms and become a habitual crutch of sorts.

This has a lot to do with the sedative effect that alcohol has during consumption; for those suffering from anxiety, alcohol can become a form of self-medication and a way in which to seek relief from their nerves and fears.

However, excessive drinking and the hangover that it causes increases symptoms of anxiety.

It can create a vicious cycle in which an alcohol dependency, if not addiction, forms as a behavioural reaction to a severe anxiety or panic disorder.

While the ‘beer fear’ which typically accompanies a hangover is neither uncommon nor particularly worrying, those already suffering from anxiety should be aware of the potential for developing a dependent relationship with alcohol as a result of the short-term relief it can provide.

Substance Abuse and Anxiety

There are many misconceptions and half-truths surrounding the consumption of narcotics, perhaps due to their taboo and often illegal status in society.

The result of this is that we are only now coming to a better understanding of how they affect our mental health on a long-term basis.

For decades there have been suggestions that drugs either cause or exacerbate latent mental illnesses, can cause knock-on addictions by acting as ‘gateway’ drugs, or that they cause lasting and irreversible damage to the brain.

The truth is that the results of studies and research are, as of yet, not entirely conclusive.

Some have shown that there are grounds for the claim that drug abuse can ‘trigger’ latent mental illnesses or exacerbate existing mental health problems [7] .

Despite this, it is unclear if they can cause certain mental illnesses (it is possible, however, as long-term drug abuse can alter brain chemistry).

What we do know for certain is that those who struggle with substance abuse are more likely to have an anxiety or panic disorder.

In fact, many have a dual diagnosis (both a mental illness as well as a substance or alcohol abuse disorder) which makes it hard to tell which came first.

Furthermore, the two conditions exist in a state of comorbidity which means they are commonly found together; around 1 in 5 people with an anxiety disorder also have a substance abuse disorder and vice versa [8] .

Risk Factors: Anxiety and Addiction

Despite being separate issues, anxiety and addiction share a number of risk factors and this may be one reason why they are so commonly found together.

These shared risk factors are [9]:

  • Environmental triggers like trauma and abuse.
  • Genetic vulnerability such as a family history of addiction or anxiety disorders.
  • Brain function irregularities in the regions which deal with stress and reward.
  • Interruption at key developmental stages; some have stipulated that drug use in teens can change the way in which their brains function in the long-term [10].

These shared vulnerabilities no doubt affect the rate of comorbidity, as well as the development of substance abuse, anxiety, and panic disorders.

Recognising and Treating Anxiety and Addiction

When you know someone who is struggling with addiction it can be hard to understand just how much anxiety and panic disorders can impact their recovery process.

If you, or someone you love, are facing the uphill struggle that is recovery with an anxiety disorder the first thing you should know is that you are not alone.

Around 18% of Americans today have an anxiety disorder of some kind, and at least 20% of them are living with a dual diagnosis [11].

Though results have been contradictory at times, studies have shown that depression and anxiety (especially when severe) increase the risk of relapse for those recovering from an addiction of any kind [12].

This means that for those seeking to recover from alcohol or drug addiction, or those supporting someone in their recovery, learning to recognise the symptoms and signs of an anxiety disorder and the panic attacks that they often include is key.

Recognising an Anxiety Disorder

There is more than one form of anxiety, of course, and each has its own specific symptoms and side effects.

The most common anxiety disorders are Generalised Anxiety Disorder (GAD), Panic Disorder, and Social Anxiety Disorder.

Symptoms of GAD

  • Restlessness
  • Irritability
  • Fatigue
  • Inability to concentrate
  • Tense muscles
  • Compulsive or unnecessary worrying
  • Disruption of regular sleep pattern

Symptoms of Panic Disorder

  • Sudden panic attacks
  • Loss of control over feelings of fear
  • Extreme worry or fear about the recurrence of panic attacks
  • Avoiding places in which previous attacks have taken place

Symptoms of Social Anxiety Disorder

  • Unwillingness to socialise or anxiety about interacting with others.
  • Preoccupation with others judgements
  • Avoiding people as often as possible
  • Sweating, blushing or having difficulty in speaking around others
  • Feeling nauseous when having to deal with others.

Recognising Addiction

It is also important that we are able to see the signs of addiction in ourselves and those we care for.

Recognising addiction can be the first step toward recovery. Signs include:

  • Continually taking or drinking more than intended
  • Craving alcohol or drugs when not using
  • Continued usage despite negative consequences
  • Continued use despite deteriorating health
  • Inability to cut back or stop usage despite trying
  • Dropping friends and hobbies in order to drink or take drugs
  • The occurrence of withdrawal symptoms when stopping

Breaking the Vicious Cycle

Learning to recognise symptoms of anxiety disorders and addiction is particularly important because of the prevalence of dual diagnosis and the self-fuelling cycle which addiction and anxiety can form when connected in this way.

Some studies, despite being limited, have shown that anxiety and addiction can feed each other in negative ways because of the relaxing and inhibition lowering effects of drugs and alcohol.

By providing short-term relief from anxiety and fear, these substances can have a positive effect in the short-term, however, over-consumption can lead us to act foolishly and cause embarrassment which increases anxiety [13] .

Furthermore, if we manage to escape this situation, there is the matter of withdrawal; the hangover created alcohol withdrawal and the ‘comedown’ from certain drugs.

This can create short-term anxiety in most people, and for those who already have an anxiety disorder this is only increased.

This positive/negative, push/pull effect can cause a cycle of symptom relief and exacerbation which increases the amount of alcohol or drugs consumed and progressively worsens any existing anxiety disorder.

As a result, beginning recovery for those with a dual diagnosis can be harder, but it is doubly imperative for both mental and physical well-being.

Breaking the cycle is not just about an immediate intervention (though that is key), it’s also about treating the underlying causes.

This means learning to prevent and cope with anxiety and panic attacks as well as seeking long-term treatment for both the anxiety disorder and any recurring substance abuse issues. [14] .

Preventing Anxiety Attacks

Preventing anxiety attacks is a complex, long-term process which hinges both on the ability to recognise impending attacks and cope with them, and seeking long-term coping mechanisms which make them less likely in the future.

For those seeking recovery, the first is most immediately pressing, but the second is most important for long-term success.

Preventing and Coping with Anxiety Attacks

Panic and anxiety attacks can come on very suddenly, and while the former is easy to recognise thanks to the intense fear, hyperventilation, and shaking they can cause, the latter is more subtle.

Anxiety attacks can be recognised by an increase in sweat production, feeling nervous, distressed, or irritable, and, occasionally, sensory overload.

When you feel symptoms like these coming on, there are a few things you can do to prevent them from becoming a full-blown attack [15];

  1. Breathe deeply and slowly. Take a breath in through your mouth for three seconds, hold it for five to seven seconds, and release over four seconds. By focusing on your breathing you can help to reduce the symptoms of an attack.
  2. Close your eyes to help reduce the stresses you are exposed to; many attacks are caused by sensory overload.
  3. Focus on relaxing your muscles one by one; these techniques help to stop attacks by controlling your bodily response to them and are most effective when you have practised them before.
  4. Take Benzodiazepines (but only if prescribed by your doctor).

Coping with Anxiety Long-Term

For those living with anxiety disorders, learning to cope with attacks as they present themselves is not enough.

It is imperative to learn how to manage symptoms long-term, even if you are using other treatment options.

Controlling the symptoms of an anxiety disorder in the long-term is as much a matter of lifestyle as it is mental health.

For example, studies have shown that exercising regularly, even if the exercise is light, can significantly reduce the symptoms of most anxiety disorders as well as the symptoms of depression [16] .

Eating well, socialising, and spending time outdoors are amongst recommended activities for controlling anxiety disorders in the long-term.

Finally, therapy and other treatment options are there for a reason; those who have severe symptoms, or who have other conditions (such as a substance abuse disorder) which exacerbate anxiety will find that some for of professional support is the best option, especially when used in conjunction with lifestyle changes.

Treating Anxiety and Addiction Disorders

Recognising the problem is the first step to recovery; this wisdom is found in every support group and treatment centre for addiction recovery, and it is equally true of anxiety disorders.

When facing a dual diagnosis of addiction and anxiety, it is easy to feel like there is no hope for long-term recovery and stability but this is not the case.

Just as alcohol addiction cannot be treated in the same way as cocaine addiction, those who are struggling with anxiety and addiction simply need a different kind of support.

If you or someone you love is in this situation, it’s important to understand that the path to recovery will be as much about managing anxiety as learning to abstain and control cravings.

Withdrawal and Relapse

While no-one likes to think about the possibility of relapse, it is important to acknowledge the risk of it happening.

First and foremost, there is a heightened risk during any withdrawal period; the pain, nausea, agitation, and even hallucinations which withdrawal can cause are too much for some people to face alone.

For those with an anxiety disorder, the heightened distress caused by the exacerbation of these symptoms as well as everything else can become incredibly distressing and even dangerous.

If you or your loved one are facing withdrawal symptoms and start to see any of the following signs you should seek medical attention [17}:

  • Extreme sickness and diarrhoea lasting more than 48 hours
  • Severe tremors
  • Hallucinations
  • Extreme disorientation
  • Fever
  • Seizures

These symptoms could be a sign of DT or Delirium Tremens, which is potentially life-threatening.

Assuming the withdrawal period passes without incident or relapse, however, those who have anxiety disorders, and those who love them, should be aware of the increased risk of relapse which panic and anxiety attacks pose.

While panic attacks are sudden and generally last 10 minutes or less, anxiety attacks are more subtle and can last for hours or even days.

In these cases, people may turn back to alcohol or substance abuse in order to cope with, block out, or stop the symptoms which are causing such distress.

Appropriately treating an anxiety disorder reduces this risk.

Treatments for Substance-Induced Anxiety Disorders

Treating anxiety disorders is often a complex and lengthy process due to the unique and often varied symptoms, triggers, and stresses that each person experiences.

Nonetheless, there is now a range of treatment options, both pharmaceutical and non-pharmaceutical, which can help those trying to combat a dual diagnosis.

1. Pharmaceutical

Medications are the most obvious treatment option for any severe disorder, but they are not always the first option doctors turn to.

Nonetheless, for those with severe symptoms (severe being classed as symptoms which interfere with daily life) Benzodiazepines and beta-blockers offer real relief from symptoms, but do not tackle the causes, of anxiety.

2. Benzodiazepines

Consisting of medications such as Xanax and Klonopin, Benzodiazepines are effective treatments for anxiety symptoms.

By slowing the nervous system and aiding relaxation they can help to stop a panic attack once it is underway. The downside is that they are highly addictive and so may not be prescribed to someone who is already struggling with an addiction.

3. Beta-Blockers

Initially used to treat high blood pressure, abnormal heart rhythms, and other such issues, beta-blockers have been found to be helpful in treating anxiety.

These medications are not always appropriate for severe panic or anxiety disorders, but they are often given to those for whom traditional anxiety medications may be dangerous.

4. Non-Pharmaceutical

When seeking long-term relief from anxiety and addiction, non-pharmaceutical methods of treatment are often the most effective, despite being slow to take root.

This is because trauma and other psychological factors are often contributory elements to both disorders. Unravelling past issues and learning healthy coping mechanisms are key to long-term recovery.

5. Self-Help Books

For many, self-help books and books written by people who have faced a similar situation are incredibly powerful tools for introspection and redirection.

When applied seriously and in conjunction with support from professionals and loved ones, these can be an effective part of treatment.

6. Cognitive Behavioural Therapy

By focusing on altering the thought patterns which feed our behavioural patterns, cognitive behavioural therapy is an incredibly effective tool for those in a comorbid cycle of anxiety and substance abuse [18].

7. Relaxation Therapy

This is a varied treatment option which utilises things like mindfulness, massage, and music therapy to aid in relaxation and, as a result, reduce levels of anxiety.

Studies have shown that while the method of relaxation matters very little, this kind of therapy can significantly reduce the symptoms of anxiety (which can only be beneficial, especially for those in early recovery) [19].

The road to recovery is neither straightforward nor easy for anyone battling addiction, but for those who also have a diagnosed anxiety disorder it the challenges can feel insurmountable.

Certainly, research has proven that the comorbidity between anxiety and addiction increases the likelihood of relapse, and worsens the mental symptoms of both disorders.

Nonetheless, there is hope; by learning to recognise and manage anxiety, and seeking appropriate treatment, wellness can be achieved!

References

[1] https://adaa.org/about-adaa/press-room/facts-statistics

[2] https://www.apa.org/topics/anxiety/

[3] https://www.apa.org/topics/anxiety

[4] https://www.medicalnewstoday.com/articles/323454.php#causes

[5] https://healthtalk.unchealthcare.org/heavy-drinking-rewires-brain-increasing-susceptibility-to-anxiety-problems/

[6] https://healthtalk.unchealthcare.org/heavy-drinking-rewires-brain-increasing-susceptibility-to-anxiety-problems/

[7] http://anxietycare.org.uk/anxiety/illegal-drugs-and-anxiety/

[8] https://adaa.org/understanding-anxiety/related-illnesses/substance-abuse

[9] https://www.sciencedirect.com/science/article/abs/pii/088761858790020X

[10] https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

[11] https://www.psychguides.com/anxiety/and-addiction/

[12] https://academic.oup.com/alcalc/article/37/6/609/205102

[13] https://www.sciencedirect.com/science/article/abs/pii/088761858790020X

[14] https://www.smartrecovery.org/smart-articles/break-out-from-the-vicious-circle-of-anxiety/

[15] https://www.healthline.com/health/how-to-stop-a-panic-attack#focus-object

[16] https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety

[17] https://www.medicalnewstoday.com/articles/322373.php#symptoms

[18] https://www.sciencedirect.com/science/article/abs/pii/088761858790020X

[19] https://www.nhs.uk/news/mental-health/relaxation-therapy-for-anxiety/

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