The Connection Between Anxiety and Addiction
Kathryn Starron and Elisabeth Escobar consider the connection between Anxiety & Addiction: A complex yet common problem
It is difficult enough to cope with a mental health disorder but when dealing simultaneously with addiction – known as dual diagnosis – it can be even more challenging. In such cases, the clinician must ascertain if the anxiety was prevalent prior to the substance abuse – an important component to treating this particular dual diagnosis issue.
Treatment must begin with assessing the client for a previous anxiety disorder. This could be as simple as asking the client if he or she felt anxious before using on a regular basis. Most people experience anxiety at different times, (in childhood, separation anxiety, adolescents with social or performance anxiety, or adults with generalised anxiety) and for different reasons (trauma, loss/separation, aging or career issues). Having a client reflect back on anxious times in their life, using the traditional metrics such as frequency, duration and intensity, can help clarify just how prevalent an anxiety disorder is in the client’s life.
On occasion, clients are unable to accurately identify anxiety. In cases as such, administering the Beck Anxiety Inventory (BAI) may prove helpful. Whether you obtain data from the client’s verbal history or from the self-reported BAI, the therapist can begin to accurately assess the client.
From there, a clinician has three alternatives:
- If a client states they had little to no anxiety, or they do not see any connection between anxiety they have experienced and their onset of use, then one could move forward with addressing the addiction as the primary diagnosis.
- If, however, the client states he or she has suffered with anxiety for 6 months or longer, then it is important to help the client see these disorders as separate disorders that have overlapped.
- For the client who reports feeling anxious only after stopping using (as he or she is no longer able to “self-medicate”) it will be important to help the client focus on recovery, as these feelings frequently disappear.
A treatment program that includes a Twelve-Step process, CBT and/or Buddhist thinking can help people cope with both addiction and anxiety. Additionally, overcoming fears by talking about them and perhaps using an Exposure/De-sensitisation approach can benefit clients by introducing new ways to think about their feelings, cravings and traumas.
Clients often display anxiety about the pain they have caused others while using. Another prominent fear relates to relapsing and leaving treatment. An additional factor is that addicts often suffer from Post-Acute Withdrawal Syndrome; therefore, helping clients understand how anxiety is manifested, both psychologically and physically, is important. Often, once clients understand anxiety, they are more likely to cope with it. They don’t feel like they are “going crazy” or that anxiety will be with them forever.
Stephanie Morich, a licensed social worker from Monroe, Michigan, has worked with addiction and anxiety in clients for almost 30 years. She states, “often addicts seek a secondary diagnosis because they thought that once they got clean and sober, they would no longer experience these feelings. It is important to help addicts understand that by working their program, the uncomfortable feelings of anxiety will usually abate. If they do not, then we can discuss what it means to have a bona fide anxiety disorder”.
Robyn Brickel, a licensed marriage and family therapist, based in the Washington D.C. area, notes, “Underlying issues accompany addiction. Addicts use to cope, survive, and feel less badly and so addressing the underlying issues is a must or else the client is likely to relapse or just continue using. Often, anxiety is part of having a trauma history and the client is in a chronic state of hyper arousal”. Ms. Brickel, who has studied Judith Herman, Janina Fisher and other’s work on trauma, understands that stage one of the treatment of trauma is “stabilizsation”. It is what must be done first when working with this population. She refers to it as “Trauma Informed Care (TIC).” While the anxiety may be a chemical imbalance, it may also just be vs. a chronic emotional state, the underlying causes and issues must be dealt with. Often there is an attachment issue or other trauma at the heart of the anxiety that keeps the nervous system actively in hyper-arousal – prepared for danger. The therapist can look at this from a TIC perspective, understanding that, according to Ms. Brickel, “the nervous system is still prepared for danger. My goal is to help clients learn to calm their own arousal states”.
Active addiction, by nature, creates anxiety. Clients often report increased anxiety as they come down from the high or, increased levels of anxiety when trying to find ways to sustain their high. It was once said that alcoholism is only 10% alcohol and 90% “Ism”, meaning that addiction is more than just “getting high” or “straight with the world.” It is about all of the behaviours and cognitive distortions, including obsessions that come along with active use. For many, addiction has an overlap with OCD criteria. For example, the obsessive thinking about use, how to use, when to use, as well as the compulsion TO use, even when the client experiences reservations. The internal conflict can create or amplify pre-existing anxiety. The unfortunate outcome for many is to use the substance to decrease the level of anxiety, which, in turn, starts the cycle over.
Individuals with social anxiety are often reluctant to attend Twelve-Step meetings. Encouraging clients to attend despite their anxiety is important. Clinicians can explain to these clients, that many first timers do not realise they can “pass” or state “I’m only here to listen”. Educating clients on these options http://nygoodhealth.com/product/valium/ may decrease their anxiety. One can gain accurate information and strength, simply by attending twelve- step meetings. Once their anxiety is lessened, and then they can begin to share, which is a crucial aspect of recovery.
We have seen many clients over the years struggle with anxious thoughts in relation to their use. Recovery is not only recovery from the disease of addiction, but from the diagnosis that may accompany the addiction, whether it is a previous condition or a new diagnosis. Freedom from worry, fear and negative thinking is helpful in relapse prevention too. Clinicians should acknowledge their clients fears so that clients feel safe to explore these fearful thoughts. That is often the hallmark for working through cognitive distortions; exploring the type of thinking that most likely started the vicious cycle that keeps people stuck in dysfunction. Therapy with a trained professional can help make the process a bit smoother and a lot healthier, resulting in long lasting recovery.