Anxiety Disorders and Addiction

We all experience some degree of anxiety and fear in life, and most of the time we can work through those fears and regain a sense of equilibrium. If you are suffering from an anxiety disorder, however, your anxiety might feel unmanageable and overwhelming. You might experience a sense of impending doom, dread, or a specific, paralyzing fear. Anxiety disorders are characterised by significant feelings of fear.[1]

Anxiety can be defined as worry about future events and fear is a reaction to current events. In addition to the emotional and psychological aspects of anxiety, you may experience physical symptoms, such as a fast heart rate and shakiness. Anxiety disorders might leave you with a disproportionate level of fear that that can interfere with;

  • productivity at work
  • close relationships
  • social activities.

In an effort to manage symptoms you may have turned to using drugs or alcohol. The National Institute on Drug Abuse estimates that if you suffer from anxiety you are twice as likely to suffer from addiction issues as the general population.

The attempt to ‘self-medicate’ often only provides very temporary relief. Substance abuse often intensifies the anxiety disorder, leading to an increased desire to use in order to function. The result is a seemingly inescapable cycle of anxiety and addiction.

Causes

Anxiety is a complex disorder and there are various theories as to what causes it. In many cases, an anxiety disorder may develop as a result of multiple factors, such as:

  • Family history: Having a parent or other close relative with an anxiety disorder can make a person more susceptible to these conditions, GAD runs in families and is six times more common in the children of someone with the condition.[3]
  • Trauma: Experiencing a traumatic event, such as child abuse or exposure to violence, increases the risk of developing an anxiety-related disorder such as PTSD.
  • Substance abuse: The misuse of alcohol or drugs can cause neurological changes that may trigger or intensify anxiety. Anxiety can also be a motivating factor in substance abuse. Anxiety and depression are both regularly triggered by alcohol abuse.[4] Additionally, addiction to Caffeine and benzodiazepine dependence can trigger anxiety.[5]
  • Overexposure to stressIf you have an extremely stressful lifestyle you are more likely than the general population to develop an anxiety disorder.
  • Other mental illnesses: If you have depression, for example, you are more likely to suffer from an anxiety disorder than the general population

Types of Anxiety Disorders

Many people with anxiety experience symptoms of more than one type of anxiety condition, and may experience depression as well. It’s important to seek support early if you’re experiencing an anxiety disorder. Your symptoms may not go away on their own and if left untreated, they can start to take over your life and lead to further problems.

The most common anxiety disorders are Generalized anxiety disorder (GAD), Social anxiety disorder (SAD), Panic Disorder, Obsessive Compulsive Disorder (OCD), and Post-traumatic stress disorder (PTSD) and we will explore these types in more detail in the following sections.

Generalized anxiety disorder (GAD)

In this form of anxiety, the individual suffers from an almost continuous sense of dread that has no specific focus. With GAD, worries move from one topic to another without any apparent connection. People with GAD may dismiss their fixations as “typical worries,” but in reality, their fears are much more powerful and pervasive than the concerns that we all face on a regular basis. Yet no matter how powerful they may be, these fears often have little or no basis in reality.

The exact cause of GAD is likely to be a combination of several factors including:

  • Brain processes – overactivity in areas of the brain involved in emotions and behaviour.
  • Chemical Imbalance – an imbalance of the brain chemicals like serotonin and noradrenaline effect the regulation of mood
  • Genetics– you’re an estimated five times more likely to develop GAD if you have a close relative who also suffers with it.
  • Trauma – such as domestic violence, child abuse or bullying
  • Chronic Pain – the physical impacts the mental and emotional
  • Addiction – can be a precursor to anxiety but addiction can also be a way that someone with GAD tries to cope with their feelings.

It may be that you cannot identify a particular reason for your anxiety, this too is very normal. GAD is a common condition, estimated to affect up to 5% of the UK population.

Social anxiety disorder (SAD)

People with social anxiety disorder, sometimes also known as social phobia, have a disproportionate fear of interacting with others. Fears of crowded places, and of participating in social activities, speaking in front of an audience, are often symptoms of this common condition.

Social anxiety is more than just shyness. It’s an intense and consistent experience of fear that permeates everyday life, self-confidence, relationships and work life.

You may have social anxiety if you:

  • Have a sense of dread about everyday activities, such as talking to strangers, starting conversations, going to work, or going anywhere where there might be other people.
  • Purposefully avoid and worry about attending social activities.
  • Are preoccupied with the potential for embarrassing yourself, appearing incompetent, sweating, or blushing.
  • Feel that you are being judged.
  • Are very sensitive to criticism.
  • Have physical symptoms related to your anxiety such as feeling sick, sweating, trembling, and palpitations.
  • Have panic attacks

Quite often people who have Social Anxiety Disorder experience co-existing mental health difficulties like depression.

Panic disorder

Panic disorder is characterised by episodes of overwhelming, uncontrollable, and extreme fear.

Everyone experiences feelings of anxiety and panic at certain times. It’s a natural response to stressful or dangerous situations. If however, you suffer from Panic Disorder the feelings of anxiety, stress and panic occur regularly and at any time, often for no apparent reason, or they are very much disproportionate.

Symptoms

  • Anxiety – You may start to avoid certain situations because you fear that they will trigger another attack and feel you are living in a cycle of fear.
  • Panic attacks – Intense mental and physical symptoms. It can come on very quickly and for no apparent reason. Symptoms include:
  • a racing heartbeat
  • lightheadedness
  • sweating
  • nausea
  • chest pain
  • shortness of breath
  • shaking
  • changes in body temperature
  • a choking sensation
  • numbness or pins and needles
  • dry mouth
  • ringing in your ears
  • a feeling of dread or a fear of dying
  • a churning stomach
  • feeling like you’re not connected to your body

Most panic attacks last for between 5 and 20 minutes. Depending on the severity of your condition you may have them monthly, or weekly. Although panic attacks feel very frightening and like you are in physical peril they are not actually dangerous.

Obsessive compulsive disorder (OCD)

OCD can be diagnosed when obsessions and compulsions consume excessive amounts of time, cause significant and persistent distress and impact on functioning at work, in social situations and with personal relationships.

OCD is characterised by:

  • obsessive thoughts,
  • impulses,
  • compulsions (overt or mental rituals)

They are:

  • Difficult or impossible to resist.
  • Impact on your personal life, your work life, and your social life.

If you have OCD, you may well experience regular obsessive thoughts and compulsive behaviours. The obsessive thought may manifest as an unwanted and unpleasant thought, image or urge that occurs repeatedly and brings about uncomfortable feelings. The compulsion is often a repetitive behaviour or mental act that you feel you need to carry out to relieve the uncomfortable feelings triggered by the obsessive thought.

It’s not clear exactly what causes OCD. A number of different factors may play a role in the condition including:

  • Family history – either because of genes or environment, this is as yet unclear, you are more likely to develop OCD if a family member also suffers with it.
  • Chemical Imbalance – sometimes OCD is associated with areas of high activity in their brain or low levels of serotonin.
  • Traumatic triggers – OCD may be more common in people who’ve experienced bullying, abuse or neglect. Sometimes the onset of OCD follows a life event, such as childbirth or a bereavement.
  • Personality– those who are generally quite anxious or have a very strong sense of responsibility for themselves and others may be at higher risk for OCD than the general population.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder is an anxiety disorder that develops after experiencing a traumatic event, such as military combat, natural disaster, violent crime, or sexual assault. PTSD is a condition characterised by flashbacks to the event, nightmares, irritability, anger, insomnia, and hypervigilance or paranoia.

If you suffer from PTSD you may relive the traumatic event via having persistent nightmares and flashbacks and may experience feelings of isolation, irritability and guilt as a result of the PTSD.

PTSD is often accompanied by problems sleeping, such as insomnia, and with finding it very difficult to concentrate. The symptoms of PTSD are often severe and persistent and have a significant impact on your quality of life on a daily basis

PTSD as a specific condition was first documented during the First World War when soldiers developed shell shock as a result of the distressing conditions in the trenches. However, the condition wasn’t officially recognised as a specific mental health condition until 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders.

Why is addiction more common in those with anxiety disorders?

Substance abuse and addiction are much more common in people with anxiety disorders than in the general population. Anxiety disorders have been linked with higher lifetime rates of alcohol abuse.

If you suffer from both an addiction and an anxiety disorder or another form of mental illness you have what is known as a dual diagnosis. There are several reasons why addiction and anxiety often exist side by side as co-occurring disorders:

  • ‘Self-medicating’: Sometimes those with anxiety disorders turn to alcohol and drugs in an effort to control their physical or psychological anxiety symptoms.
  • Biochemical factors: Both anxiety disorders and substance use disorders may be related to similar chemical imbalances in the brain. For instance, low levels of serotonin – the neurotransmitter that regulates mood, energy levels, sleep, and metabolism.
  • Genetics: if you come from a family where both conditions are common you may be more likely to experience both conditions.
  • Effects of substance abuse or withdrawal: The misuse of drugs or alcohol can cause symptoms that resemble anxiety like agitation, sleeplessness, irritability, and obsessive fears. When going through the detox process you may experience anxiety, restlessness, and insomnia as the brain attempts to recover its chemical balance, this will usually resolve itself in the weeks following detox and with the development of healthy coping mechanisms.

The term dual diagnosis refers to when one person is suffering from both an addiction to alcohol, drugs or gambling, and that is complicated by a mental health problem such as depression, anxiety, post-traumatic stress disorder, an eating disorder or a personality disorder. People suffering from an addiction are much more likely to be diagnosed with a mental health disorder than a non-addict; and also those with a diagnosed mental health disorder have a higher likelihood of developing an addiction.

Treatment Options

Dual Diagnosis is a complex condition and there is no single treatment option as each case is unique. The addiction and the underlying mental health issues are best managed and treated through rehab, medication, and therapy, or most effectively by a combination of all three.

Rehab

When anxiety is complicated by substance abuse, the need for effective recovery services becomes even acuter. Anxiety can make withdrawal difficult and can also increase the risk of relapse. In rehab, you will be supported around the clock in letting go of your addiction and in developing healthy coping mechanisms.

Constant worry and fear are very difficult to live with, perhaps it is no wonder that many turn to self-medicating through drugs and alcohol. In rehab, you can treat both your addiction and your debilitating psychological symptoms with a combination of research-based therapies, in a warm and supportive environment.

Rehab for anxiety and addiction offers a comprehensive therapeutic and holistic programme that integrate recovery tools for mental health and addiction. A residential rehab is a great option for the treatment of addiction and anxiety because it provides intense and rigorous professional support in a therapeutic community setting. Residential rehab programmes usually require a 90-day stay, giving you the opportunity to work with addiction experts, mental health counsellors, and holistic therapists.

It is important to treat addiction on the physical, emotional, mental and physical level, and the programmes provided reflect that. You will have the opportunity to have a full medical detox and to have any other symptoms be assessed by a consultant doctor. You will benefit from round the clock support and both individual, group, family therapy. As well as a full and comprehensive therapeutic programme for recovery, you can benefit from a holistic approach including fitness, healthy eating. Many rehabs also offer ongoing aftercare and relapse prevention support.

While therapeutic interventions for anxiety were once kept separate from substance abuse treatment, research now shows that the most effective way to help clients with dual diagnoses is to provide integrated services that address both conditions at the same time.

> Our rehab programme for Anxiety and Addiction

Medication

There are many medication used to treat co-occurring addiction and anxiety. Here you will find a list of major medications and the issues that they address:

Benzodiazepines

  • alprazolam (Xanax) panic, generalized anxiety, phobias, social anxiety, OCD
  • clonazepam (Klonopin) panic, generalized anxiety, phobias, social anxiety
  • diazepam (Valium) generalized anxiety, panic, phobias
  • lorazepam (Ativan) generalized anxiety, panic, phobias
  • oxazepam (Serax) generalized anxiety, phobias
  • chlordiazepoxide (Librium) generalized anxiety, phobias

Beta-blockers

  • propranolol (Inderal) social anxiety
  • atenolol (Tenormin) social anxiety

Tricyclic antidepressants

  • imipramine (Tofranil) panic, depression, generalized anxiety, PTSD
  • desipramine (Norpramin, Pertofrane and others) panic, generalized anxiety, depression, PTSD
  • nortriptyline (Aventyl or Pamelor) panic, generalized anxiety, depression, PTSD
  • amitriptyline (Elavil) panic, generalized anxiety, depression, PTSD
  • doxepin (Sinequan or Adapin) panic, depression
  • clomipramine (Anafranil) panic, OCD, depression

Other antidepressants

  • trazodone (Desyrel) depression, generalized anxiety

Monoamine oxidase inhibitors (MAOIs)

  • phenelzine (Nardil) panic, OCD, social anxiety, depression, generalized anxiety, PTSD
  • tranylcypromine (Parnate) panic, OCD, depression, generalized anxiety, PTSD

Selective serotonin reuptake inhibitors (SSRIs)

  • fluoxetine (Prozac) OCD, depression, panic, social anxiety, PTSD, generalized anxiety
  • fluvoxamine (Luvox) OCD, depression, panic, social anxiety, PTSD, generalized anxiety
  • sertraline (Zoloft) OCD, depression, panic, social anxiety, PTSD, generalized anxiety
  • paroxetine (Paxil) OCD, depression, panic, social anxiety, PTSD, generalized anxiety
  • escitalopram oxalate (Lexapro) OCD, panic,depression, generalized anxiety, social anxiety, PTSD, generalized anxiety
  • citalopram (Celexa) depression, OCD, panic, PTSD, generalized anxiety

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

  • venlafaxine (Effexor) panic, OCD, depression, social anxiety, generalized anxiety
  • venlafaxine XR (Effexor XR) panic, OCD, depression, social anxiety, generalized anxiety
  • duloxetine (Cymbalta) generalized anxiety, social anxiety, panic, OCD

Mild tranquilizer

  • buspirone (BuSpar) generalized anxiety, OCD, panic

ANTICONVULSANTS

  • Valproate (Depakote) panic
  • Pregabalin (Lyrica) generalized anxiety disorder
  • Gabapentin (Neurontin) generalized anxiety, social anxiety

Therapy

The Anxiety and Depression Association of America reports that anxiety is highly treatable with a combination of therapy, behavioural modification strategies, and anti-anxiety medications. There are various different therapeutic school that may be useful for treating co-occurring anxiety and addiction such as:

Cognitive behavioural therapy

Cognitive Behavioural Therapy (CBT) is a popular treatment approach for both addictions and anxiety. CBT focuses on exploring, challenging, and changing negative and unproductive thoughts and beliefs in order to improve behavior and emotions that lead to addictive behaviour.

Individual counselling

Individual counselling sessions between yourself and a focal counsellor – who will is chosen as the best fit for you and your disorders can be very useful. These sessions will typically last for fifty minutes to an hour.

The private and individual nature of counselling sessions will give you the best opportunity to really explore your issues in depth and identify areas which you would like to work on. Your counsellor will help you to share, to challenge your unhelpful thinking patterns, and to heal from your anxiety disorder and your addiction. Your counsellor might set you assignments to complete between sessions.

Group therapy

Group sessions will usually consist of a group of peers that share similar issues to yourself. Group therapy is facilitated by an expert counsellor. In these sessions, you will benefit from both the facilitation of the counsellor and from the insights and experience of your peers, and they yours.

Counselling can help you to get clean and stay clean and with overcoming obstacles and resistance to recovery.

Attending therapy will enable you to break the ties of addiction and anxiety. Therapy can help you to overcome your fear of change, and help you to believe that yes, you can do it!

[1] Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Associati (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195. ISBN 978-0890425558.

[3] Patel, G; Fancher, TL (3 Dec 2013). “In the clinic. Generalized anxiety disorder”. Annals of Internal Medicine159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11; quiz ITC6–12. doi:10.7326/0003-4819-159-11-201312030-01006. PMID 24297210.

[4] Evans, Katie; Sullivan, Michael J. (1 March 2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 75–76. ISBN 978-1-57230-446-8.

[5] Lindsay, S.J.E.; Powell, Graham E., eds. (28 July 1998). The Handbook of Clinical Adult Psychology (2nd ed.). Routledge. pp. 152–153. ISBN 978-0-415-07215-1.

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