Anxiety is one of the most common mental health problems in the U.S. Almost 30% of Americans struggle with it at some point in their lives. And if you’ve got an anxiety disorder, research shows you’re two to three times more likely to struggle with substance abuse than the general population. It’s a combo that can greatly complicate treatment. Here’s a look at a few of the ways anxiety can creep in at each stage of addiction recovery.
Stage 1: Active Addiction
Many people who abuse drugs are unknowingly self-medicating an underlying mental health issue like anxiety. Those with generalized anxiety disorder or panic disorder appear to be at highest risk of drug addiction, while people with post-traumatic stress disorder or obsessive compulsive disorder are typically more prone to alcoholism. When anxiety occurs alongside substance abuse, research shows at least 75% of the time the person is self-medicating. Although it’s rare, others may develop anxiety symptoms as a result of their drug use. At first, drugs and alcohol may seem to work well to quell anxiety, but as clients often tell Jennifer Pullaro, LCSW, LCADC, a primary therapist at Park Bench Group drug rehab in New Jersey, “It worked, until it didn’t.” Drugs and alcohol often make anxiety worse, not better. This creates a dynamic in which drug use perpetuates anxiety, and increased anxiety prompts further substance abuse. “Many people don’t realize they’re using alcohol or other drugs to ease symptoms of a mental health issue like anxiety,” says Pullaro. “What they feel is the need to use drugs to function. The pain they feel otherwise closes them off to seeing the possibility of a different way of life.”
Stage 2: Withdrawal
Anxiety is a common symptom of drug withdrawal. During this phase, Pullaro says, “anxiety is palpable — you can see it and feel it.” In addition to feeling bad physically, the reality of the situation sets in. “People feel things they’ve spent a long time trying not to feel,” she explains. This is the first time they’ve sat with themselves and thought about what’s ahead. They’re uncomfortable in their own skin and wonder, “Why am I doing this?” All of these feelings contribute to a high risk of people leaving treatment during detox. That’s why detox centers use medication and alternative therapies to make clients as comfortable as possible. If clients give up at this stage, there’s a very high likelihood that they’ll run right back to drugs and alcohol. Even if recovery is wanted and needed, for many people with addictions there is a very real fear of getting sober. Will they ever feel good again? How will they survive if drugs and alcohol can never be part of their life? This type of future-focused thinking increases anxiety and can be crushing to someone new to recovery. That’s why 12-step programs emphasize taking it “one day at a time” and focusing on the present moment. “Once people start moving through treatment, they realize sobriety really isn’t so bad,” says Pullaro. “A few months later they discover it’s actually pretty great.”
Stage 3: Drug Rehab
In drug rehab, people look beneath their drug use to figure out the underlying problem(s) they were trying to medicate. The therapeutic process is powerfully healing, but also can be anxiety-provoking at times. “It requires a leap of faith to trust the staff and the process, especially at a time when clients don’t really want to work toward a solution that doesn’t involve drugs or alcohol and they’re just beginning to develop the tools they need to cope,” says Pullaro. “Their addicted brain tells them they can’t handle sobriety. We assure them they can. It’s a battle we see them working through during treatment. With support, they realize the bad things they’ve done don’t define them and they can rewrite their story.”
Stage 4: Post-Treatment
After finishing drug rehab, one of the biggest anxiety inducers is the threat of relapse. For the 40% to 60% of people who slip at least once, there’s a great deal of anxiety around admitting to themselves and their loved ones that they need help again. “The normal things we all face in daily life that trigger anxiety are more than just worrisome for people in recovery,” says Pullaro. “They could jeopardize the person’s sobriety and make them lose everything they’ve worked so hard for.” Relapse prevention planning, ongoing therapy and support groups are some tools to help keep people on track during this stage.
Recovering From Anxiety and Addiction
Treatment is more complex for those who have both an anxiety disorder and a substance use disorder. For example, studies have shown that people with anxiety disorders tend to have more severe withdrawal symptoms and higher relapse rates. Similarly, studies have shown that people who abuse drugs have decreased recovery rates from generalized anxiety disorder and an increased risk of suicide for those with panic disorder. These findings underscore the importance of treatment that addresses both addiction and anxiety at the same time. A strong body of research supports using cognitive behavioral therapy for addiction to help people change their thought and behavior patterns. However, some people with co-occurring anxiety may find that talk therapy leaves them feeling overly exposed and vulnerable, which fuels their need to self-medicate with drugs. These individuals may benefit from alternative approaches like art therapy or journaling. Certain medications, such as serotonin reuptake inhibitors (SSRIs), also have shown promise in treating anxiety disorders and addiction. Pullaro says yoga, meditation, fitness, grounding exercises, journaling and art therapy are helpful approaches for clients with anxiety. Because some clients brush anxiety off as “just another label” if it’s addressed directly, she takes a backdoor approach when needed. “We focus on building life skills, practicing self-care and making healthy choices, which in turn help with anxiety.” For many, anxiety isn’t an issue that comes up once and is resolved for good. Anxiety and other co-occurring mental health disorders can derail recovery at various stages in the process. This means a special type of treatment is needed — one that spots and manages anxiety before it poses a threat to treatment and recovery.