‘Bossing Back’ Anxiety Helps Alcoholics Stay Sober

You’ve probably heard about “co-morbidity” - when two or more disorders are present at the same time. For people battling addictions, co-morbidity is a big issue. How to treat the different illnesses most effectively has been an important area for researchers to focus on, and therapists, doctors and people in the self-help community have all had different opinions and approaches to managing these concerns for years. For people who work hard in recovery, only to be triggered to relapse when symptoms of a mental illness such as depression, anxiety or bipolar disorder flare up, managing both conditions is paramount.

Similarly, for those who get clean and sober, only to struggle with depression or anxiety, sobriety starts to look less appealing. Medications are helpful for some disorders, but for some addicts or alcoholics, the medications prescribed for depression or anxiety are not as effective as drinking or the drugs they were using before they got clean, which can lead to deeper feelings of depression, frustration and even despair. Finding a way to manage both the addiction and the co-morbid conditions, so that living sober can deliver on all its promises, is the goal of this area of treatment.

The good news is that managing these co-morbid conditions and moving forward in recovery can go hand in hand. Recent research on using cognitive behavioral therapy (CBT) to address anxiety and alcoholism indicates that this treatment modality can be helpful - even more helpful than medication, in fact - when used as described in the study.

The people participating in the study were diagnosed with anxiety disorders and also met criteria for a diagnosis of alcoholism. The participants were not required to be in recovery, and were still actively drinking during the study time period. The purpose of the study was to compare CBT techniques with progressive muscle relaxation to determine which approach would have the best chances of reducing heavy drinking, so the before and after tests measured how much participants were drinking, not how severe they felt their anxiety was. But the CBT or relaxation techniques were not aimed at reducing drinking specifically - they were designed to reduce anxiety. The researchers were testing the assumption that reducing anxiety would lead to a reduction in heavy drinking.

Over an 11-week time period, participants received either CBT or the muscle relaxation treatment, and either an antidepressant medication known to be effective at reducing anxiety or a placebo. After the 11-week time period, participants reported their drinking again, and the group that experienced the greatest reduction in heavy drinking? It was the group that received CBT plus the placebo. In this study, CBT was more effective than progressive muscle relaxation and adding medication to CBT did not increase its effectiveness.

Why might CBT be so much more effective than progressive muscle relaxation? The researchers theorized that while relaxation techniques, such as progressive relaxation or yoga or breathing techniques, do help quell anxiety in the moment, CBT helps prevent future anxiety as well as managing anxious feelings in the moment. How does it do that? The more you practice CBT techniques, the more rational your approach to your anxiety becomes. Anxiety is based in irrational fear; if the fears were rational, you wouldn’t be anxious, you’d be appropriately concerned about something real. Learning to identify the thought errors and patterns that lead to increased anxiety, you gain ease and practice in “bossing back” the anxious thoughts and replacing them with alternatives. It doesn’t take long for a person practicing this way of handling anxiety to be able to forecast: if I keep thinking this way, I’m going to get really anxious. For an alcoholic, it becomes a clearly visible and wonderfully bright blinking road sign flashing its warning: If you continue down this thought pathway, you will drink. CBT helps you create and place that road sign.

CBT is a versatile therapeutic technique: you can learn and practice in a group setting, or in a one-on-one therapy session. You can learn it and use it when you’re in a rehab or a hospital setting, as an outpatient, or even in self-help groups. Some therapists like to use written exercises to teach CBT, but for people who have a tough time with reading or writing, it can be done without. What is CBT actually like? In the beginning it might feel like you’re back in school - the way CBT is learned is quite structured. Oftentimes, your therapist will help you find your way by having you provide examples from your life of situations in which you became angry or upset, or did things you later regretted. From the situation, your therapist will guide you “backward,” to your feelings that led to those actions. And from you emotions, your therapist will help you back up one more step, to arrive at the thoughts - the actual words you might have said to yourself - that led to those feelings. That is the main work of CBT, to identify the thoughts that trigger those chain reactions that end with unwanted consequences. You can also use CBT to discover thoughts that lead to positive and pleasant consequences in the same way: take a positive situation and track back to the feelings and thoughts that set those events in motion.

The bottom line? Even if you struggle with more than one issue, and are working on your recovery from addiction as well as anxiety or other troubling symptoms, there are techniques that work. You can feel better and live better, and treatment can help. Talk with your therapist about CBT and give it a try. You may find that “bossing back” anxiety or depression makes recovery that much easier.

Posted on October 10th, 2014

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