A dual diagnosis of a mental illness and a substance abuse disorder is not uncommon.…
Anxiety: A Lifestyle Problem for Addicts
“About four months into sobriety, I knew if I didn’t address my anxiety, I would go back to drinking. It was so severe, and I had no way to relieve it,” says Catherine Henricks, MS.
Her situation is not uncommon. An astonishing 40 million people in the U.S. suffer from anxiety, and they are two or three times more likely than people without anxiety to abuse drugs or alcohol. It’s a destructive cycle. Those with anxiety may use alcohol or drugs to temporarily relieve their symptoms, but alcohol and drugs often create additional anxiety. As physical and psychological dependence develops, more amounts of alcohol or drugs are needed to achieve the desired effect.
Henricks, 32 years’ sober, is a licensed chemical dependency counselor helping others tackle their addictions and anxiety at Promises Austin drug rehab.
There are multiple forms of anxiety. While the precise cause is unknown, research indicates that both genetic and environmental factors play a role in the mental illness. Anxiety can develop early in life due to unhealthy attachment issues with parents or an erratic home environment. Henricks says many people she treats were raised by physically or emotionally abusive parents, alcoholic parents or parents who frequently fought. Even if a person is not the direct target of abuse or conflict, research shows that merely witnessing traumatic events can have long-term psychological consequences.
In an unpredictable home, children never know what to expect. Will it be a “good” day or a “bad” day? They learn to be hypervigilant, always on guard in order to emotionally and physically “survive” their living situation. For many, this anxiety stays with them into adulthood. Everyday stressors like jobs, relationships and social situations can trigger deep-rooted anxiety. “These people have been raised in environments where there are real threats and reasons to be afraid, and that transfers into their adult lives,” says Henricks.
Drugs and Alcohol as Self-Medicating Tactics
Alcohol and some drugs like benzodiazepines and marijuana can have sedating or calming effects. People with anxiety may abuse these substances in an attempt to soothe symptoms like ruminating, nervousness, self-consciousness in social situations, excessive worry and insomnia.
Using alcohol and drugs as coping mechanisms for anxiety symptoms is a temporary solution to a long-term problem, and one that ultimately backfires. In addition to substances losing their sought-after effects as dependence develops, anxiety is a common withdrawal symptom of alcohol and drug abuse. The addict eventually needs more in order to prevent physical and psychological discomfort. Also compounding anxiety are the worries that can accompany substance abuse like fear of discovery, fear of arrest, fear of being unable to drink or get more drugs, and even fears about getting sober.
An Often Silent Partner in Substance Use
Anxiety disorders are very treatable but only about one-third of people with anxiety receive treatment, according to the Anxiety and Depression Association of America. Dr. Stevie Stanford, clinical director for Promises Austin, estimates that 75% of their clients with anxiety are unaware of it when they enter the Texas drug rehab center. “We see a lot of overachievers here — doctors, lawyers, CEOs,” she says. “We must help them realize that if they are constantly ‘going’ and not looking at the anxiety, not looking at what is going on underneath it, they will eventually do whatever they can to calm down or numb out.” Dr. Stanford explains that many times the only way they know how to quell this underlying anxiety is with scotch or whiskey at the end of the day. That becomes their coping mechanism. “Unfortunately, when the anxiety is not addressed, it only festers,” she says.
Dr. Stanford says that some clients unwittingly stay caught up in the hustle and bustle because if they slow down, anxiety creeps up. That’s when they’ll turn to alcohol or drugs to numb feelings. “Sometimes when I lead mindfulness groups, I’ll have some clients who can’t even close their eyes because they are so distraught by the anxiety that arises when they no longer have their cell phone, laptop or other device. It can seem unbearable to them.” She says this is a ripe time to help them start tiptoeing into that place where they can admit they are powerless over their situation, start addressing the underlying issues and learn how to manage their lives and symptoms.
How Anxiety Can Hinder Addiction Treatment
Inpatient addiction treatment is often the first time clients have stopped numbing their emotions long enough to allow uncomfortable feelings like anxiety a chance to surface. These feelings can be overwhelming, even paralyzing. This may begin in drug and alcohol detox. “Clients may experience severe anxiety as a withdrawal symptom,” says Henricks. “This can put them at high risk for leaving treatment prematurely to self-medicate — which has previously been their solution.”
In order to mitigate this risk, Henricks explains the importance of educating clients from day one about uncomfortable feelings they may experience, and how these feeling are a normal part of the recovery process. Through this initial education process, clients learn that the medical team can help ease anxiety and other symptoms through evidence-based medications as clinically appropriate. They also learn that while in treatment, they’ll develop a toolbox of skills to help manage anxiety long-term; skills like mindfulness practices and therapeutic approaches to change unhealthy thought patterns and behaviors.
Addressing Anxiety in Treatment and Beyond
In addiction and anxiety rehab, clients are provided a safe, accepting space and specialized therapies to explore uncomfortable emotions and underlying issues around addiction and anxiety. They are also removed from the often anxiety-cultivating culture of today where many people are constantly “plugged into” their jobs or texting, checking emails and on the go.
Dr. Stanford explains how Promises Austin drug rehab draws upon several approaches to treat clients with these difficulties. She says an important part of treatment is helping clients understand the different ways they’ve coped with anxiety in their lives. This may have started in their family of origin and continued into their jobs and personal lives as adults. Some people may over-function (“the perfectionist”), some may under-function (withdrawing or self-sabotaging). “We teach them grounding techniques and emotion-regulation skills,” says Dr. Stanford. “This helps them feel safe enough to let themselves feel their feelings and deal with them when that anxiety comes up.” For example, clients may practice breathing into feelings of anxiety rather than running from them.
Other anxiety-reducing therapies that Dr. Stanford’s team uses include trauma-based therapies like EMDR, alternative medicine approaches like acupuncture, and mindfulness techniques such as guided meditation, integrative breath work and therapeutic yoga. Clients are also taught proper self-care such as eating well, getting enough sleep and exercising. “They have a whole lot of energy that needs to be released,” says Henricks. “Exercise releases some of that energy that can come in the form of restlessness.” Henricks also notes the importance of teaching anxiety-prone addicts about a low-caffeine, low-sugar diet. Removing these from the diet may help regulate anxiety.
Like addiction, there is no magic pill to cure anxiety. It’s an issue that gets better with appropriate treatment and lifestyle changes. Many people with anxiety never learned proper coping skills, so they turned to substance abuse and other destructive behaviors. “They never learned to challenge irrational thoughts. They didn’t develop the skills to calm themselves down,” says Henricks. Treatment helps them learn to re-parent themselves and acquire critical life skills.
With both a personal and professional understanding of addiction and anxiety, Henricks has some valuable advice for those caught in the anxiety-addiction cycle. “For me, it’s mostly about getting to it [anxiety], so it’s not a factor in relapse,” she says. “You can’t push anxiety away or ignore it. We need to address it and treat it so it’s not so debilitating that you can’t function without using drugs or alcohol.”
By Sara Schapmann