The Connection Between Anxiety and Addiction
By Michael Rass
Anxiety disorders are among the most common mental illnesses in the United States. An estimated 40 million American adults suffer from some type of anxiety disorder in any given year. That is approximately 18 percent of the population. Among American children, such disorders are even more prevalent, affecting more than 25 percent of children between the ages of 13 and 18. The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists eleven different anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder.
Anxiety disorders have increased dramatically among college students. In 2014, the American College Health Association found more than 50 percent of students had felt “overwhelming anxiety” in the previous 12 months. In 2013, almost all the college mental health directors surveyed by the National College Counseling Association said they’d seen a recent increase in students with serious psychological problems at their schools.
In her 2017 book On Edge: A Journey Through Anxiety, Journalist Andrea Petersen uses her personal experience and expertise as a health reporter to explore the nature of anxiety and how it can be treated. The impact of anxiety disorders should not be underestimated. As Petersen explains, they can easily derail lives.
“Someone who develops an anxiety at a young age is less likely to attend college. Anxious people who work have lower incomes. They are less likely to marry and, if they do, more likely to divorce. Anxious women face a greater risk of getting into unhealthy relationships and being the victim of domestic abuse.”
They are also more likely to develop a substance use disorder (SUD). It is not uncommon for people suffering from an anxiety disorder to self-medicate with either drugs or alcohol in an attempt to get their anxiety under control.
Anxiety and Opioids
A recent study revealed that people with anxiety and depression are consuming a disproportionate share of opioid prescription painkillers. Researchers at Dartmouth College and the University of Michigan found that nearly 19 percent of patients with those two mental health disorders received at least two prescriptions for opioids during a year. Adults with depression and anxiety receive 51 percent of the 115 million opioid prescriptions distributed each year in the United States, the study found.
In On Edge, Petersen recalls the travail of her friend Mike, who “turned to alcohol and drugs to try to ease his anxiety and depression.”
“For Mike, marijuana and narcotics like Vicodin were a revelation,” she writes. “They took away the worrying. They calmed his twitchy body.” It didn’t last, of course. “After a while, the marijuana turned on Mike. It started making him more anxious. His drinking and use of narcotics slid into addiction. He went to rehab. He relapsed. He kicked the drugs and alcohol again. Now he combats anxiety with an SRRI (serotonin reuptake inhibitor), daily exercise, and a strong spiritual practice.”
Mike’s experience is not unusual. Substance use and anxiety disorders can be explosive combinations, evolving quickly into a vicious cycle. The symptoms of one disorder can make the symptoms of the other worse. An anxiety disorder may lead to using drugs and alcohol to self-medicate and alleviate symptoms. Ironically, the substance use can exacerbate the anxiety symptoms, especially if an addiction develops.
According to Joshua P. Smith and Sarah W. Book, studies show that “anxiety disorders are related to an increased severity of lifetime alcohol use disorders, increased lifetime service utilization among individuals with a substance use disorder, increased the severity of alcohol withdrawal, and higher relapse rates following substance abuse treatment.” On the other hand, “the presence of a substance use disorder can impact the course of anxiety disorders. Along these lines, a 12-year prospective study showed that the presence of a substance use disorder decreased the recovery rate and increased the likelihood of recurrence of GAD.”
The Trauma Factor
The reason for both the anxiety disorder and the substance abuse can also be trauma. Post-Traumatic Stress Disorder (PTSD) is a condition that can develop after experiencing or witnessing a traumatic event, or learning that a traumatic event has happened to a loved one. Many people with addiction have experienced sexual assault or domestic violence.
According to PTSD United, 70 percent of adults in the US have experienced some type of traumatic event at least once in their lives. Twenty percent of them suffer from PTSD. Many of those individuals turn to drugs or alcohol as a way to numb their pain and in the hope of gaining some measure of control in their lives.
It is consequently vital that addiction professionals be aware of the prevalence of trauma and any resulting anxiety disorders as underlying conditions of substance use disorders. All staff at Lakeview Health—from the dietary and environmental staff to senior leadership—have been trained in trauma-informed care. Creating a safe space for patients to address their trauma and anxiety issues openly is crucial in early recovery.
Treating substance abuse disorders separately will not eliminate a co-occurring disorder, so anxiety treatment usually requires that both be treated together, particularly to lessen the chance of relapse. Doctors and therapists need to be aware of both conditions. A careful assessment of a patient’s history, including their substance use, will determine which therapies will best meet their needs. “Different people bring different developmental experiences into a therapeutic community,” says Dr. Philip Hemphill, the chief clinical officer of Lakeview Health. Many of them have experienced traumatic events in their lives, and it is important to explore how that has affected them. “At Lakeview, we address all aspects of a patient’s life, not just the addiction,” says Hemphill.
The holistic treatment at Lakeview addresses body, mind, and spirit. The health and fitness program focuses on the needs of the body. Psychotherapy helps heal the mind, while the inclusion of spirituality and mindfulness allows patients to develop a new sense of purpose and to connect with a more positive sense of self.
Since trauma or mood disorders are often the real reason for the substance use, these conditions need to be addressed in therapy. The integrative health approach at Lakeview goes beyond the cessation of drug and alcohol abuse. Lakeview’s abstinence-based, comprehensive, dual-diagnosis treatment program addresses the whole self of the patient to ensure a sustained recovery from addiction.