Anxiety Disorders and Addiction

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Anxiety and addiction are among the most common co-occurring disorders in the US. Anxiety itself affects 28.8% and 14.6% of the population respectively. Anxiety disorders can lead people into substance use disorders. 

 Both disorders have some common side effects which can make the diagnosis difficult.

We are a Scottsdale drug and alcohol treatment center that specializes in diagnosing and treating co-occurring disorders such as anxiety and substance use disorders. 

Our programs focus on healing the mind, body, and spirit from addiction.

We’re here to help you overcome addiction and build a life that you are proud of! 

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Defining an Anxiety Disorder

An anxiety disorder is a mental condition marked by unmanageable feelings of fear, anxiety, and unease. A person affected by an anxiety disorder experiences both cognitive and physical symptoms.

Cognitive symptoms include irritability, difficulty concentrating, restlessness, and nervousness. Physical symptoms include muscle aches and tension, palpitations or irregular heartbeat, trembling or shaking, abdominal pain or a churning feeling in the stomach, sleep disturbances, dizziness, and fatigue.

The distinction between anxiety and anxiety disorders is that the former is a normal response to stressful situations in everyday life and the latter refers to prolonged feelings of apprehension and unease with higher intensity.

According to the Diagnostic and Statistical Manual (DSM-5), anxiety refers to excessive worry and restlessness associated with a direct cause, such as academic performance or work. These feelings are temporary and do not last for more than six months.

Over 30% of adults suffer from an anxiety disorder at some point in their lives. Though anxiety disorders are the most common psychiatric disorders, they are highly treatable, and effective treatments can help individuals lead normal lives.

Anxiety Disorders
and Addiction

Anxiety and substance abuse have multiple connections. Addiction worsens the psychological symptoms of anxiety and vice versa. When an individual abuses a specific substance for a prolonged period, their body may become tolerant to it and they may need to increase the dose to experience the same effects.

The likelihood of developing both addiction and anxiety is greater in people with a history of trauma. However, chemical imbalances in the brain and genetic factors can also lead to the development of these disorders.

Substance Abuse as a Cause of Anxiety

Individuals affected by anxiety disorders are at significant risk of developing substance use disorder. Marijuana, opioids, and stimulants like amphetamines are the most common drugs abused by victims of anxiety disorders to cope with intense feelings of apprehension. Substance abuse becomes an outlet for them to escape anxiety and experience pleasure.

Though these drugs put unwanted symptoms associated with anxiety disorder on hold for a short time, they can cause the anxiety to worsen in the long run. When an individual develops a psychological and physical dependence on a substance, they experience severe anxiety it’s not in their system. This can lead to substance-induced or withdrawal-related anxiety even if the individual had no independent anxiety symptoms before.

Prolonged use of substances alters neural connections in the brain and can worsen prior symptoms of anxiety or even cause an individual to develop an anxiety disorder.

Anxiety as a Cause of Substance Abuse

People with substance use disorders (SUDs) can develop anxiety in the wake of financial problems, legal trouble, and ostracization caused by their addiction. Individuals with untreated mental illness often turn to substance abuse to attenuate their symptoms and relax.

Prolonged exposure to alcohol, opiates, and other substances alters the brain’s chemistry to facilitate the development of anxiety disorders.

Research shows that people with psychiatric disorders are more likely to abuse substances than the average population. According to the National Institute on Drug Abuse, individuals with anxiety face a twofold greater risk of developing a substance use disorder than individuals without an anxiety disorder. They face a significant risk because:

  • Marijuana, alcohol, and other substances can tone down anxiety.
  • Prescription drugs like opiates provide short-term relief from the physical symptoms of anxiety.
  • The psychological distress caused by anxiety can force individuals to self-medicate in order to escape mental anguish.
 

Physical pain caused by anxiety can be debilitating to an extent that the individual becomes unable to perform their daily activities. People also consume prescription medicines in excess to seek relief from pain and other physical symptoms of anxiety disorders, including muscle tension, palpitations, trembling, difficulty in breathing, digestive problems, stomach pain, and nausea.

Anxiety disorder can also lead to hallucinations, delusions, and paranoia which adds to the risk of substance abuse. Constant anxiety produces changes in brain chemistry which make the individual more vulnerable to substance use disorders.

When anxiety persists for more than 6 months, the amygdala (the brain’s center for emotions and motivation) undergoes changes and becomes larger. This weakens the connection between the prefrontal cortex (the brain area responsible for executive control) and the amygdala and impairs rational thinking. Due to impairment in rational thinking, individuals with anxiety become more susceptible to substance abuse.

An anxiety disorder and a comorbid substance use disorder significantly strain an individual’s physical and mental health. As anxiety is symptomatic of all substance use disorders, the comorbid anxiety disorder often goes undiagnosed. The identification of substance-induced anxiety versus symptoms of anxiety disorder is a big challenge for professionals.

Cocaine addiction, for example, causes a set of psychiatric symptoms which resemble an anxiety disorder, making it difficult to differentiate between cocaine-induced anxiety and a pre-existing anxiety disorder.

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How Cornerstone Treats Anxiety and Substance Abuse

As co-occurring disorders involve complex challenges, an integrated approach that simultaneously or parallelly addresses both psychiatric concerns should be taken to the treatment.

We, at Cornerstone, treat co-occurring anxiety and substance use disorders in a parallel yet integrated fashion. We seamlessly blend psychotherapy and pharmacotherapy into a single coherent treatment package to treat both substance abuse and anxiety disorder. After adequate assessment and evaluation of the patient, our clinicians devise a treatment plan that caters to the unique needs of the patient.

Our clinicians firmly believe that partial treatment or sequential treatment can aggravate both conditions. Despite ample evidence that parallel treatment results in better outcomes, many treatment programs continue to treat both conditions separately.

We openly renounce traditional models of treatment for co-occurring disorders that primarily address only one condition. Both substance abuse and anxiety treatment continue alongside each other at our co-occurring disorder treatment center. We believe the integration of treatments for both disorders is essential for the optimal treatment and long-term recovery of the patient. Here’s a breakdown of our treatment model:

Pharmacotherapy

Pharmaceutical drugs are an essential part of our treatment model. Patients are kept on various therapeutic drugs throughout the treatment. We only use medications that have been targeted and tested as safe and effective for anxiety and substance use disorders.

Selective serotonin reuptake inhibitors like citalopram, fluoxetine, paroxetine, and escitalopram are administered to patients with comorbid generalized anxiety disorder, panic disorder, or obsessive-compulsive disorder. Most patients are kept on SSRIs for the most part of the treatment as they are highly efficacious in the long-term treatment of anxiety disorders.

Benzodiazepines like lorazepam, diazepam, and clonazepam may also be used during the detox phase to manage withdrawal symptoms. Patients with benzodiazepine addiction are given other anxiolytics for anxiety relief.

Though our priority is to maximize the use of non-medication treatment strategies, some phases of the treatment require pharmacotherapy for smooth and efficient recovery of the patient.

Psychotherapy

Our treatment model primarily uses psychotherapy to address both substance abuse and comorbid anxiety disorders. We understand that traditional approaches like 12-step therapy may not work for co-occurring disorders and therefore use more palatable approaches like cognitive-behavioral therapy (CBT) to parallelly address both illnesses.

Cognitive-behavioral therapy (CBT) has been proven as the most effective psychosocial treatment for SUDs and comorbid anxiety disorders.

With psychotherapy, our clinicians aim to teach patients vital strategies that help them self-regulate their anxiety and cope with other unwanted symptoms. They work closely with patients to help them unlearn the maladaptive learned behaviors that significantly impair their functioning and cause their anxiety to worsen in the long run.

The initial focus of the treatment is to interrupt the destructive cycle of abusing substances to fight intolerable subjective states. Psychotherapy begins with the assessment phase in which psychologists identify critical behaviors of the patient; evaluate their duration, intensity, and frequency; classify behaviors into ‘excesses’ and ‘deficits’, and attempt to adjust them accordingly.

After the psychological assessment, the re-conceptualization phase begins wherein psychologists assess whether the behavior has increased or decreased relative to the baseline. Depending on the unique needs of the patient, other types of therapies may also be delivered in conjunction with CBT.

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Understanding ANXIETY & ADDICTION

Like other forms of mental illness, anxiety disorders are not caused by faulty upbringing, personal weakness, or character imperfections. Though social factors are not directly causative of anxiety disorders, they can improve or worsen them. Researchers have identified the following factors as the causes of anxiety disorders:

  • Chemical Imbalance: Prolonged stress can alter the chemical balance that regulates mood. These chemical imbalances act as facilitators for anxiety disorders.
  • Environmental Factors: Individuals who have lived through stressful events or experienced trauma, such as abandonment or childhood abuse, are more likely to develop an anxiety disorder.
  • Heredity: Anxiety disorders are heritable and tend to run in families. There’s a strong connection between anxiety disorders and genes. However, researchers don’t understand it fully yet.
  • Brain Chemistry: Some research shows that faulty neural circuits or abnormal changes in brain chemistry may cause anxiety disorders.
  • Substance Abuse or Withdrawal: Substance-induced brain changes can facilitate the development of anxiety disorder. Withdrawal from substances may also heighten or diminish anxiety symptoms.

Substance abuse with a comorbid anxiety disorder can have devastating effects on both the physical and mental health of the individual. People with addiction often believe that their anxiety is insurmountable and they need to keep abusing the substance to escape it. The co-occurrence of anxiety and substance abuse poses social, personal, and occupational risks for the affected.

People having co-occurring anxiety and substance use disorder can become addicted to anxiety medication. Almost all anti-anxiety medications cause physical and psychological dependence, including selective serotonin reuptake inhibitors (SSRI), barbiturates, and benzodiazepines.

Misuse of these substances can lead to severe headaches, insomnia, sexual dysfunction, muscle spasms, movement disorders, concentration impairment, and gastrointestinal problems.

Social isolation can also occur as a result of having co-occurring anxiety and substance abuse. People with anxiety tend to avoid social contact and isolate themselves. This can keep them from getting the help they need as their problem can go completely unnoticed.

Furthermore, addiction can take a heavy toll on their relationships and consequently worsen anxiety. As substance abuse causes tension within a family unit, the affected individual may also avoid contact with family members to escape anxiety.

About 14.6% of the US population suffer from a substance use disorder at some point in their lives. Over 7.7 million adults with substance use disorders have comorbid illnesses. Both anxiety disorders and SUDs are highly treatable with extraordinary success rates.

Getting help for anxiety and drug use is extremely essential as both have devastating effects on all areas of an individual’s life, from social to personal to occupational. The comorbidity of generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), or specific phobias with substance abuse has a high prevalence. However, these co-occurring disorders often go misdiagnosed, underdiagnosed, or inappropriately treated.

Underdiagnosed and untreated anxiety disorders can cause many negative consequences, including disability, loss of productivity, susceptibility to infection due to a weakened immune system, major depressive disorder, and a high risk of suicide.

In addition to physical and psychological effects, individuals who do not seek treatment face long-term societal consequences, such as interpersonal violence, increased risk of committing a crime, unemployment, stress in relationships, and social exclusion.

Chronic social exclusion can cause severe trauma which can exacerbate the individual’s substance abuse problem, resulting in a cycle of further exclusion. The only way to put an end to this vicious cycle is by seeking help from a reputable co-occurring disorder treatment center.

All types of anxiety disorders are characterized by unmanageable feelings of fear and anxiety. Here’s an overview of six different types of anxiety disorders:

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by long-lasting, non-specific anxiety. Individuals with generalized anxiety disorder (GAD) experience chronic anxiety which is not associated with any particular object or situation. In addition to fear and worry, people with GAD also experience fatigue, irritability, sleep disturbances, restlessness, muscle tension and aches, concentration problems, memory problems, and difficulty making decisions.

A diagnosis of this type of anxiety disorder is made when an individual has been worrying about a trivial or everyday problem for over six months. Drug-induced anxiety is ruled out before a diagnosis of GAD is made.

Specific Phobias

Specific phobias constitute the largest category of anxiety disorders, including all cases of anxiety related to a specific situation or stimulus. About 5 to 12 percent of the global population is affected by specific phobias. The National Institute of Mental Health describes phobia as an intense or irrational fear of specific situations and objects. A person with a phobia thinks that an encounter with the object of their fear will result in horrifying consequences. The object of fear can be anything, ranging from an animal to a particular situation.

Panic Disorder

Panic disorder is characterized by brief attacks or episodes of intense apprehension accompanied by other symptoms, such as trembling, nausea, and difficulty in breathing. The American Psychological Association describes panic attacks as bouts marked by fear and discomfort that emerge and climax within ten minutes and can last for hours. These attacks can be triggered by irrational thoughts, stress, fear, or strenuous physical activity.

Social Anxiety Disorder

People with social anxiety disorder feel overly anxious in social situations and fear how they will present themselves to others. They are extremely self-conscious and try to create a genuine impression toward others, however, believe they are unable to do so. An affected individual may pay high self-attention after performing a social activity.

Though this fear can be specific to a particular social situation, it is more typically experienced in all social settings and interactions. Fear of negative evaluations from other people, public embarrassment, and public scrutiny is symptomatic of social anxiety disorder.

Physical symptoms of social anxiety include excess sweating, trembling or shaking, palpitations or irregular heart rate, nausea, stammering or difficulty speaking, and excessive blushing.

Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is marked by obsessions and compulsions that do not have physiological or substance-induced causes. Obsessions refer to persistent, recurrent, and intrusive thoughts and mental images; while compulsions are repetitive mental and physical actions that are meant to reduce discomfort and anxiety. The DSM-5 does not classify obsessive-compulsive disorder (OCD) as an anxiety disorder but the International Classification of Diseases (ICD) does.

Agoraphobia

Agoraphobia is an anxiety disorder wherein a person experiences intense worry about being in an inescapable place or situation. The condition has a strong connection with panic disorder and is often manifested as a fear of having a panic attack.

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