More Americans suffer from anxiety disorders than from any other type of mental illness, with over 18 percent of adults in the US experiencing some form of anxiety, according to the National Institute on Mental Health.
Unlike the normal, healthy reactions that everyone experiences in response to stressful or dangerous situations, clinical anxiety is characterized by persistent, often unfounded fears that can interfere with work, close relationships, and social activities. The symptoms of anxiety can be both physical and psychological, and addressing these symptoms requires a multidisciplinary approach to treatment.
In an effort to cope with their symptoms, it is not uncommon for people with anxiety disorders to misuse alcohol or drugs. In fact, the National Institute on Drug Abuse estimates that individuals with anxiety are twice as likely to suffer from substance abuse as the general population. Unfortunately, attempts at self-medication often backfire by intensifying the effects of this psychiatric condition. Alcohol and drug use can worsen the psychological and physical symptoms of anxiety, reinforcing the need to use more of these substances in order to function normally. The result is a cycle of substance abuse that can lead to chemical dependence and addiction.
Types of Anxiety Disorders
Anxiety can manifest itself in many ways, from a vague sense of continuous dread to a specific, paralyzing fear. There are several types of anxiety disorders, and each requires a multifaceted approach to treatment. Listed below are some of the most frequently diagnosed anxiety disorders:
- Generalized anxiety disorder (GAD): In this form of anxiety, the individual suffers from an almost continuous sense of dread that has no specific focus. With GAD, worries move from one topic to another without any apparent connection. People with GAD may dismiss their fixations as “typical worries,” but in reality, their fears are much more powerful and pervasive than the concerns that we all face on a regular basis. Yet no matter how powerful they may be, these fears often have little or no basis in reality.
- Social anxiety disorder (SAD): People with social anxiety disorder — also known as social phobia — have an unreasonable fear of interacting with others. Fears of appearing in crowded places, participating in social activities, speaking before an audience, and other interactions with the public are typical of this common condition, which affects nearly 15 million American adults, according to the Anxiety and Depression Association of America. SAD may go hand in hand with other anxiety-related disorders, such as panic disorder, which can cause episodes of intense fear in public places, or agoraphobia, the fear of places or situations that make the individual feel helpless or out of control.
- Post-traumatic stress disorder (PTSD): This anxiety disorder can develop after an individual experiences a traumatic event, such as military combat, a natural disaster, a violent crime, or a sexual assault. The U.S. Department of Veterans Affairs estimates that about 8 million Americans who experience trauma will manifest symptoms of PTSD, a condition characterized by flashbacks to the event, nightmares, irritability or anger, insomnia, and hypervigilance or paranoia.
- Panic disorder: Episodes of overwhelming, uncontrollable terror are the hallmark sign of panic disorder. Although panic attacks are rarely fatal, a person suffering from one of these episodes may feel an overpowering sense of doom and impending death. Physical symptoms may include hyperventilation, a rapid heartbeat, sweating, dizziness, nausea and vomiting, chest pain, a feeling of choking, and other unnerving side effects. Like other anxiety-related responses, these panic attacks usually are not founded in any real source of danger. In fact, the fear of having a panic attack in public is one of the most common triggers for these episodes. Psychology Today states that approximately 1 million people experience panic attacks each year, with each episode lasting an average of 10 minutes.
- Specific phobias: The irrational, debilitating fear of a particular object, situation, or animal is considered to be a specific phobia. People with this form of anxiety will go out of their way to avoid the object of their fear, even if this avoidance interferes with their everyday lives. Some of the most common specific phobias include the fear of enclosed spaces (claustrophobia), the fear of flying (aviophobia), and the fear of heights (acrophobia). The National Institute of Mental Health states that nearly 9 percent of adults in the US experience a specific phobia in any 12-month period, and that approximately 22 percent of these cases could be classified as severe.
Signs and Symptoms
Although anxiety takes many forms, all of the anxiety disorders have certain signs and symptoms in common. Some of the key warning signs of an anxiety disorder include:
- An intrusive fear — either general or specific — that occurs on most days of the week for six months or more
- A decline in the quality of relationships, job performance, social activities, or overall satisfaction with life as a result of this fear
- Repeated attempts to resolve the fears without success
- The use of substances such as alcohol, drugs, or tobacco, or behaviors such as overeating, to manage anxiety symptoms
Anxiety can also have a direct influence on the body. People with anxiety may have strong physical responses to situations or objects that do not seem intrinsically dangerous or threatening. These responses may even seem life-threatening under certain circumstances:
- Shortness of breath
- Sweating or clamminess
- Rapid heartbeat
- Chest pain
- Choking sensations
- Stomach pain
In order to meet the diagnostic criteria for an anxiety disorder, the individual must experience the symptoms on most days of the week for six months or more.
However, people whose lives are affected by disabling fear should not wait to seek professional help. With the right combination of therapies, anxiety can be treated.
Although there are many theories about the root sources of anxiety, researchers are still exploring the causes of these complex disorders. In many cases, an anxiety disorder may develop as a result of multiple factors, such as:
- Family history: Having a parent or other close relative with an anxiety disorder can make a person more susceptible to these conditions, notes Mayo Clinic.
- History of trauma: Experiencing a traumatic event, such as child abuse or exposure to violence, increases the risk of developing an anxiety-related condition like PTSD.
- Substance abuse: The misuse of alcohol or drugs can cause neurological changes that may trigger or intensify anxiety. At the same time, anxiety can be a motivating factor in substance abuse.
- Overexposure to stress: Individuals who are constantly exposed to high levels of stress — emotional, psychological, or physical — are more likely to show symptoms of an anxiety disorder.
- Other mental illnesses: Psychiatric disorders often go hand in hand with anxiety. Someone with depression, for example, is more likely to suffer from an anxiety disorder than an individual with no other existing mental health issues.
Anxiety and Substance Abuse
Substance abuse is more common in people with anxiety disorders than in the general population. For example, anxiety disorders have been linked with higher lifetime rates of alcohol abuse and higher relapse rates after alcohol rehab, notes Psychiatric Times, and individuals with anxiety may also experience more severe withdrawal symptoms when they stop using alcohol or drugs.
The existence of a substance use disorder with an anxiety disorder or other form of mental illness is known as a dual diagnosis, or co-occurring disorders. There are several reasons why anxiety may trigger the need to misuse substances, or vice versa:
- Self-managing symptoms: One of the most prevalent theories about the relationship between anxiety and substance abuse holds that individuals with anxiety disorders turn to alcohol or drugs in an effort to control their physical or psychological symptoms. For instance, a business manager with social anxiety disorder may use alcohol to cope with stressful presentations or meetings, putting the person at risk of chemical dependence and addiction.
- Biochemical factors: Both anxiety disorders and substance use disorders may be related to chemical imbalances in the brain. For instance, low levels of serotonin, a neurotransmitter that regulates mood, energy levels, sleep, metabolism, and other functions, have been linked with both alcoholism and mental illness.
- Genetic predisposition: There is some evidence that both addiction and anxiety disorders have a genetic component. People who are vulnerable to anxiety may also be prone to substance abuse and addiction if they come from a family where both conditions are common.
- Effects of substance abuse or withdrawal: The misuse of drugs or alcohol can cause symptoms that resemble anxiety, such as nervousness, agitation, sleeplessness, irritability, and obsessive fears. When withdrawing from the effects of substances, individuals may experience anxiety, restlessness, and insomnia as the brain attempts to recover its chemical balance.
Helping a Loved One with Anxiety
Talking to a family member or friend about anxiety can be challenging, especially if substance abuse is involved. Both topics are very personal and sensitive, and it might seem easier to overlook these issues, hoping that they’ll resolve on their own or that the individual will seek help independently. However, taking the initiative to express your concern to a loved one could be the factor that motivates the person to the next stage of recovery. Here are a few tips to keep in mind when talking to someone about drug or alcohol abuse and anxiety disorders:
- Take a compassionate, nonjudgmental approach. Both addiction and mental illness can take a toll on the quality of relationships, job performance, and overall quality of life. Instead of focusing on the negative consequences of the individual’s substance abuse, focus on the benefits of recovery and the positive consequences of healing.
- Be prepared for denial or defensive behavior. Denial is a common symptom of addiction, and many people who are engaged in substance abuse will become defensive or hostile when they’re approached about their problem. In addition, anxiety disorders like PTSD can cause paranoid thinking or delusional beliefs that make communication more difficult. An intervention may be more effective if two or more close friends or family members are involved. Crisis intervention specialists can also be valuable allies, especially if there is a potential for angry or violent reactions.
- Remember that substance abuse and anxiety disorders are both disease processes. Drug and alcohol addiction were once considered to be signs of moral weakness, but now addiction is recognized as a chronic disease of the brain. Likewise, anxiety is not simply a feature of the personality, but a form of mental illness. Both anxiety and addiction can be treated with therapeutic interventions and the support of qualified professionals.
- Offer specific solutions. When talking to someone about addiction, it is useful to be able to suggest specific recovery resources, such as the name of a therapist, physician, 12-Step group, or rehab facility that specializes in treating clients with dual diagnoses of anxiety and substance abuse.
- Offer practical assistance as well as emotional support. In addition to reassuring your loved one of your care and concern, be prepared to provide practical help, such as going along to a 12-Step meeting, giving a ride to a therapist’s office, or making the phone call to arrange detox.
Addiction is a progressive disease process that will continue to get worse without intervention, eventually leading to worsening health complications, disability, injury, or death. It is better to risk offending or angering a loved one than to let the process continue. Professional crisis intervention services are available to help friends and family members who need support in getting a loved on into treatment.
According to the Anxiety and Depression Association of America, anxiety is highly treatable with a combination of therapy, behavioral modification strategies, and anti-anxiety medications. Cognitive Behavioral Therapy is one of the most effective therapeutic modalities for both the treatment of anxiety and chemical dependence. In Cognitive Behavioral Therapy, or CBT, clients learn how to identify and modify self-defeating thought patterns that make them anxious and fearful. Clients with a dual diagnosis of an anxiety disorder and substance abuse can use CBT to acquire new coping strategies that will help them maintain their recovery goals, even in the face of high-stress situations. CBT can be applied in individual therapy and in group therapy settings.
Anxiety disorders are often linked with unresolved experiences of trauma. Statistics from Harvard Medical School/McLean Hospital indicate that up to 34 percent of males and 59 percent of females in substance abuse treatment meet the criteria for PTSD. There are several therapeutic modalities that target the effects of trauma and help clients cope more effectively with the repercussions of emotional pain or loss. Seeking Safety is an integrated, present-focused approach to treating PTSD and addiction through a focus on discontinuing substance abuse, managing symptoms of both disorders, reducing self-destructive behaviors, and fostering more positive, life-affirming views of the future.
When combined with psychological and psychosocial therapies, medication can be a valuable tool in overcoming anxiety. Medications in the SSRI category (selective serotonin reuptake inhibitors) are frequently prescribed to treat the symptoms of anxiety and help these individuals lead more satisfying lives. Drugs in this category are generally considered safe and effective, and they have a low potential for abuse or addiction. SSRIs — which include medications like citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft) — work by increasing the amount of serotonin available to the brain, thus reducing the negative thoughts and persistent worries associated with anxiety.
Eye Movement Desensitization and Reprocessing, or EMDR, has had positive outcomes in the treatment of clients diagnosed with anxiety and substance use disorders. A study published in the Journal of Psychoactive Drugs showed that eight sessions of EMDR, combined with traditional treatment for patients with dual diagnoses, resulted in an improvement in PTSD and depressive symptoms. In EMDR, therapists work with clients to resolve past traumas by guiding them through a series of rapid eye movements that make new informational connections that help to resolve unprocessed memories. This therapy, which has been applied effectively to PTSD and other psychological disorders, aims to help patients overcome the emotional suffering caused by past events while restoring their hope for the future through positive ideals.
Individuals with a dual diagnosis require specialized treatment that addresses both issues. A comprehensive recovery program for co-occurring substance abuse and anxiety includes several levels of care, beginning with detox and continuing through residential or inpatient rehab, outpatient treatment, and aftercare. Family therapy, 12-Step involvement, and modalities such as equine-assisted therapy also assist in the recovery process by strengthening the individual’s support system and reinforcing a sense of self-worth.
Integrated Treatment Solutions
Constant worry and fear are not just personality quirks; they are debilitating symptoms of a psychological condition that can be treated with a combination of research-based therapies. When anxiety is complicated by substance abuse, the need for effective recovery services becomes even more acute.
Together, anxiety disorders constitute the most common type of mental illness in the US.
The solution to anxiety and substance abuse lies in comprehensive recovery programs that integrate services for mental health and addiction. While therapeutic interventions for anxiety were once kept separate from substance abuse treatment, research now shows that the most effective way to help clients with dual diagnoses is to provide integrated services that address both conditions at the same time.