Treating Anxiety alongside a Substance Abuse Issue

Anxiety disorders are the most common form of mental illness in the United States, according to the Anxiety and Depression Association of America (ADAA). About 18 percent of the adult population over the age of 18 – or 40 million people – struggle with some form of anxiety disorder. Almost 23 percent of anxiety disorders are classified as severe, according to the National Institute on Mental Health (NIMH).

Women are 60 percent more likely than men to develop an anxiety disorder, and people between 30 and 44 years old are most likely to self-report an anxiety disorder. These disorders may begin due to trauma in adulthood, but they also begin in childhood or adolescence; about 8 percent of youth, according to the National Alliance on Mental Health (NAMI), have an anxiety disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that anxiety disorders can begin as early as 6 years old.

Prevalence of Anxiety Disorders

Although these conditions are very treatable with a combination of medicine and therapy, only about one-third of people suffering from any anxiety disorder seek diagnosis and treatment. Not only are those struggling with anxiety 3-5 times more likely to end up at the doctor, and six times more likely to be hospitalized for other psychiatric disorders, they are at significant risk of also developing a substance use disorder to self-medicate the symptoms of their mental illness.

NAMI reports that 10.2 million adults in the US have co-occurring disorders, or a combination of mental illness and a substance use disorder. The American Psychological Association (APA) has found that those suffering from an anxiety disorder are twice as likely to experience a drug use disorder, and substance use disorders are likely to trigger anxiety disorders or other mood disorders. However, a study conducted by National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) on the co-occurrence of these conditions found that anxiety predated substance abuse in 75 percent of cases while substances triggered an anxiety disorder in about 0.2 percent of cases.

Physical Manifestations of Anxiety Disorders

Anxiety disorders can manifest in a variety of symptoms, many of which are physical. For example, generalized anxiety disorder (GAD) is signified by consistent worry about one’s safety, finances, or relationships, which likely manifests as muscle aches, stress headaches, heart palpitations or feeling breathless. People with GAD are also likely to experience insomnia, nausea, and exhaustion.

People with panic disorder struggle with regular panic attacks, which make them feel like they can’t breathe, their hearts race, they sweat, and they may feel dizzy from increased blood pressure. People with post-traumatic stress disorder (PTSD) will experience anxiety from recurring, uncontrollable flashbacks, and physical symptoms may include chronic pain, insomnia, fatigue, and high blood pressure.

Physical symptoms may be the focus of a medical visit, so people suffering from any anxiety disorder may receive prescription drugs to treat the physical manifestations of their disorder; this will not help their anxiety, and it may lead to a dependence on and addiction to their prescription medications. Additionally, people who struggle with insomnia, consistent stress, and related physical symptoms are more likely to self-medicate these issues with relaxants. This leads to substance abuse problems, which are likely to increase the painful physical manifestations of the anxiety disorder.

Common Substances of Abuse

People who struggle with anxiety disorder typically turn to central nervous system (CNS) depressants to relieve symptoms of their mental condition. The National Institute on Drug Abuse (NIDA) found that marijuana was one of the most commonly abused drugs, with about 18 percent of people struggling with marijuana abuse suffering from a comorbid anxiety disorder. Alcohol is also widely abused among those with anxiety conditions.

  • Alcohol: This is a legal (for those 21 and over) CNS depressant that acts on the GABA receptors in the brain – receptors that anxiety medications also typically target. Consuming alcohol changes the release and absorption of neurotransmitters, especially serotonin.

    The euphoria from drinking can temporarily relieve anxiety, relax the body, and make the individual feel better; however, because alcohol changes the balance of neurotransmitters, which affects mood, anxiety can be worsened once the alcohol leaves the body. In fact, a person may experience alcohol-induced anxiety; this occurs in about 7 percent of these comorbid cases. About 20 percent of those who struggle with anxiety develop an alcohol use disorder to cope with their mental illness.

  • Marijuana: As marijuana becomes more popular, and more states legalize both medical and recreational use, a discussion of the drug’s potential use in treating some mental illnesses has come up. For some people, using marijuana to treat anxiety disorders, especially social anxiety, appears to work; however, there is more evidence that recreational marijuana abuse increases anxiety symptoms.

    While the immediate effects from consuming marijuana include relaxation, sleepiness, and a sense of calm, the chemical THC has some psychedelic properties, so it can change a person’s sense of reality. In people who suffer from anxiety disorders, this can increase their fear and potentially induce some psychotic symptoms. People who use marijuana consistently develop a tolerance, and their brains process dopamine, a mood-elevating neurotransmitter, less effectively. This increases anxiety symptoms and can also affect depression.

  • Opioids: There is less research on the connection between mood disorders and opioid abuse, but some evidence suggests that people who suffer from anxiety and are introduced to narcotics will develop an addiction to these drugs. In addition, people who struggle with opioid addiction, are more likely to experience anxiety or panic as a withdrawal symptom or a side effect from chronic abuse of these drugs. Anxiety disorders are associated with physical pain, like muscle aches that develop into joint pain, which may lead to a person receiving prescriptions to treat chronic pain issues instead of the underlying mental condition.

    Additionally, people who struggle with post-traumatic stress disorder (PTSD) are more likely to experience physical pain from a related injury or from the disorder itself. These symptoms are intense and are more likely to be treated first without understanding the underlying PTSD.

Treating Co-Occurring Anxiety and Substance Use Disorders

Since most instances of co-occurring anxiety disorders and substance abuse begin with the anxiety disorder manifesting itself, these conditions must be addressed together, so the person can avoid relapse of either condition. Withdrawal symptoms associated with CNS depressants may mimic some of the symptoms of anxiety, including panic, insomnia, fatigue, and physical pain. Working with a doctor to detox safely will help to ease these symptoms, sometimes using over-the-counter medicines or prescription medications.

A physician or therapist may begin with a self-assessment to understand the individual’s experience of anxiety symptoms and withdrawal symptoms. These assessments may include the Modified Mini Screen (MMS), the Mental Health Screening Form III (MHSF III), or the PTSD Checklist (PCL). The doctor will determine, based on the individual’s history of substance abuse, which prescription medicines can be helpful. The doctor may treat a panic disorder, for example, with a low-dose benzodiazepine, but they are more likely to prescribe a selective serotonin reuptake inhibitor (SSRI) for GAD, since these have a low instance of addiction or abuse.

Most importantly, treating both addiction and mental illness requires therapy. Cognitive Behavioral Therapy helps the person understand their current behaviors and how those are driven by their emotions and mental state; then, they can begin changing those behaviors on purpose since they understand their mind. Many rehabilitation programs offer therapy to treat substance abuse, and with a greater understanding of the co-occurrence of substance abuse and mental illness, many of these programs offer more comprehensive therapies to treat both conditions at the same time.