Concurrent Disorders: Anxiety

Anxiety is a common feeling shared by all addicts and alcoholics. Anxiety can suck all the joy out of living. It can turn the world into a dark place where there are threats to our well-being around every corner. This feeling of apprehension can mean we feel alienated from those we love, and it can lead to depression, hopelessness, and despair. Some of us turned to alcohol or drugs in an attempt to deal with this discomfort*, but this only made things worse.

*We strongly suggest that anyone self-medicating using alcohol read the following article – how drinking makes anxiety worse.

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Anxiety is one of the Most Frequently Diagnosed Mental Health Concerns of our Time

Next to depression, anxiety is the most frequently diagnosed mental health concerns of our time, and substance users are 20-40% more likely to experience anxiety disorders as compared to the general population. Conversely, individuals diagnosed with any Anxiety Disorders are at higher risk of developing addictive behaviours, and Generalized Anxiety Disorder was most frequently associated with alcohol and drug problems. Anxiety is also often experienced by those suffering from depression.

What is Anxiety?

Everyone experiences anxiety sometimes; anxiety is closely related to the stress response in our body, which alarms us to any potential danger and is thus crucial for our survival. This automatic fight, flight or freeze response to danger can be noticed as tightness in the chest, an accelerated heartbeat, gastrointestinal problems, racing thoughts about impeding catastrophies or constant worrying, and difficulties thinking clearly.

…anxiety is a more enduring experience than fear. It’s a state of apprehension and physical arousal in which you believe you can’t control or predict potentially aversive future events.

– David A. Clark (Anxiety and Worry Workbook)

If Everyone Experiences Anxiety, Why is it a Problem?

Our stress response can be seen as a smoke alarm: it is very helpful when real danger exists, such as a fire. It is not so helpful when this alarm system goes off indiscriminately, constantly and for no good reason. For individuals suffering from General Anxiety Disorder (GAD), this is the case: they constantly worry about potential and disastrous ‘what ifs’ of the future, they experience chronic bodily symptoms such as angina or Irritable Bowel Syndrome (IBS), and they feel tense and unable to relax or sleep. Among the various forms of anxiety disorders, GAD is the one most often experienced by substance users.

How do I Know that my Levels of Anxiety are Beyond what is Considered ‘Normal’?

We all experience anxiety sometimes; no doubt about that. It is very normal, for example, to experience anxiety when going for a job interview or entering rehab for the first time; in short, when we face uncertainty and when circumstances and events are outside of our control. While most of us manage these short-lived anxiety provoking situations without lasting problems, individuals suffering from anxiety disorders may feel so stressed and become so worried about all the potential ‘what ifs’ of the situation that they feel unable to cope, and they are thus inclined to avoid and withdraw.

When Anxiety Interferes with Day to Day Functioning it’s Time to Seek Help

This typically starts in one area of one’s life, for example when we are socially anxious we may avoid invitations to social events. Over time, anxiety silently slithers into other areas of our life, making us believe we don’t have what it takes to meet the challenge at hand. Eventually, if we let it, anxiety tends to shrink our life to the point where we are afraid to face any challenge at all, no matter how minor. In short, if anxiety interferes with day to day functioning as it pertains to social relationships, works or leisure, or if it renders us unable live life fully, then it is time to seek help.

Are there Different Types of Anxiety, and What is the Overlap with Substance Abuse?

Anxiety Disorders often precede substance use, and they are the most common mental health concern experienced among individuals suffering from alcoholism. For example, individuals diagnosed with an anxiety disorder are 50% more likely to engage in problematic alcohol use compared to the general population. Apart from the aforementioned Generalized Anxiety Disorder (GAD), anxiety symptoms can be a reflection of the following specific anxiety disorders:

  • Post-Traumatic Stress Disorder (PTSD): Trauma is unfortunately rather common in substance users, either in the form of childhood trauma preceding addictive behaviours, or trauma (such as sexual assault) experienced as a consequence of substance abuse. Individuals suffering from PTSD are 20-40% more likely to develop problematic substance use or other addictive behaviours compared to those not affected by PTSD, and conversely, PTSD prevalence among substance users is at least 50% higher compared to the general population.

  • Obsessive-Compulsive Disorder (OCD): This can involve highly intrusive and unwanted thoughts, coupled with some compulsive behaviour such as repeated checking or hand washing. While many of us double-check things and tasks to ensure we have done them to our satisfaction, individuals suffering from OCD are never satisfied that they’ve done things right, and they may, therefore, be unable to complete any task for fear of not doing it well enough. Based on current research, OCD is least associated with substance misuse, potentially due to low levels of impulsive behaviours so commonly observed in substance users.

  • Social Anxiety Disorder (SAD) involves fear of social contacts and relationships. SAD is often, but not always, a consequence of interpersonal trauma such as bullying or violence. Individuals suffering from social anxiety report fear of being embarrassed, judged or ridiculed by others, and they often avoid social events like the plague. Individuals with SAD are two to three times more likely to abuse alcohol compared to the general population. Entering any form of treatment, especially treatment involving group therapy, is especially frightening to SAD sufferers and needs to be addressed if treatment is to be successful. At Hope Rehab, we assist individuals affected by SAD by initially limiting and only gradually increasing group therapy time, by allowing participation at their own pace, and by providing initial extra support, for example by assigning a buddy.

Fear and anxiety are like a pair of overzealous bodyguards… Rather than bringing you peace of mind, they commandeer your attention until everything seems like a potential threat, making it hard to pursue what matters to you most.

– Susan M. Orsillo & Lizabeth Roemer (The Mindful Way through Anxiety)

Symptoms of Anxiety

  • Urge to run

  • Feeling “hyper”

  • Urge to use toilet

  • Bodily trembling

  • Numbness

  • Feeling weak

  • Nervous system activated

  • Blushing

  • Goosebumps

  • Feeling light-headed

  • Stomach upset

  • Voice trembling

  • Sweating

  • Unhealthy posture

  • Chest pains

  • Crying

  • Fidgeting

  • Impaired breathing

  • Zoning out

  • Biting fingernails

The old-fashioned remedy for dealing with anxiety was to try to avoid stressful situations. This is an ineffective solution because stress is a normal part of everyday life. It’s also usually the case that those of us who suffer due to anxiety are always going to be able to find something to worry about.

People don’t get anxious because of stress, but because of their inability to deal with stress. This is why at Hope Rehab we are going to provide you with some tools for managing your anxiety.

How are Anxiety Disorders Treated?

As anxiety symptoms can be mimicked, exacerbated or caused by substance use or withdrawal from substance use, abstinence alone may suffice to alleviate or eliminate symptoms of anxiety. For those symptoms persisting or even increasing past the initial withdrawal phase, treatment options range from medication, cognitive-behavioural therapy and mindfulness approaches. Comprehensive anxiety treatment will address physical, mental, emotional and behavioural aspects of anxiety, including:

  • Psycho-education to understand all aspects of anxiety

  • Relaxation training to counter physical manifestations of anxiety and to calm the overactive nervous system

  • Thought awareness and thought challenging to address anxious types of thinking, such as catastrophizing or excessive worrying

  • Exposure therapy to counter avoidance behaviours so commonly associated with anxiety disorders

  • Mindfulness to learn about and accept uncertainty as part of our life

As you practice mindfulness, you will have a rich opportunity to discover the inner peace, stillness, and simplicity that are our natural heritage as human beings…you can realize in yourself the spaciousness and stillness that can safely contain even the most anxious moments of heart and mind.

– Jeffrey Brantley (Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You from Anxiety, Fear, and Panic)

Importance of Being Able to Manage Anxiety in Recovery

If you have been using alcohol or drugs to help you manage your anxiety, it is vital that you have an effective coping strategy to replace this. Otherwise, there is going to be a temptation to relapse as soon as life becomes challenging. We are going to provide you with a selection of evidence-based tools for dealing with anxiety, so you will be able to face the future with confidence.

Anxiety Treatment Program at Hope Rehab

At Hope Rehab we provide you with effective tools for managing anxiety, so you can start to experience what it is like to be joyous, happy, and free. Hope’s multiple interventions that can help address difficulties anxiety include:

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