According to the Anxiety and Depression Association of America, around 20% of Americans struggling with anxiety or depression also have a substance abuse disorder (SUD). Does substance abuse cause anxiety? Or does the anxiety cause the person to reach out for a drink or drug? Though research continues, the evidence isn’t clear on this just yet.
The reality is that those diagnosed with an anxiety disorder are more likely also to develop co-occurring substance use disorders (SUD). When they occur simultaneously, (termed dual diagnosis) each condition tends to be experienced at a more debilitating level. This is in comparison to having only one of the conditions by itself. Co-occurrence also correlates with more difficulties in treatment strategies and a greater chance for relapse.
Experts in the field have reported some important findings such as:
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Some people use substances to self-medicate as a way to manage social anxiety and maintain a more positive outlook. Acute feelings of anxiety are usually the reason for immediate drug consumption. Substances are also used as a way to detach and feel less affected by the potential negative judgments of others. This feeling is often rooted in a sense of fear, which tends to be reduced by substances.
A few types of drugs are generally used to self-medicate. Cocaine, alcohol, and marijuana are frequently used to negate feelings of anxiety. Smoking cigarettes also help people feel less anxiety, or at least this is their perception as they reach for a smoke when stressed out. Benzodiazepines, while helpful as a prescribed anti-anxiety medication, can also be abused as one develops a tolerance to it.
Conversely, substance use also tends to help some people feel more confident, and thus, less anxious when socializing. Sometimes, those with generalized anxiety disorder (GAD) have a poor self-image and may reach for substances to feel more confident. Despite feeling good when intoxicated, becoming sober causes unpleasant feelings to return once again. These feelings of anxiety can worsen over time, causing one to feel even more dependent on the drug to escape once again.
Regular use of these substances can cause one to become dependent, and people may increase use to replicate the same high as experienced in earlier times with less of the substance. This paves the way to addiction. When one takes a large amount of substances frequently, it can be dangerous for the person to come off the drugs without professional intervention.
Those with SUD can reach out to professionals, getting treatment in either an inpatient or outpatient setting. Detox specialists can assess as to which type of treatment is more appropriate, although both forms will also be able to treat anxiety disorders too. Inpatient treatment is warranted when symptoms of withdrawal can be dangerous or fatal, such as the presence of seizures or delirium tremens (DTs) with alcohol withdrawal.
For subsequent admissions to detoxification facilities, merely having a history of seizures or DTs warrants an inpatient stay, even if not present at the time. Additionally, if there is the possibility of suicidal or homicidal behavior, the person might need to be admitted for psychiatric reasons.
Inpatient detoxification units allow for monitoring a person closely for both physical and psychiatric conditions. It also provides a place for a person to escape their surroundings, staying away from people who may enable their drug use. Providers can also facilitate interventions with family and friends present, and supervision allows for people to be more likely to complete treatment. Nevertheless, negative aspects of inpatient treatment include being unable to fulfill outside obligations such as work, school or family care. Inpatient treatment is also 20 times more costly than outpatient care, and insurance may not fully cover treatment costs.
When withdrawal effects are expected to be less severe, outpatient treatment is sufficient for helping with detoxification. Medications may be prescribed, which can be taken for either short or long-term use. The benefit of outpatient treatment is that a person can potentially stay home, being able to access multiple community resources for treatment. Medical professionals may also visit the person in their home for added support. Overall, long-term treatment is more successful than short-term acute treatment.
As one addresses their SUD with professionals, they can also develop coping skills to better manage GAD and overall stress as well. Therapy for anxiety reduction takes time, so committing to a few months or more of sessions can be helpful. Techniques include reaching out to others for support, exercising, deep breathing and remaining mindful with meditation and/or redirecting the attention to the senses. Working with a psychotherapist can help with self-exploration, which can lead to greater confidence and self-efficacy.
Anxiety and Depression Association of America. Substance Use Disorders. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/substance-abuse
Glasofer, Deborah R. Generalized Anxiety Disorder and Substance Use Disorders. Very Well Mind. Retrieved from https://www.verywellmind.com/anxiety-substance-use-disorders-1393073
NCBI. Anxiety and Substance Use Disorders: A Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/
JAMA. Role of Self-medication in the Development of Comorbid Anxiety and Substance Abuse Disorders. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107248