Co-Occurring Disorders: Addiction and Anxiety
Anxiety and addiction seem to go hand in hand. Not all addicts suffer from anxiety and not every anxious person becomes an addict. However, we find that many people show symptoms of both conditions.
Unfortunately, when someone does struggle with both conditions, the symptoms of each illness tend to exacerbate those of the other. Oftentimes, people who have anxious tendencies will use drugs to self-medicate. Someone who uses drugs to cope with their anxiety disorder will often find that they only grow more anxious over time.
So many folks struggle with anxiety and addiction simultaneously that the two conditions are often diagnosed as co-occurring disorders. If you or someone you love has these disorders, this article may be useful for you.
What is the Definition of Co-Occurring Disorders?
Co-occurring disorders, also called "comorbidity" and "dual diagnoses", mean that an individual shows symptoms of both mental health problems and a substance abuse disorder. When a patient suffers from social anxiety or performance anxiety but also struggles with addiction, they will receive a dual diagnosis.
It is important for the doctor to identify both disorders, as the patient will require special treatment. Because the individual has a tendency to become addicted to substances, they may need to avoid certain medications. The purpose of a diagnosing anxiety and addiction as co-occurring disorders is to ensure that the individual receives the safest and best possible treatment for both conditions.
The relationship between anxiety and addiction is somewhat of a "chicken or egg" scenario. It's nearly impossible to determine whether someone's tendency to use drugs stems from their desire to quiet their anxiety. We do know, however, that people who use drugs tend to get more anxious over time.
One of the biggest problems that people face when struggling with this particular pair of disorders is anxiety about withdrawal. If someone uses drugs such as marijuana, cocaine or heroin regularly in order to cope with their anxiety, they become accustomed to the temporary relief these substances offer.
At the same time, however, someone who self-medicates often will find that they build a tolerance quite quickly. While opiates or cocaine might temporarily relieve their symptoms and calm their anxiety attacks, the effects of these drugs don't last forever. The individual, therefore, will require constant self-medication in order to fend off anxious feelings. Even worse, the fear of being sober can be quite anxiety-inducing for an addict as they start to worry about the pain and anguish they'll experience in the absence of drugs.
Signs and Symptoms of Co-Occurring Disorders
Sometimes, individuals with co-occurring anxiety and addiction disorders will find that they develop both conditions around the same time. This is particularly true for people who weren't particularly anxious people until they developed a drug addiction. However, many people find that their anxiety predates their addictive tendencies.
Someone who turns to drugs to cope with anxiety will find that the drug helps to relieve their symptoms for a short time. However, drug use may quickly cause their anxiety to evolve into depression. It may also cause:
- Intense cravings for drugs or alcohol
- A high tolerance for their favorite drug
- Regular panic attacks or anxiety episodes
- More intense or longer-lasting anxiety episodes
- Lapsed judgment and poor decisions
- An inability to function without the drug
Using Drugs to Cope with Social Anxiety Disorder
Nearly 7% of all Americans suffer from social anxiety disorder. The condition is characterized by an intense fear of judgment and rejection. People who have SAD often spend time focused on the opinions of other people and, in extreme cases, avoid social situations altogether. When individuals with social anxiety are forced to interact with others, they often get very nervous and show physical symptoms such as increased heart rate, sweating, and even nausea. Face-to-face interactions may even trigger panic attacks in some people.
Drugs are particularly dangerous for people with social anxiety disorder. Because many drugs lower our social inhibitions, it is easy for us to use drugs as a social coping mechanism. If a person fails to seek proper treatment for anxiety and self-medicates with illicit substances, they run the risk of developing a serious drug addiction.
Other Types of Co-Occurring Anxiety
There are several different types of anxiety disorder. While they share some characteristics, each one comes with different symptoms and may be treated with separate medications. It is common for addiction and social anxiety to overlap, but addicts may suffer from any of the following conditions:
Anxiety and Common Drugs
Learn more about anxiety and how it manifests itself with alcohol and commonly abused drugs.
It's common for people to use alcohol as a social lubricant. Some people have a few to let their guard down, to stop worrying what other people think of them and to enjoy themselves more at parties or other situations. For people with anxiety disorder, however, alcohol can have negative short and long-term consequences.
Because social anxiety causes a person to be nervous or shy around other people, anxious people often find that booze makes their life a little easier. While it isn't a huge problem for someone to have a few drinks, research shows that socially anxious folks are far more likely to develop serious alcohol addictions.
Almost 28% of people who suffer from social anxiety disorder can also be characterized as having alcohol use disorder. The majority of these people tend to drink only in social situations like parties and gatherings. It is common for socially anxious people to abstain from drinking in situations where being drunk would call attention to them. The problem, therefore, has less to do with constant drinking than with drinking excessively during social scenarios.
Alcoholism and alcohol dependence are not always the same thing. Or rather, alcoholics are not always people who crack open a beer every morning. Sometimes, alcoholism can be classified as the need to drink excessively in certain situations. When it comes to people with social anxiety, for example, what we often see is that the individual is unable to drink small quantities or abstain from drinking if they are going to be around other people. Over time, this is particularly worrisome, as it can lead to a more severe dependence on alcohol.
The relationship between marijuana and the various forms of anxiety is quite interesting. It's common, after all, to hear people claim that marijuana "calms their nerves". While this may be true for some individuals, cannabis is also closely tied to paranoia and other forms of stress.
For one, people who suffer from anxiety are far more likely to develop cannabis use disorder. Someone to smokes or ingests pot in order to ease their stress is at risk of becoming dependent on the drug. Marijuana dependence can be dangerous if it alters the person's ability to be productive or causes them to put themselves in dangerous situations (such as driving or operating machinery while high). Regular marijuana use can also lead to a lowered IQ and have negative physical side effects like lung cancer.
If someone suffers from anxiety disorder and uses weed, the drug can make their condition much worse. Depending on how their brain responds to the drug, pot can turn a simple case of anxiety into full-blown schizophrenia. In its worst cases, anxiety can already cause the individual to experience hallucinations. They may see or hear things that aren't really there. Marijuana can aggravate this tendency, causing them to experience more intense hallucinations and become more paranoid.
Stimulants and anxiety don't mix well. Illicit drugs such as cocaine and meth, therefore, are particularly harmful to anxious people. Anxious people tend to have a high-level of brain activity already, which is only excited by cocaine, methamphetamine and other "uppers". Even caffeine can exacerbate anxiety disorder.
While most anxious people prefer "downers" like alcohol, some use cocaine and meth. These drugs are highly addictive substances. They also limit inhibitions, making easy for a person to say what they're thinking and do whatever feels right (something that anxious people can have trouble with in everyday life). Therefore, it isn't uncommon to find people with an anxiety disorder who are hooked on stimulants. Simply trying these drugs out a few times can lead to a heavy addiction.
Cocaine and methamphetamine are known to cause anxiety, as well, even in people who never had it before. Someone who abuses meth or develops a coke habit might find themselves getting anxious more often.
The Dangers of Self-Medicating
While scientists still don't fully understand the complex nature of anxiety, they have identified a few important aspects of it. For one, we know that the human brain is equipped with several mechanisms that help it to fight off anxiety. We are animals, after all, and being anxious doesn't lend itself always lend itself well to survival. The brain, therefore, tries its best to regulate anxiety in order to keep us moving forward throughout the day.
Of course, not all of us are lucky enough to be anxiety-free all of the time. The chemical mechanism in the brain that fights anxiety is off-balance for some of us. Antidepressants and anti-anxiety meds were developed to help restore that balance, which is why many anxious people find that those medications help.
Self-medication, however, can be detrimental to the anti-anxiety mechanisms in the brain. Drugs like alcohol and cocaine can cause damage to the parts of the brain that usually work to cope with anxiety and depression. While this might not seem like much to a person who already struggles with anxiety (if you're already anxious, how much worse could it get, right?) some illicit drugs can make anxiety drastically worse.
Treatments for Anxiety and Addiction
In order to treat anxiety and addiction simultaneously, the addict will need to go through physical and psychological rehabilitation. First, they'll need to go through detox to flush the chemical out of their system. This can be particularly unsettling for anxious people, as the common conception of withdrawal is that it's a painful process.
Once the addict cleanses their body of drugs, they'll need to address the psychological aspects of their addiction. They may want to see a therapist who specializes in drug addiction. The therapist will help them to identify the root causes of their addiction and work with them to develop positive coping skills for managing their anxiety without illicit drugs or alcohol.
Anxious Addicts Should Avoid Benzos
Anti-anxiety medications are often prescribed to people with an anxiety disorder. SSRIs, SNRIs and a number of other drugs are used to calibrate the chemical imbalances that are known to cause anxiety. In some cases, the doctor will prescribe benzodiazepines like Xanax and Valium.
Benzos, however, should not be used as a treatment for co-occurring cases of anxiety and addiction. This class of drugs carries a high risk of addiction and many people become dependent on the pills after using them for a short amount of time.
For this reason, benzos are not a recommended form of anxiety treatment for people with addictive tendencies. Because the drugs carry such a high risk of abuse and are the cause of addiction for so many people, doctors tend to prescribe them much less than they once did. There are a few non-addictive anti-anxiety medications that are promoted by rehab programs as an alternative to benzos.
Non-Addictive Meds for Co-Occurring Anxiety Disorder
SSRIs such as Lexapro or Zoloft and SNRIs like Effexor are often used to treat anxiety. While these drugs don't work for everyone, they work to regulate the parts of the brain that anxiety stems from. These drugs can be good for people with co-occurring cases of anxiety and addiction as they do not get the user high. Therefore, it is far less common for people to abuse these drugs in the same way that benzos are abused.
Both SSRIs and SNRIs are habit-forming, however. Because they are taken daily, the user can become chemically dependent on these substances. It is possible to experience withdrawal symptoms if you attempt to stop using anti-anxiety medications abruptly. When treating anxiety and addiction at the same time, medication should only be taken with a doctor's approval. The doctor will ensure that the patient is safe and that the potential for drug abuse is eliminated as much as possible.
Do You Struggle with Anxiety and Addiction?
If you or someone you know suffers from anxiety disorder and addiction disorder, it is important to seek recovery help. Co-occurring conditions can take quite a toll on your quality of life. If left untreated, these two disorders can cause very negative consequences down the road.
It can be overwhelming to try and fight two diseases at the same time. Luckily, there are plenty of people out there who are ready to help. There are doctors, therapists, addiction specialists and other recovering addicts who can provide the treatment and support you need to get better. If anxiety and addiction are causing problems for you in your life, feel free to reach out for help. You'll be glad you did.