Substance Abuse and Anxiety

Woman Drinking, Image Courtesy of YaiSirichai, FreeDigitalPhotos.net

According to the Anxiety and Depression Association of America (2012), 20% of those with an anxiety disorder also have a substance abuse disorder. Alcoholics are particularly likely to suffer from anxiety, with between 10% and 40% of alcohol abusers also meeting the diagnostic criteria for panic disorder (Cox et al., 1990).

Although some people who suffer from mental health disorders use alcohol or drugs to self-medicate, the temporary relief from anxiety and depression comes with a price – rebound anxiety and worse depression in the long run.

Are You a Substance Abuser?

Signs of a substance abuse problem include the following:

• You feel you should try to cut back but either can’t or won’t.
• You rely on alcohol or drugs in order to socialize or just get through the day.
• You do things you regret while under the influence of substances.
• You lie about the amount of alcohol or other substances you consume.
• Family or friends have expressed concern about your drinking or drug use.
• You have suffered one or more blackouts after drinking or doing drugs.
• Your substance use is damaging your relationships.
• You have lost a job or endangered your work situation due to substance use.
• You have had legal trouble as a result of substance use.
• You have had a car accident or lost your license due to driving under the influence.
• You have put yourself in physical danger while under the influence.

The Link Between Anxiety and Substance Abuse

There have been a couple of theories put forward to explain why anxiety sufferers may be more prone to substance abuse. The most straightforward is that many substances provide temporary relief from anxiety or sadness. In addition, in the case of certain anxiety disorders such as social phobia, alcohol or other substances lower inhibitions, making it easier for the anxiety sufferer to socialize.

Some anxious or depressed people self-medicate using drugs that can cause euphoria, such as marijuana or cocaine, but these drugs can also trigger severe panic attacks. Many people don’t think of coffee as a problematic substance, but overuse of caffeine can be a problem for some people, as it increases the risk for suffering from panic attacks and generalized anxiety.

Another theory that has been suggested to explain the anxiety-and-substance-abuse connection is that people who have a genetic predisposition toward anxiety may also have a predisposition to use substances and develop addictions. This is supported by the fact that both anxiety disorders and substance abuse disorders often run in the same families (though it’s possible that both anxious reactions and the tendency to abuse substances are learned behaviours in many cases as well, or a combination of learned behaviour and genetic vulnerability).

Substance abuse is particularly bad for people who suffer from anxiety. It can trigger worse rebound anxiety and depression, cause panic symptoms, and lead to impulsive or destructive actions that cause further stress. Also, if substances are used as a crutch to face feared situations on a regular basis, the person develops an increasingly high tolerance, which means that he must consume more and more of the substance to get the same effect, increasing the risk of overdosing and the overall negative health effects.

The relationship between substance abuse and anxiety may vary from one anxiety disorder to the next. For example, those who suffer from agoraphobia or social phobia usually begin drinking after the anxiety disorder develops, as a form of self-medication or to make social situations feel easier, whereas panic disorder and generalized anxiety disorder often begin around the same time as problem drinking begins, which suggests that the symptoms may be partially attributable to alcohol withdrawal for some people (Brady et al., 2007).

Although it can reduce anxiety in the short run, alcohol makes the autonomic nervous system hyper-excitable (and thus, over-reactive to stress), as well as creating stressful life problems (conflicts with others, car accidents, job loss, health problems, etc.) that can make anxiety worse.

Treatment for Alcoholism and Drug Abuse Caused by Anxiety

Cognitive-behavioural therapy (CBT) and/or support groups tend to be the most effective treatments for substance abuse, and CBT is particularly effective for anxiety disorders as well. There are also medications available specifically for targeting substance abuse. Talk to your doctor about options.

If you’ve been drinking heavily or doing drugs regularly, you’ll need to withdraw slowly with medical supervision. If you’re just drinking a little more than you should (using it as a crutch for anxiety), see How to Stop or Reduce Drinking for tips on how to cut back or quit altogether. If you’re not sure how serious your substance abuse problem is, err on the side of caution and consult a doctor.

As for medications designed to treat anxiety directly, tranquillizers and other addictive medications should be avoided by those with a tendency to abuse substances. SSRI antidepressants are a safer option for treating the anxiety disorders that often accompany substance abuse, and they have the added benefit of treating the depression that often accompanies anxiety disorders. However, there are plenty of alternative anxiety treatments for those who want to avoid medication altogether.

Building overall resilience and coping skills can reduce anxiety and the tendency to abuse substances in response to stress. In addition to CBT, realistic thinking; building social support; cultivating mindfulness; getting more exercise; meditating; doing yoga; and/or engaging in relaxation techniques such as calm breathing, visualization, and progressive muscle relaxation can be beneficial. Improving your sleep and consuming an anti-anxiety diet can also help to reduce the anxiety and depression that can make you vulnerable to abusing substances.

See the main Anxiety and Panic Disorder Remedies page for a full list of natural anxiety treatments. If you suffer from depression as well, see the main Depression page for information and treatment options.

This article is provided for informational purposes only and is not intended as a substitute for medical or psychiatric advice. Medical concerns should be referred to a qualified doctor.

References:

• Ankrom, S. (2009, February 1). “Using Alcohol to Relieve Anxiety.” About.com.
• Anxiety and Depression Association of America. (2012). “Substance Abuse.” ADAA.org.
• Bryan, K.T.; Tolliver, B.K.; & Verduin, M.L. (2007). “Alcohol Use and Anxiety: Diagnostic and Management Issues.” American Journal of Psychiatry, 164, 217-221.
• Cox, B.J.; Norton, G.R.; Swinson, R.P.; & Endler, N.S. (1990). “Substance Abuse and Panic-Related Anxiety: A Critical Review.” Behavioral Research and Therapy, 28(5), 385-393.
• Losinno, N.D. (n.d.). “Double Trouble: Anxiety and Substance Abuse.” BNL.gov.
• MedScape Education. (n.d.). “Anxiety and Substance Abuse.” MedScape.org.
• Saison, J., MSW; Smith, M., MA; & Segal, J., PhD. (2012). “Substance Abuse and Mental Disorders.” HelpGuide.org.