Medicating Anxiety Symptoms With Alcohol or Drug Abuse
Written By: Dr. Mel Vincent, BASc, MSc, MD, FRCP(C ), ASAM Certified
Director Psychiatric Services at Edgewood Treatment Centre
There is clearly a very important relationship between anxiety symptoms, disorders and addiction. Research has repeatedly demonstrated an important relationship between anxiety disorders and substance use disorders in both directions.
Patients who suffer from an anxiety disorder such as generalized anxiety disorder, panic attacks with or without agoraphobia, social anxiety disorder and Post Traumatic Stress Disorder have a higher rate of developing addictions to alcohol and other drugs. Conversely, patients who are identified with substance use disorders have an elevated risk of having an underlying anxiety disorder or significant anxiety symptoms, associated with their addiction.
The implications of this relationship are important. There are clearly some patients who identify using alcohol or other substances as a means of coping with their anxiety disorders. This process has been described as “self-medication”. This is particularly true with substances that are sedating “downers” such as alcohol, benzodiazepines, marijuana and opioids as common examples. While these may initially appear to provide effective temporary relief from anxiety symptoms, the development of subsequent addiction, in vulnerable populations, inevitably leads to further problems and challenges. Tolerance frequently develops, requiring increasingly larger quantities of these drugs to reduce anxiety symptoms and withdrawal symptoms generate or exacerbate anxiety when the substances are not available. This leads to a very complicated “trap” where the addiction continues to progress and the initial benefits are no longer present.
Stress Vulnerability Hypothesis
Commonly, individuals will experience a high level of anxiety when undergoing withdrawal or intoxication from various substances, even though they do not have an actual anxiety disorder prior to the development of addiction. There is also considerable interest in the concept that there may be a shared genetic vulnerability to both disorders. One example is the “stress vulnerability hypothesis”, which states that when individuals experienced childhood neglect, abandonment, trauma or adversity, they are left with a vulnerability to a variety of mental health related conditions which may include anxiety disorders, mood disorders and substance use disorders.
How to Treat Anxiety Disorders and Addiction Together
The clinical tasks faced when confronted with co-morbid anxiety disorders and addictions include management of both disorders. This requires an in-depth assessment by a trained professional. On the basis of the assessment, appropriate referrals will then be made. This will involve assessment of withdrawal requirements from the various substances, the severity of the underlying mental health and medical issues, the level of supports and motivation of the patient and various other factors.
Depending on the severity of the two disorders, treatment may take place in an outpatient setting, a residential addiction treatment program or psychiatric hospital setting. Anxiety disorders are generally treated with medications such as antidepressants or with psycho therapy approaches, particularly cognitive behavioral or mindfulness-based.
Generally, the use of benzodiazepines is contraindicated in the management of anxiety disorders in patients with addiction. Withdrawing benzodiazepines from patients with anxiety disorders and benzodiazepine dependence can be particularly challenging due to the distressing withdrawal symptoms which can last for extended periods of time, as well as possible worsening of the underlying anxiety disorder for which benzodiazepines were initially prescribed.
It’s not uncommon to have patients in our treatment centres with mental health illnesses and addictions. Approximately 20% of the Canadian population with mental health illnesses also have substance abuse problems. Anxiety disorders often complicate integration of patients into group therapy, particularly if they have social anxiety disorder.
If you’d like to learn more about how we diagnose and treat clients with anxiety disorders and addiction- my book, Diagnosing and Treating Addictions: An Integrated Approach to Substance Use Disorders and Concurrent Disorders covers this topic along with other mental health illnesses.
To learn more about our addiction treatment and the therapies used at our treatment centres, please visit the Edgewoodhealthnetwork.com.
 Rush et al (2008). Prevalence of co-occurring substance use and other mental disorders in the Canadian population. Canadian Journal of Psychiatry, 53: 800-9.
Seeking Treatment for PTSD: The Recovery Process
Post-traumatic stress disorder (PTSD) is by definition a set of symptoms resulting from a traumatic experience of “death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. “ More broadly, PTSD can also be defined as having experienced an overwhelming situation where your normal coping strategies are not adequate. Symptoms of PTSD can vary, but most people with the disorder experience sleep disturbances, hyper-arousal, flashbacks and mood disturbances.
At Bellwood, we see clients who have experienced such traumas and are struggling with the symptoms of PTSD. Our program for hazardous employment groups includes members of the Canadian Forces, the RCMP, the police, EMS and fire services and would potentially be open to other work related traumas. We added the term of operational stress injury (OSI) to our program description since it is something first responders would often experience.
As a therapist in the Addiction & PTSD/ OSI program at Bellwood, I’ve found that the traumatic experiences at work change how a person functions and relates at home. Clients often experience alienation. For example, they report “not knowing where to put their keys in their own homes” and don’t know how to relate to normal life or perform day-to-day tasks, including shopping or driving in traffic. Everything feels too mundane to be of interest compared to active duty. In their deployments, they experienced high arousal and adrenaline-inducing activities.
As a result of their alienation, people with PTSD might resort to drugs or alcohol to find relief from the emotional pain, loneliness and the feeling of “going crazy.” They might find themselves covering up anger and pretending that things are alright. Using also becomes a way of dealing with the irritability, intrusive memories, and nightmares. Sometimes, the only time an individual with PTSD feels “normal” is when intoxicated or when involved with work. When at work or deployed, job tasks are pre–determined and the soldier or officer focuses only on work tasks – something at which they believe they excel.
Clients that I see often express the feeling that no one outside of work could possibly understand what they are going through and that no one is as “messed up” as they are. Many express the wish to either have been killed (because then, “at least my kids would think of me as a hero”) or physically injured because then they would receive support from the whole community upon their return home. With something physical, the nature of the injury is apparent and no one would think they are making it up. The problem with PTSD is that it is invisible and remains that way until the person realizes that they are not alone and accepts that their experiences have changed their feelings.
One of our goals in treatment is to reduce or eliminate the emotional disturbances related to the traumatic work experiences by learning grounding techniques and self- regulation tools. Our treatment approach is the establishment of safety and stabilization. Through this process, trust is built. This work is enhanced by successfully identifying and continuously managing environmental and emotional triggers. By employing the emotional regulation and grounding techniques, clients can ultimately master their triggers, lessening their impact on their mental health. Other key features of our program include: stress management techniques, anger management, sleep hygiene, resilience identification and recovery planning.
As a result, major PTSD /OSI symptoms are reduced and clients can begin to realize that when triggered the traumatic experience is not happening anymore and that they are able to deal with their feelings in more constructive ways. However PTSD/ OSI symptoms need long-term care and management. Treatment does not “cure” the individual but with ongoing support, the client can more successfully deal with life’s problems without the use of drugs and alcohol and can learn to put their traumatic experiences into a better perspective. At times people may learn to refer to their symptoms as post traumatic growth or post traumatic success and can appreciate their experiences as important.