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.
Treating Multiple Addictions: Why We Treat Sexual Addiction and Substance Abuse Concurrently
Sexual addiction can be accompanied by other addictions and/or substance abuse. While on the surface, different addictions seem to be associated with their own unique set of behaviours, they are often fueled by the same underlying feelings of guilt, shame, avoidance and trauma. Addictions interact within the individual making it difficult to tease them apart.
When examining patterns of problematic substance use in individuals seeking help for a sexual addiction, it becomes clear that the two are inextricably linked. It is estimated that between 40-60% of individuals with a sexual addiction also meet the criteria for alcohol or drug addiction (Vesga-Lopez et al., 2007). Many individuals with sexual addiction admit to using substances in order to deal with, or escape from, the pain that is caused by their sexual behaviour. People may also use substances to get over their inhibitions in order to engage in sexual behaviours that might be uncharacteristic for them if they were not drunk or high.
It is important to investigate how multiple addictions can feed into one another. Sometimes people use one of their addictions to mask or dismiss the other, perhaps more shameful addiction. For example, an individual may deny having a problem with sexual addiction and insist that their problematic sexual behaviour is only caused by intoxication. However, it may be the case that drugs or alcohol are merely masking the pain and shame associated with the sexual addiction and help the person withdraw from the emotional consequences of his or her actions. By the same token, both addictions may work on intensifying one another in such a way that the person only engages in their sexual addiction under the influence of alcohol or drugs. These rituals then serve to protect the addiction and ensure that patterns of use are stable and predictable (Schneider et al., 2005).
A major concern with treatment of substance use disorder alone is that untreated sexual addiction often precipitates a relapse of substance use. Dealing with one addiction while ignoring the other may end up intensifying the problem that has not been addressed. A good example used by Schneider and colleagues (2005), is when a person in early recovery from a substance addiction turns to sexual performance enhancers in order to continue the ritualized sexual behaviour that was previously enhanced by the substance use. This sexual behaviour can continue to be problematic for the individual. The individual may continue to feel a sense of shame and pain. Therefore recovery is about addressing the entire addictive process, not just those associated with a particular substance or behaviour. The addictive process, whether it be related to sexual behaviour or substances is often characterized by a pattern of secrecy, cognitive distortions and rituals. Therefore recovery from addiction regardless of type, would involve embracing and attempting to live a life of honesty, authenticity and emotional growth.
Fortunately, many underlying similarities between multiple addictions mean that the underlying framework for concurrent treatment is quite effective. A recent study conducted at Bellwood Health Services confirms that individuals with a comorbid sexual addiction and substance use disorder attending the same treatment centre as those with only sexual addiction, have comparable treatment outcomes at six-months follow-up. Both groups demonstrated substantial improvement not only on measures of substance use and sexual impulse control but also on self-reported measures of well-being and quality of life (Hartman et al., 2012).
Past psychological trauma, sexual abuse, abandonment and neglect are important issues that need to be addressed in treatment. The recovering addict must learn to recognize the signs of being actively involved in the addictive process and work hard at replacing maladaptive coping strategies with positive and affirming ones. The individual needs to be given the tools to be able to function effectively in their environment and successfully meet life’s challenges without turning to substance use or problematic sexual behaviour.
By Iryna Gavrysh and Simone Arbour
A Self-Assessment for Sex Addiction
Are you worried about your sexual behaviour? Worried if it’s a sex addiction? Test yourself here: https://www.bellwood.ca/sexual-addiction-treatment.php
Hartman, L. I., Ho, V., Arbour, S., Hambley, J. M., & Lawson, P. (2012). Sexual addiction and substance addiction: Comparing sexual addiction treatment outcomes among clients with and without comorbid substance use disorders. Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 19, 284-309.
Schneider, J., Sealy, J., Montgomery, J. & Irons, R. (2005). Ritualization and
reinforcement: Keys to understanding mixed addictions involving sex and drugs.
Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 12, 121–148.
Vesga-Lopez, O., Schmidt, A., & Blanco, C. (2007). Update on sexual addictions
Directions in Psychiatry, 27(2), 143–158.