To to casual observer, addiction and anxiety don’t seem to be related. After all, addiction is when you can’t stop doing something that’s bad for you, and anxiety is when you can’t stop worrying about something that’s probably not. Both terms have negative connotations in that neither one is something that people want to experience. And both can cause problems in people’s lives. But that doesn’t mean there are similarities, does it?
Or does it?
So, is there a relationship between addiction and anxiety? The answer is a bit involved, but that’s what we’re going to be answering today. And in order to answer that question, we first have to look at the nature of anxiety.
What is Anxiety?
Anxiety it is a psychological, emotional, and often physical phenomenon characterized by nervousness, irritability, and excessive worry. It is almost always triggered by an imminent or any scenario where the outcome is not known. In a word, anxiety is a state of uncertainty.
As in uncertainty about the future, a job interview, a date, or any other life event whether big or small. Every person experiences anxiety from time to time. For most people, anxiety is helpful. Nervousness about a major meeting at work can lead one to spend extra time preparing for it. Worry over poor road conditions can lead one to drive more carefully. Fear of walking alone in a dark parking lot can lead a person to stay alert and vigilant while walking to the car.
Anxiety is not, by definition, a bad thing.
However, for an estimated 40 million adults and 8% of children in the United States, anxiety is chronic, excessive, and persistent. It affects everyday life and causes worry in situations that are not life-threatening. Chronic anxiety can lead to a host of problems, including insomnia, avoidance of everyday situations, isolation, and even substance abuse.
Recent statistics show that about 20% of Americans who have anxiety or depression also meet criteria for substance abuse. In addition, those with anxiety are two to three times more likely to develop a drug or alcohol addiction at some point in their lifetime. Likewise, about 20% of Americans with a substance use disorder also meet DSM-V criteria for anxiety or depression.
Symptoms of Anxiety
For those that suffer from anxiety disorders, the symptoms can be debilitating. Some symptoms can even mimic a heart attack or feel so life-threatening that the individual seeks emergency medical care. In most cases, the symptoms are disproportional to any actual threat that might exist in the situation. Some symptoms of anxiety include:
- Intrusive thoughts or fears
- Thoughts of death or worries about dying
- Shortness of breath
- Nausea or stomach pain
- Trembling or shaking
- Chest pain or pressure
- Feeling like you are going to choke
- Rapid heartbeat
- Sweating or feeling clammy
- Feelings of impending doom
- Dry Mouth
- Racing thoughts
- Numbness or tingling in hands or feet
- Avoidance of situations that trigger anxiety or panic
Any of these symptoms can be acute or chronic, depending on the anxiety disorder. In generalized anxiety disorder, for example, symptoms can occur several hours a day nearly every day of the week. In social anxiety or other forms of phobia, symptoms typically only exist when the person is in the anxiety-producing situation.
So What is Addiction?
Addiction is a neuro-biological and behavioral condition characterized by obsessive thinking, compulsive behavior, self-centered justification, and psychological denial of its harmful effects. People can become addicted to all manner of behaviors and substances, from drugs to self-harm to shopping and even criminal behavior.
Addiction is incredibly complicated. It is part disease, part behavior. Its roots are part hereditary, part environmental. It’s outcomes can range from mildly annoying to fatal. It is vexing, difficult to understand, and shocking common. And where there is addiction, there is always anxiety.
Which Comes First: Anxiety or Addiction?
While many with anxiety or addictive behaviors do not have co-occurring disorders, for those that do, it can be difficult to determine which came first and whether one – anxiety or substance abuse – caused the other. In many cases it doesn’t really matter, because you can’t just ignore one and treat the other. They are a package deal. You either learn to manage both, or either one can lead to major problems.
Anxiety’s Effect on Addiction
Some people with anxiety disorders, such as those with post-traumatic stress disorder, panic disorder, or social anxiety disorder, might start using alcohol, marijuana, or other drugs as a way to cope with uncomfortable symptoms. For example, a person with social anxiety disorder might feel like he or she needs to drink a beer or two at every social gathering to cope with the anxiety of the situation. A person with PTSD might choose to drink or use drugs to drown out intrusive thoughts or flashbacks.
Addiction can also start as a result of treatment for anxiety disorders. Benzodiazepines are frequently prescribed to those with chronic or severe anxiety. The medications can cause euphoria and calm feelings, which can counteract feelings of anxiety and nervousness. However, those same side effects increase the risk of benzodiazepine addiction.
Addiction and Anxiety
Unfortunately, anxiety can be a side effect of many drugs, both licit and illicit. For example, some of the most commonly-prescribed medications to treat ADHD are stimulant medications such as Concerta and Ritalin. Stimulant medications have the potential to increase anxiety and restlessness, especially at high doses. These medications are also considered controlled substances and are addictive, sometimes even being used by high school or college students to enhance their ability to study.
While alcohol is often used by those with anxiety disorders to calm their nervousness and anxiety, alcohol can also interfere with how the brain processes information and stimuli, significantly affecting mood and behavior. Some people can experience increases in symptoms of anxiety after drinking alcohol, especially following long-term use.
Finally, illicit drug use can cause changes in mood and behavior. For example, some side effects of marijuana, such as shortness of breath, lightheadedness, racing heart, and feeling detached are also symptoms of panic attacks. Cocaine, ecstasy, bath salts, and methamphetamine are all stimulants and lead to rapid excitement of the brain’s neurotransmitters. This can lead to the development of anxiety symptoms or the worsening of pre-existing anxiety.
Anxiety and Withdrawal
After long-term use of addictive medications or substances, the brain often has difficulty adjusting to the absence of those drugs. This can lead to withdrawal symptoms, including sweating, shaking, nausea, increased heart rate, racing thoughts, trembling hands, and anxious feelings. In the short term, these can happen every time the drug or medication leaves the body, such as during the “hangover” period. During treatment for substance abuse, withdrawal also happens during the detox period.
In both cases, the anxiety that occurs during withdrawal is often a trigger for the person to start using again. For those in recovery from addiction, these uncomfortable withdrawal symptoms can lead to a relapse when the individual self-medicates with drugs or alcohol as a way to cope with the anxiety.
Treating Co-Occurring Addiction and Anxiety
Regardless of which came first, however, both conditions existing simultaneously can result in a vicious cycle that is difficult to overcome without appropriate treatment. Dual diagnosis treatment centers are often the best option for those with both anxiety and substance use disorders. These rehab facilities specialize in addressing both mental health and addiction rather than simply focusing on ending the drug or alcohol use.
Dual diagnosis treatment can help end the cycle of self-medication and rebound anxiety that often leads to relapses of both conditions. This often means providing high levels of support during the withdrawal period to help the individual cope with new or increasing anxiety symptoms. It also means making mental health treatment and support a cornerstone of the rehab process.
Recent studies show promising results when co-occurring addiction and mental health issues are treated simultaneously, including lower rates of relapse of either condition, reductions in hospitalizations for mental health crises, lower rates of attempted or completed suicides, and substantially increased rates of remission for both conditions.
This suggests that for those living with both substance abuse disorders and anxiety, seeking treatment from a qualified dual-diagnosis facility is one of the best ways to start on the path to a full recovery from both conditions.