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The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

Alcohol. A beverage that many people enjoy drinking; be it for socialisation or as an escape from reality. However, it is also a beverage that can harm your health and adversely affect many lives. Indeed, alcohol abuse has become increasingly rampant, where it is one of the leading causes of disease and death, with 5.3% of all global deaths and over 200 diseases and injury conditions resulting from the harmful use of alcohol. Worryingly, it is also a phenomenon that has affected Singapore, with 9.6% of Singaporeans engaging in binge drinking (as of 2016) and an increasing number of Singaporean young adults battling Alcohol Use Disorders (AUD). As such, alcohol abuse has become a growing cause of concern.

There are many reasons why alcohol consumption is increasing. Alcohol consumption has been perpetuated by the media in recent years, with an increase in advertising and marketing of alcohol. For instance, in Australia, people are exposed to about nine alcohol televised advertisements every month. In turn, exposure to such advertisements causes alcohol consumption to be glorified and promoted, where people have unrealistic positive expectations towards alcohol, believing that it boosts one’s mood and invokes cheerfulness and confidence. Additionally, alcohol consumption has also increased due to peer pressure. Be it a work engagement or partying with friends, people often find it hard to say no to alcohol, as that rejection may cause disapproval among colleagues or friends. Thus, many people engage in risky drinking behaviour to socialise and develop their relationships.

However, a more significant reason behind alcohol consumption is feelings of anxiety or having anxiety disorders. People with anxiety disorders have 2 to 3 times the risk of having alcohol use disorders (Smith & Randall, 2012). Many people tend to use alcohol to reduce social anxiety, as they believe that alcohol is an excellent aid to speak up and gain more confidence around others. Similarly, people use alcohol as a form of self-medication to overcome anxiety symptoms and stress, relying on it as a coping mechanism. However, contrary to popular beliefs, alcohol exacerbates rather than alleviates anxiety symptoms. This worsened anxiety makes them drink more and have more alcohol-related problems, which causes further anxiety and stress.

Alcohol abuse also causes anxiety. Drinking alcohol builds a tolerance to de-stressing effects of alcohol. This creates a temporary sense of relaxation but later leads to feelings of depression and anxiety. This is because the prolonged use of alcohol can act as a stressor and activate the body’s stress response system, changing neurotransmitter levels in the brain and causing an increase in stress and anxiety. As such, alcohol can worsen anxiety symptoms.

Therefore, anxiety and alcohol abuse tend to fuel each other in a vicious feed-forward cycle of co-occurring addiction and anxiety, which is difficult to break out from. As such, integrated treatment for both anxiety and alcohol use should be readily available.

Treatment

There have been existing parallel or subsequent attempts to treat both anxiety disorder and AUD (i.e. treatment for anxiety disorders first, followed by AUD). However, studies have found that parallel treatments have caused worse alcohol outcomes compared to just seeking one treatment. This is possible because the cognitive load of receiving two separate treatments may be confusing or overwhelming for people, causing them to feel anxious or turn back to drinking as a coping mechanism. As such, these type of treatments causes a “co-morbidity roundabout”, which is a metaphor of mental health problems resurfacing when attempting to tackle substance disorders (and vice versa), thus failing to break out from the vicious cycle of these co-morbid disorders. Therefore, it is clear that both anxiety disorder and AUD are inter-related issues, and an integrated treatment approach is vital to tackle both disorders.

Stapinski et. al. (2015) carried out an integrated treatment for comorbid social anxiety and AUD, where participants undergo both Cognitive Behavioural Therapy (CBT) and motivational interviewing. Moreover, it involves core components such as building coping skills, developing alternative reinforcers and preventing relapse. This provides participants with useful skills such as enhancing social support networks, correcting misconceptions towards the benefits of drinking, reducing avoidance of social situations and developing healthy coping skills to manage triggers for drinking or anxiety.

This study took place over ten 90-minute sessions, where 117 participants with both social anxiety and AUD took part in this study. 61 of the participants received integrated treatment (both AUD and social anxiety) and 56 of the participants received treatment for AUD only. Results showed that both treatments enabled a great reduction in alcohol use and dependency. However, participants that underwent the integrated treatment were observed to have a greater decrease in social anxiety symptoms and a greater increase in overall quality of life. More importantly, these results remained constant even after a 6-month follow-up. This means that integrated treatment has long term effects on overall functioning and quality of life.

Early Interventions

While the above has proven that integrated treatment is indeed useful in overcoming social anxiety and AUD, the road to recovery is a long and arduous journey, where there are a lot of physical and mental challenges suffered by both the clients and their families. Hence, these issues could be more easily overcome or even avoided if there are early intervention and support to at-risk youths.

Over the years, the number of youths drinking alcohol has increased. According to the Avon Longitudinal Study of Parents and Children (2004), the number of youths that engage in binge drinking increase tremendously between the age of 18 and 21 (from 18% to 35% respectively). Furthermore, 18-year-olds who drank alcohol as a coping mechanism or who had anxiety disorders were 1.8-3.8 times more likely to drink. Both groups had a greater risk of transitioning from low-risk alcohol use at age 18 to high-risk alcohol use at age 21.

There are many motives that may drive youths to drink alcohol. A primary reason is that youths are at a phase where they are transitioning to adulthood. Adulthood brings more stress and anxiety due to changes such as new relationships; along with new responsibilities and challenges such as living in a dormitory and budgeting. Additionally, this phase of life also provides youth with more autonomy and drinking opportunities (e.g. clubbing, drinking games). With these drastic changes in life, youths often drink to enhance positive moods, socialise with others, conform to social groups, or as a coping mechanism to overcome stress or anxiety. This causes harms associated with alcohol to peak in early adulthood, emphasising the importance of early intervention to avoid these detrimental consequences.

An ongoing programme called “Inroads Study” (Stapinsky et. al., 2019) aims to provide early intervention to youths with anxiety disorders and AUD. It seeks to enhance anxiety coping skills and address coping-motivated drinking. Moreover, this programme is specially tailored to make it more relevant and appealing to youths. This includes making the programme available online, which is preferred by youths as it is more convenient, affordable and reduces stigma. Participants can freely access online therapy sessions and modules about tackling challenges often faced by youths. Thus, such interventions can address the interconnections between anxiety and alcohol use, as well as reach out successfully to youths in a relevant and appealing manner.

Prevention programmes are also forms of early intervention that may benefit younger youths (i.e. 13- or 14-year-olds) that have a ‘high-risk’ of developing substance disorders, even if they do not currently have a substance disorder. It is vital to identify early onset of problems faced by youths and nipping them in the bud, providing them with early support and teaching them relevant life skills. This prevents problems faced by youths from developing into more severe adulthood problems such as substance disorders, chronic mental health problems and delinquency.

One such prevention programme was organised by Edalati & Conrod (2019), who first identified at-risk youths through the Substance Use Risk Profile Scale; where those with higher levels of certain personality traits (e.g. sensation seeking and negative thinking) were at higher risk of abusing substances before the onset of use. Afterwards, these youths attended coping skills workshops, CBT and motivational interviewing.  Results showed that the programme proved effective in reducing alcohol use, alcohol-related harms and emotional and behavioural problems (i.e. symptoms of anxiety and depression). This shows the importance of early intervention and prevention programmes.

In conclusion, it is apparent that there are interconnection and the longstanding link between anxiety and alcohol use, where this co-morbidity can cause huge effects on one’s physical and mental wellbeing. Thus, this raises the importance of integrated treatment, allowing both conditions to be resolved at the same time. Furthermore, early intervention is extremely vital to offer support to youths and prevent potential disorders from occurring. More importantly, all this shows that alcohol is not the answer to relieve stress and anxiety, and can only serve to exacerbate rather than resolve our problems. Thus, such action could be done to reduce excessive alcohol use in our society, such that harmful usage and effects of alcohol could be prevented.


 

References:

https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-link-between-anxiety-and-alcohol-use-implications-for-treatment-and-early-intervention

Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.

Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.

Golding, J., & ALSPAC Study Team (2004). The Avon Longitudinal Study of Parents and Children (ALSPAC)–study design and collaborative opportunities. Eur J Endocrinol. 151, U119-U123.

Stapinski, L., Prior, K., Newton, N., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. Journal of Medical Internet Research, 8(4), 1-14.

Edalati, H., & Conrod, P. J. (2019). A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents. Frontiers in psychiatry, 9, 770.

https://www.who.int/news-room/fact-sheets/detail/alcohol

https://www.straitstimes.com/singapore/alcohol-abuse-worse-among-younger-people

https://www.drugrehab.com/addiction/alcohol/peer-pressure/

Photo by Q.U.I on Unsplash

 

Intrinsic motivation as a source of vitality?

Intrinsic motivation as a source of vitality?

“Vitality management is provided for organizations that have a vision”. A quote from Pauline van Dorssen, writer of “Vital People in a Vital Organisation”. This is a new successful training (NIP). Positive psychology and the use of vitality are central. The response from Occupational and Organisational Psychologists and Occupational Health Psychologists was exuberant, with all available places booked. In addition, the same question arises from organizations, who often need advice and coaching in the field of vitality.

To know more, here is the original article in Dutch language: Artikel_De Psycholoog_lisa van der Heijden

Written by Lisa van der Heijden, Clinical Psychologist.

If you are interested to know and learn more therapy for children/adolescents, contact Promises Healthcare for more information.

Hong Kong Murder Trial – Understanding ‘Diminished Responsibility’

Hong Kong Murder Trial – Understanding ‘Diminished Responsibility’

mental-health-court

As harrowing details of the British banker murder trial emerge, the media have shone a spotlight on his mental health and use of the ‘diminished responsibility’ defence. Here is a short introduction to the concept of ‘diminished responsibility’ and the role that forensic mental health experts may play in this trial written by Leeran Gold, Psychologist in our Forensic Service.

To read more:https://www.linkedin.com/pulse/hong-kong-murder-trial-understanding-diminished-leeran-gold?trk=hp-feed-article-title-publish

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. Contact us to find out more.

Confidentiality, Consent and Landmark Litigation.

Confidentiality, Consent and Landmark Litigation.

Following a landmark case that ordered all privileged medico-legal reports to be struck off the record, the High Court of Singapore has set a new precedent in applying litigation privilege in criminal cases. Here are 3 key takeaways for forensic mental health professionals following the case written by Leeran Gold, Psychologist in our Forensic Service.

To read more:https://www.linkedin.com/pulse/confidentiality-consent-landmark-litigation-leeran-gold?trk=hp-feed-article-title-comment

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. Please contact our clinic on for inquiries and consultations.

Can Sex be a Real Addiction?

Can Sex be a Real Addiction?

Loved ones struggle to believe that sex can be a real addiction. Isn’t it simply bad behavior and selfishness? Isn’t it just a lack of self-control? Surely serial infidelity is a moral failing and should be punished? Those suffering from compulsive sexual behavior are also confused. It’s not like drugs or alcohol – which are not things that you need. Sex is like food – we all want and need it.

Sufferers are often exasperated.

“I love my wife and my family. They are the most important part of my life. I can’t live without them. But the thought of losing them just doesn’t seem to stop me. I can’t figure out why. It’s so crazy!”

Compulsions are defined in many ways – but there is a common thread. When a person is bonded to compulsive behavior: their life is unmanageable, and they cannot stop. What does that look like for sexual compulsion?

Here is a checklist.

Is the person about to lose or have they already lost their job? Their marriage? Their children? Their health (e.g. an STD)? Their finances?
And are they still acting out anyway?
Are they isolated from their friends?
Do they want to act out rather than spend time with their spouse or children?
Do they stop hobbies and sports?
Do they lie? Cheat? Deny? Justify? Rationalize and minimize – even about the most trivial things?
Do they spend most of their time obsessing about acting out?
When they are not acting out: are they anxious? Fearful? Jumpy? Depressed? Sleepless? Restless? Angry and snappy? Distracted and distant? Aloof and tearful?
Do they appear to drink more? Smoke more? Eat more junk food? Or lose interest in eating?
Do they go back to using sex to deal with all these things?

If the answer to more than one question is “yes” – there may be a problem.

Sex addiction is as real as the suffering it causes. But there is good news! It is manageable and it is treatable. Professionals and self-groups can help. If you are suffering or know others to be suffering, there is hope. At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. Please contact our clinic for inquiries and consultations.

Written by: Andrew da Roza – Psychotherapist and sex addiction specialist, Promise Healthcare Pte. Ltd.: