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Dual Diagnosis: Anxiety and Substance Use Disorder

Dual Diagnosis: Anxiety and Substance Use Disorder

Anxiety, stress, and fear are common emotions people experience through the course of everyday life.  Anxiety disorders, on the other hand, go beyond our daily worries and fears. Stress and pressure is subjective to each person – anxiety disorders can induce heavy stress and pressure, and these feelings can become more intense over time. Issues that crop up for anxiety disorder sufferers range from anodyne to hair-raising. For example, some people are terrified of meeting new people and having to interact with strangers, while others suffer panic attacks when memories of past traumas surface. The most common types of anxiety disorders are diagnosed as:

  • Panic Disorder (PD)
  • Generalised Anxiety Disorder (GAD)
  • Social Anxiety Disorder (Social Phobia)
  • Agoraphobia (Perception of certain environments as unsafe, with no easy escape)
  • Obsessive Compulsive Disorder (OCD)
  • Post Traumatic Stress Disorder (PTSD)

Not only are there psychological symptoms, people dealing with anxiety disorders may also experience a litany of physical symptoms such as insomnia; inability to concentrate or relax; heart palpitations; gastroenterological issues; and sexual frustration, among others. When all these problems start impinging on one’s behaviour, mood and thoughts, life can start to feel like a slog through quicksand. A once “normal life” now appears out of reach, and getting there again can feel like a Sisyphean task.

What makes people suffering from an anxiety disorder seek out substances?

It’s important to understand a little more about addiction before dealing with this question. Addiction is indubitably a very uncomfortable disorder, and that’s characterising it mildly. For a “preference” to devolve into full blown addiction, a person must keep making the same conscious decisions every day, day after day, that facilitate  indulgence in his or her vice – in spite of a mounting cornucopia of problems. Maintaining an addiction certainly is tiresome. People suffering from addiction make these choices because their addiction serves them a purpose. Concomitant discomfort is tolerated in light of perceived benefits garnered from substance abuse.

A parsimonious way to think about addiction is to assume that it is a simple cost-benefit analysis. For someone struggling with an anxiety disorder, the allure of a “quick-fix” in the form of a suitable drug or drink is hard to ignore. What may begin as a misguided attempt to ameliorate paralysing fear can eventually develop into a fully-fledged addiction. With this in mind, it is now a lot clearer why substance use disorder (SUD) is a co-occurring psychiatric disorder that is one of the most prevalent among people with an anxiety disorder. The most recent and largest comorbidity study to date (with over 43,000 participants), the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), found that 17.7% of respondents with an addiction problem also had an anxiety disorder.

Ironically, the problem with the “solution” of substance abuse is that the ”solution” hurts more than helps. It can often exacerbate the anxiety disorder – which becomes ensnared in the convoluted mess that is addiction. Thus comes the slippery slope of anxiety, substance use, and elevated tolerance.

Chronic dependence is the likely consequence of this chain of events. For example, a person who suffers from social phobia might employ stimulants or anxiolytics to engender artificial confidence during a social situation. This can feel liberating, exhilarating, even, for someone who has spent a lifetime on the sidelines. The folly in this endeavour lies in the eventual normalising of this ‘chemically induced courage’ – if you turn it into a precondition to interacting with other human beings, you will only succeed in erecting progressively more imposing barriers in a completely self-defeating, tautological situation.

Are there psychotherapies out there that treat anxiety and addiction together?

Diagnosing a mental disorder in a person who also suffers from an addiction is challenging.

It may be hard to determine which came first, the addiction or the anxiety/depression. A clinical history, which is triangulated with loved ones, teachers and others may assist to know which came first. In any case, both the addiction and the disorders have to be treated at the same time. Otherwise, if untreated, the anxiety and depression may lead to the resumption of drug or alcohol use.  Cognitive behavioural therapies (CBT), meditation and mindfulness therapies, experiential therapies and medication can assist to address both compulsive behaviour and anxiety and depressive disorders.

A trained and experienced mental health professional can help you navigate your addiction recovery journey to ensure that you get the best possible outcome within the guidelines of your values and needs. While this article is about substance addiction, you will find that our team of psychiatrists, psychologists and therapists have the expertise and experience to work with a variety of addictions, and mental health issues such as anxiety disorders.

Feeling fearful or anxiety? – recovery is possible

Feeling fearful or anxiety? – recovery is possible

There are times when we feel fear and we may be anxious in different moments in our life. We may feel fear when we are in situations where we are threatened or perceive  a threat. Individuals may feel anxious when facing stresses at work and having to meet deadlines. In fact, having some form of anxiety may actually be productive in getting people into action in completing tasks or in making changes in their lives.

While anxiety and fear are common emotions, these emotions can become overwhelming if they are excessive and irrational. Individuals may develop difficulties in being able to work and to meet the demands of life or in relationships which results in a condition called an anxiety disorder.

Some of the symptoms of an anxiety disorder may include a sense of helplessness, worry and repeated negative thoughts. Physical symptoms such as muscle tension, rapid heartbeats and difficulty in breathing may be experienced. At Promises healthcare we offer a variety of treatment options for the treatment of anxiety.

Recovery is possible and the aims of undergoing anxiety treatment is to reduce and eventually eliminate the symptoms of anxiety disorders, and to restore a person’s functioning and emotional well-being. This will involve a holistic approach of using medications or using therapy that will be catered to an individual’s needs. If you or if anyone that you know suffers from an anxiety disorder do know that help is available. Please contact our clinic if you have any inquiries or if you wish to have a consultation.

Written by: Jesudas Soundhraj – Counsellor, Promise Healthcare

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