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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.

Understanding Addiction Series – What is Addiction?

Understanding Addiction Series – What is Addiction?

All compulsions, whether to substances or behaviors are usually characterized and observed to have 3 distinct elements for it to be classified as an addiction.

  1. There is preoccupation or obsession: The individuals spend a large amount of time thinking and planning towards acting out their behavior or to obtain substances. There is also an increased amount of finances used to continue the addiction.
  1. There is a loss of control: This usually means that the behavior has become compulsive in its nature. The individual is unable to stop and would have tried unsuccessfully to stop many times. The individual’s life begins to deteriorate but he or she may not admit to themselves and to others that their life has become unmanageable.
  1. There is a continuation of the use of substance or the performance of a behavior that results in negative consequences: This is where individuals tend to incur many losses from their addiction. Finances dry up, relationships become broken. There may be loss of work and emotional or physical difficulties begin taking over the individual’s life as the addiction grips a tighten on them.

Once these are observed, a person may be suffering from an addictive disorder. In addition to the above 3, another feature called tolerance tends to be present as well in addictive disorders. Tolerance basically means needing more of a substance or performance of a behavior to achieve the effect of a “high” in the brain.

As with individuals with a drug addiction they would need an increased amount of the drug to achieve the effect of the high as they become tolerant of the drug. The same is with a gambling disorder where greater risk or bets need to be played and the amount of time spent is much more longer as compared to when they first started gambling. With pornographic addiction, more explicit and arousing images are needed to maintain the fantasy. While the tolerance sets in, the experience of withdrawal begins if the substance or behavior isn’t engaged in. For an alcoholic, tremors may begin when the drinking stops. Irritability and loss of sleep starts taking over as the drug is not present. Thus the need to use over and over again. The chasing of a “high” and the cravings becomes all-consuming and the individual becomes wrapped in a cycle of self-destruction.

The individual’s family and friends would start noticing problems and will often confront the addicted individual. The person may become outright angry and irritated, or defensive if the addiction has been kept a secret. Many family and friends become helpless as they see their loved ones deteriorate.

If you know of anyone or if you might be having difficulties with addiction, do know that help is available. Seek an addictions counsellor or psychiatrist who can help you through treatment for your addiction. You are not alone and don’t need to live in isolation but live the life that you want and be free from the bondage of addiction. Recovery is possible. Contact us for a confidential enquiry today. To understand what causes addiction look out for the next article.

Written by: Jesudas Soundhraj – Counsellor, Promise Healthcare