Anxiety and addiction often co-occur. When they do, it’s important to find a rehab center with experience in treating these co-occurring disorders. If only one issue is addressed, it’s likely that the other condition will trigger a relapse.
Many rehab facilities are equipped to treat anxiety and addiction simultaneously.
Since the time of Sigmund Freud, anxiety has been believed to be an important part of many psychopathological conditions.
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In his classic series of lectures, psychiatrist Paul Hoch stated that every psychiatric disorder included some elements and expression of anxiety and depression.
Traditionally, anxiety was viewed as a different concept from fear. Anxiety was believed to be uneasiness or nervousness that resulted from an undifferentiated source, whereas fear was related to a direct threat. The two terms are now used synonymously, although anxiety is still considered to be a significant component in the presentation of nearly every type of mental illness.
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Anxiety can be associated with particular states of being, or it may be considered as part of the habitual reaction of a particular person’s character.
The term state anxiety refers to the temporary nervousness or uneasiness that occurs in association with a perceived threat in most people. State anxiety typically resolves when the threat is diminished or removed.
Trait anxiety refers to how different people experience the quality or intensity of their anxiety. For instance, some people may become very anxious in social situations, whereas others may not.
Anxiety can be functional to help people recognize and avoid threatening situations. Everyone will experience some level of anxiety in situations they find potentially threatening or embarrassing. They will feel anxiety in unfamiliar, difficult, or challenging situations.
The experience of anxiety produces higher levels of arousal. However, the usual experience of anxiety is not considered to be clinically significant enough to require treatment in most cases. In fact, anxiety can be functional.
One of the oldest notions in psychology is the idea that people function best under moderate states of stress and anxiety. This is known as the Yerkes-Dodson law. When the law is depicted as a graph, with the quality of the person’s task performance represented on the vertical axis and the level of anxiety represented on the horizontal axis, it presents as an inverted U shape, indicating that people tend to perform worse when stress, anxiety, and stimulation are extremely low or when arousal is extremely high, especially for novel tasks. People tend to perform better on tasks when arousal is in the moderate range, indicating that feelings of anxiety can sometimes be functional.
Some people experience levels of anxiety that have prolonged durations, or they experience higher states of anxiety in certain situations than most people. When the experience of anxiety is so intense or pervasive that it interferes with daily functioning consistently, it may represent an anxiety disorder.
Anxiety disorders are clinically significant psychological disorders that have dysfunctional levels of anxiety as their major feature.
People diagnosed with anxiety disorders can experience levels of anxiety that are out of proportion to the actual threat (dysfunctional trait anxiety), or they may have lingering states of anxiety that do not go away when the threatening situation is terminated (dysfunctional state anxiety).
According to the American Psychiatric Association (APA), the major recognized anxiety disorders are:
- Panic disorder. The person experiences frequent panic attacks and significant anxiety associated with the anticipation of having a panic attack.
- Agoraphobia. The person fears being in places that are not considered to be “safe.”
- Specific phobias. The person has dysfunctional levels of anxiety associated with specific situations.
- Social anxiety disorder. The person has dysfunctional anxiety associated with social situations.
- Generalized anxiety disorder. The person has chronic levels of anxiety that remain present over most situations in life.
The APA also categorizes other types of diagnosable anxiety conditions, such as medication-induced anxiety or anxiety due to a medical condition.
Substance Abuse and Anxiety Disorders
There is a relationship between substance abuse and psychiatric disorders, such that people who are formally diagnosed with psychiatric disorders have a higher rate of substance abuse than the general population.
One of the major research studies of the relationship between substance abuse and other mental health disorders found that about 18 percent of all individuals who were diagnosed with any substance use disorder also met the diagnostic criteria for some other mental health disorder.
The research also found that the odds of having an anxiety disorder and a comorbid (co-occurring) substance use disorder are greater than the odds of just being diagnosed with an anxiety disorder.
Why Do Anxiety and Substance Abuse Commonly Co-Occur?
There are three general theoretical explanations for the relationship between anxiety disorders and comorbid substance use disorders.
- Substance abuse often leads to higher and more dysfunctional levels of anxiety. Physical dependence on drugs or alcohol is associated with anxious states when individuals begin to experience cravings or withdrawal.
- Individuals who have types of mental health disorders may attempt to self-medicate their anxiety by using certain types of drugs. This can lead to the development of a substance use disorder later.
- The risk factors that make a person more vulnerable to developing any type of psychiatric disorder also make them more vulnerable to developing issues with substance abuse. Risk factors include genetics, significant trauma and/or stress at an early age, early exposure to substance use, and other factors.
Rehab for Co-Occurring Addiction and Anxiety
The treatment for dual diagnosis concentrates on addressing both disorders at the same time as opposed to first dealing with one of the disorders. Research has indicated that attempting to address a substance abuse problem and not dealing with anxiety, or vice versa, is generally not successful because the two disorders fuel one another.
An integrated treatment protocol utilizes a team of treatment providers to address all present issues. The team will consist of specialists, including physicians to address medical issues and deliver medication-assisted treatment, therapists, case managers, and other treatment providers to ensure the individual gets the full spectrum of treatment they need.
Different members of the team address the individual according to their specialty, and the team will meet periodically to discuss the client’s progress and update treatment goals.
Both substance abuse and anxiety disorders can be treated effectively with a combination of medications and behavioral treatments. This combination of treatments is more effective than using any treatment alone.
Do You Need a Specialized Rehab Center?
In most cases, rehab centers for substance abuse also offer treatment for comorbid mental health disorders like anxiety. As mentioned above, it is not uncommon for individuals who are diagnosed with substance use disorders to have comorbid anxiety disorders, depression, stress-related disorders, and other types of psychological disorders.
There are some instances where a rehab program that specializes in the treatment of specific types of anxiety disorders may be advantageous. Individuals who are diagnosed with social anxiety disorder may have difficulty interacting with others in group situations. These individuals may initially do better in a treatment program that specializes in the treatment of anxiety disorders and substance use disorders.
It is notoriously difficult to convince those diagnosed with agoraphobia to enter treatment programs that are away from their safe places.
These individuals may require a specialized situation to help them feel comfortable while they are in the early stages of recovery.
In some cases, individuals with these disorders can initially be treated as outpatients, although they will not receive the full benefits of rehab. If they require physician-assisted medical detox, they will need to be placed in an inpatient or residential unit that can address their special issues.
Most rehab programs can treat both addiction and anxiety. However, if you have both disorders, it is advised that you confirm this is the case before enrolling in any facility’s recovery program.
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(May 2001). State and trait anxiety revisited. Journal of Anxiety Disorders. Retrieved March 2019 from http://www.ncbi.nlm.nih.gov/pubmed/11442141
(November 2018). The Yerkes-Dodson Law and Performance. Verywell Mind. Retrieved March 2019 from https://www.verywellmind.com/what-is-the-yerkes-dodson-law-2796027
(April 2012). (2012). Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations. Alcohol Research: Current Reviews. Retrieved March 2019 from https://psycnet.apa.org/record/2013-28231-006