Mental health and substance abuse are often linked. When this occurs, the relationship between the two can become quite complex, with each influencing the other in multiple negative ways. When a substance use disorder occurs with a mental health disorder, it is referred to as a co-occurring disorder or a dual diagnosis. One such illness, generalized anxiety disorder (GAD), is exceedingly prevalent within our nation, affecting 6.8 million adults, equating to 3.1 percent of the population, according to the Anxiety and Depression Association of America (ADAA). Characterized by constant and intense worry, a person with GAD may face long-term challenges, including substance abuse and addiction, conditions which only serve to worsen the anxiety.
What Is Generalized Anxiety Disorder?
Generalized anxiety disorder is a mental health disorder marked by persistent and overwhelming fear and anxiety, to the extent a person cannot control these feelings. Reaching excessive levels, these states of mind may occur for no clear reason and may even arise with the mere thought of facing a single day. This chronic and often debilitating disorder can drastically affect a person’s quality of life by interfering with their day-to-day activities and responsibilities.
Symptoms of generalized anxiety go beyond the emotional and also include the ways the anxiety affects a person’s physical standing. In considering these elements, there are certain other factors which define the presence of GAD. According to the ADAA, as set forth by the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, a person must experience, at minimum, three of the following symptoms, the majority of days, over a period of six months or more:
- Becoming easily tired or lethargic
- Feeling restless, agitated, or tense
- Trouble concentrating or holding onto thoughts
- Becoming irritable
- Muscles become tense
- Poor quality of sleep (cannot fall asleep, remain sleeping, or waking up not feeling rested)
Many of these things may lead to adverse effects which trigger or worsen anxiety. For instance, an individual who struggles to sleep or concentrate may fall behind within their work duties, becoming anxious about job security, finances, etc. Even more troublesome, dependent on the drug of abuse, substance use disorders may cause these very factors, and consequences, as well.
How Are These Disorders Connected?
For an individual with generalized anxiety, adding drugs or alcohol to the mix is playing with fire. When a person suffers from GAD, even normal thoughts, actions and circumstances may evoke an anxious reaction; coupled with a substance use disorder, which elicits abnormal thoughts, behaviors and situational reactions, the anxiety may further intensify.
Research illustrates that anxiety is more heavily linked to substance dependence than substance abuse, with this relationship being more predominant with GAD than with most other disorders. The connection between these two disorders is complex, occurring several ways. The aforementioned research published by Psychiatric Times asserts, “these disorders are functionally intertwined in both the development and maintenance of comorbidity.”
As anxiety puts a person on high alert, creating a constant onslaught of negative thoughts and emotions, some individuals may be prone to use drugs or alcohol in an attempt to reduce these symptoms. What many of these individuals may not know is that these behaviors only serve to accelerate the existing anxiety over time.
Over time, a person may develop a tolerance to the substance, finding that they need more to create the same pleasurable effect. As this occurs, physical dependence may take hold. If this continues, with repeated and chronic abuse, the compulsive habits of addiction may quickly follow, granting the anxiety a further hold over your life.
Some individuals may have not suffered from GAD prior to substance abuse. But as the substance abuse becomes uncontrollable, and a person forms an addiction, the chemical burden of certain drugs may actually cause anxiety, due to the way they impact your brain.
How Does An Addiction Alter Your Brain Chemistry?
Drugs are chemicals which your body views an invasive toxins. When a drug of abuse enters a person’s system, it goes immediately to work by altering crucial physical, mental and emotional functions, rendering many of them less efficient, or significantly impaired.
The human brain is responsible for overseeing and directing neurochemical functions that support critical life support systems, immune functioning, and various processes related to mental and emotional health. With the introduction of a drug on a repeated basis, many of these functions begin to change, acting in a manner that manifests as illness, disease and mood disturbances.
Drugs and alcohol change the way neurotransmitters, or chemical messengers, within your brain process and relay information. These chemicals are responsible for regulating systems of pleasure and reward and a person’s mood functions. With prolonged substance abuse and addiction, an individual may no longer be able to experience a sense of reward, pleasure or emotional stability without the presence of the drug. This is why, when a person suddenly quits, that they are affronted with symptoms of withdrawal, including one that is predominant across many drugs of abuse—anxiety.
How Do These Disorders Affect Each Other?
A Psychiatric Times article paints a harsh picture of how these disorders are connected, writing that “For patients with generalized anxiety disorder (GAD), the lifetime prevalence of co-morbid alcohol abuse and dependence is 30% to 35%, and the prevalence of drug abuse and dependence is 25% to 30%.” It is no wonder then, that these two disorders, when combined, bring a host of adverse effects to the individual who suffers from them.
Standing alone, generalized anxiety and certain substance use disorders can create:
- Intense fatigue
- Mood instability
- Social isolation
- Increased risk of certain diseases
They can also significantly impairing an individual’s ability to focus, sleep properly or carry out the requisite tasks of their career, educational pursuits or family obligations. Combined, these two disorders can compound these adverse effects, along with numerous others. Both of these disorders, if left untreated, carry heightened risks of a person developing another, co-occurring disorder.
The Psychiatric Times research draws our attention to the numerous ways in which these disorders negatively affect the other. The article cites research which found that anxiety disorders are linked to:
- Lifetime prevalence of alcohol use disorders
- Higher rates of repeated substance abuse treatment
- Alcohol withdrawal becomes more intense
- Relapse occurs more frequently after treatment
It also notes that “the presence of a substance use disorder decreased the recovery rate and increased the likelihood of recurrence of GAD.” Other research suggests that GAD, if not properly addressed, can decrease treatment retention rates.
What Treatment Exists For These Concerns?
As both of these disorders have great potential to aggravate the other, effective addiction treatment must address each concurrently. This is to say, if a person only treats one, when they enter into life after recovery, the untreated disorder may create triggers or stress which could cause a person to relapse. A thorough treatment program will address these co-occurring disorders by utilizing a variety of treatment modalities. However, the following have shown specific benefit for both disorders, both during, and after treatment.
Cognitive Behavioral Therapy (CBT)
CBT has been shown to be effective when used within dual diagnosis treatment. This psychotherapy helps an individual to recognize negative thought patterns, while aiding them in developing more effective means of coping, so that they can change damaging behaviors.
Medication-Assisted Therapy (MAT)
MAT is utilized as a way to help a person withdraw safely and comfortably, but beyond this, it may also aid an individual in maintaining their sobriety or treating the symptoms of their anxiety. With concerns of addiction, treatment providers will strive to utilize medications which have the least potential for abuse, but the highest measure of effectiveness.
Family therapy and support
Family therapy and support is a way to provide a person with positive encouragement and words of affirmation. Both disorders often draw an individual into a state of isolation. Being surrounded by your loved ones can buoy you against this loneliness while helping to allay any fears you may have.
Peer support groups
Peer support groups hold great benefit in addressing, and supporting, concerns of both disorders. Not only do they aid an individual in protecting and nurturing their sobriety, but they provide positive companionship, useful coping skills and a place where people can constructively release fear or tension.
Find Mental, Emotional And Physical Balance
We realize that a co-occurring disorder can change the landscape of your life. While these things make treatment more complex, they do not make it impossible. At Turning Point, we are committed to delivering evidenced-based care that can aid you in finding sobriety and in making the positive and lasting changes that are essential towards a successful recovery. Contact us today.
Psychiatric Times — Anxiety Disorders With Comorbid Substance Abuse
PubMed Health — Generalized anxiety disorder: Overview
U.S. National Library of Medicine — Anxiety and Substance Use Disorders: A Review