A character saying, “I need a drink,” has become a common phrase in movies and TV shows. When someone goes through something strange or unpleasant, it’s normal for them to seek alcohol as a release, right? Treating stress with alcohol is actually a dangerous way to cope with stress. If you have an anxiety disorder, it can make symptoms a lot worse.
Anxiety has made its way into American culture as a common word for a general nervousness. Anxiety and anxiousness are everywhere and you have probably heard scores of people say, “I have anxiety.” In one sense, it’s perfectly valid to say that you are feeling anxious before big or intimidating moments.
However, anxiety disorders are something very different than simply feeling nervous. If you are about to give a speech and you feel butterflies in your stomach, you’re experiencing a normal emotional state.
When that feeling comes out of nowhere for no reason, or when it becomes debilitation, you may be dealing with an anxiety disorder.
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An anxiety disorder is a mental health problem that’s characterized by restlessness, fatigue, racing or unwanted thoughts, and hypervigilance. As opposed to normal nervousness, anxiety will often persist for long periods or recur often. Without treatment, anxieties can get worse over time. These disorders represent one of the most common mental health issues facing the Americans.
There are a few common types of anxiety disorder that you may experience and each one has a unique set of symptoms and triggers, including:
Anxiety seems to share some significant overlap with addiction, and more specifically, alcoholism. Understanding the relationship between these two mental disorders can help people get the right help for their specific needs.
Both anxiety and addiction make up some of the most common psychological disorders in the United States. According to a 2008 National Institutes of Health (NIH) review of anxiety and addiction data, 28 percent of Americans experience anxiety disorders in their lifetime and 14 percent experience substance abuse disorders. The overlap between the two is so significant that one disorder is a risk factor for the other, meaning that if you have a SUD you are more likely to also have anxiety and vice versa.
The NIH study also revealed that anxiety typically predated substance use issues, showing that anxiety was a more typical precursor to addiction and alcoholism than it was the other way around. In fact, in as many as 75 percent of cases, anxiety came first. Researchers concluded that this statistic supported the self-medication pathway to addiction.
The opposite is rare. Clear examples of substance abuse leading to anxiety disorders only occur in about two percent of cases where both disorders are present.
When a mental health issue and a substance use disorder occur at the same time, it is referred to as dual diagnosis in the addiction treatment field. The phenomenon has a variety of potential causes and it requires personalized therapies to effectively treat.
One of the most common addictions associated with dual diagnosis is alcoholism. Alcohol and binge drinking represent one of America’s favorite vices. The NIH reports that more than 86 percent of people have drunk alcohol at some point in their lifetime. In a culture where drinking is a social norm, this may not be an alarming statistic. But the number dwarfs America’s usage of most other psychoactive substances.
Alcohol is a central nervous system (CNS) depressant and it works on the brain in a way that’s similar to medicinal CNS depressants like benzodiazepines. It increases the efficiency of a neurochemical called gamma-Aminobutyric acid (or GABA) and binds to GABA receptors. These receptors are responsible for regulating excitability throughout the nervous system. It’s designed to kick in when you need to feel relaxed or go to sleep. Drinking alcohol excessively can cause feelings of sleepiness, a lack of inhibitions, and relaxed euphoria. That’s because it’s working on your GABA receptors and telling your brain that it’s time to slow down your nervous system.
Since anxiety causes people to feel on edge, fearful, and cause sleeplessness, alcohol should help calm them down right? Unfortunately, the brain is more complicated than that, and alcohol can actually make anxiety worse.
One of the most compelling reasons alcohol abuse and anxiety seem to be related has to do with a process called self-medication. When alcohol use moves out of the context of social, recreational activity and becomes a “need,” drinking becomes self-medication. For many people, anxiety is a product of a chemical imbalance in the brain that causes nervous system overexcitement. Insomnia, the fight-or-flight response, and fear can all be caused by nervous system excitability. If your brain chemistry is unbalanced in a way that causes overexcitability, you may be experiencing symptoms of an anxiety disorder.
Alcohol suppresses the nervous system and it will seem to help in the short term. However, your brain will start to develop tolerance and dependence on alcohol, making your symptoms worse when you don’t drink.
Dr. Joseph Troncale, a physician specializing in addiction medicine, says, “What is happening in the brain is the building of receptors that have to be filled with alcohol or drugs to achieve a calm state. So tolerance develops and one needs more and more alcohol or benzodiazepines or nicotine to calm the individual.”
Once a person becomes addicted to alcohol or another substance they are using to self-medicate, your brain may even stop or slow production of naturally occurring GABA or other essential neurochemicals because it’s relying on alcohol. Stopping alcohol use can cause you to go through a period of withdrawal where your anxiety symptoms come back worse than ever. In many cases, the fear of these intense withdrawal symptoms stops people from getting the help they need.
Recognizing the signs of self-medication can help you avoid or address a developing alcohol use disorder in trying to seek anxiety relief. Some of the signs of self-medication are:
If you think that you or a loved one has been self-medicating with drugs or alcohol, a substance abuse disorder might be around the corner. It’s important to address alcohol use, anxiety, or other underlying issues before the problem escalates.
The presence of anxiety disorders and other co-occurring mental health issues alongside addiction highlights the need for personalized therapy options in addiction treatment. When you enter a treatment program, you should go through an intake and assessment process that allows your clinicians and therapist to understand more about the underlying factors in your addiction. Likewise, you should have an active hand in creating your treatment plan.
According to the NIH study, people who enter addiction treatment programs with an anxiety use disorder tend to find traditional therapy options like 12-step programs less helpful than others. Instead, psychotherapy seems to be more successful. Cognitive-behavioral therapy, which is one of the most commonly recommended therapies in the treatment of addiction, has also shown to be effective in treating anxiety.
Alcohol use disorders come with serious consequences, especially when they are combined with co-occurring mental health issues like anxiety. If you or someone you know has become dependent on alcohol, or another CNS depressant, it’s important to seek medical assistance as soon as possible. Alcohol withdrawal can cause nervous system overactivity which can result in dangerous symptoms like seizures and delirium. Medical detox is the safest way to treat alcohol dependence and a full continuum of care is the best way to treat underlying issues like anxiety.
National Institute on Alcohol Abuse and Alcoholism. (2017, June). Alcohol Facts and Statistics. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
National Institute on Drug Abuse. (2010, September). Comorbidity: Addiction and Other Mental Illnesses. from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf
SAMHSA. (2017, March 28). Anxiety Disorders. from https://www.samhsa.gov/treatment/mental-disorders/anxiety-disorders
Smith, J. P., & Book, S. W. (2008, October). Anxiety and Substance Use Disorders: A Review. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/#
Troncale, J., M.D. (2014, August 14). Anxiety and Addiction. from https://www.psychologytoday.com/us/blog/where-addiction-meets-your-brain/201408/anxiety-and-addiction