More than just a popular word to describe the 21st century, anxiety is actually the most common mental disorder in the United States, and according to a report from the Anxiety and Depression Association of America (ADAA), it affects at least 40 million adults as of 2020. In 2017, the World Health Organization estimated that at least 264 million adults all over the world suffer from one form of anxiety or another.
The ADAA report points out that at least 19 million adults in the US suffer from specific phobias, making this the most common anxiety disorder in the country. The same report also includes a specific breakdown of the most common forms of anxiety, listing at least 15 million adults suffering from social anxiety, 7.7 million have anxiety in the form of post-traumatic stress disorder (PTSD), 6.8 have generalized anxiety, and 6 million have panic disorders.
The sheer numbers in the US alone prove that anxiety is a massive concern, as there are simply too many who suffer from it. Even worse is the fact that many specialists are listing anxiety as one of the reasons why people engage in substance abuse, also known as a dual diagnosis. This is why many medical and psychotherapy experts are looking at the anxiety and substance abuse connection to see if solving one could also lead to a solution for the other.
What is Anxiety?
Anxiety is the typical reaction to stress and it serves a vital function in the continued survival of a living being. Technically speaking, anxiety is defined as the anticipation of a future concern, triggering muscle tension in the body in response to whatever it is that is being anticipated.
Many often equate anxiety with fear, which is why some believe they are one and the same. Anxiety, however, is different from fear. While they might generate similar feelings, anxiety is a reaction to emotions that arise in response to dangers, or perceived or anticipated, in the environment. To further make a difference, fear triggers the release of energy for movement in the body, in connection with the “fight-or-flight” response to ensure survival. Anxiety, on the other hand, stops the reaction that releases the energy. This is why the more correct term would be “paralyzed with anxiety” rather than “paralyzed with fear.”
Another difference is that fear is something already hardwired in the brain, to ensure that a sense of self-preservation is activated to ensure survival. Seeing the surrounding area engulfed by a fire instills great fear, so self-preservation kicks in, and the person does everything possible to not be burned alive. Anxiety, on the other hand, is learned and acquired. The most common teacher in this aspect is trauma, and the imprint that trauma leaves has a way of “short-circuiting” the natural impulse for self-preservation.
This “short circuiting” is mostly done by anxiety flashing conflicting emotions, memories, or thoughts that interfere with the natural response for self preservation. A person sees a raging fire, but because of the trauma of seeing a loved one die from a fire, they are instead frozen in place and are unable to save themself because in their mind, they are reliving the fiery death of the loved one.
What are the Symptoms of Anxiety?
As there are different forms of anxiety, there are also a number of different signs and symptoms associated with the different forms. Most of the symptoms have the commonality of being unusual and of being unique specifically to the person with the anxiety. This is why when someone is having an anxiety attack, others have a difficult time trying to understand what they are going through.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is the most prevalent in people who suffer from anxiety disorders. This type is characterized by the persistent presence of feelings of fear or dread, whether explained or unexplained, and depending upon the severity of the feeling, could be quite debilitating.
This anxiety form stays with the person for a very long time, with many suffering from it for years already. Some of the symptoms of this type include:
- Constant or persistent feeling of being on-edge
- Fatigue (from being tense for so long)
- Difficulty in concentrating
- Easily or constantly distracted
- Unexplained pains
- Inability to quell feelings of worry
- Disruption of sleep patterns
People with this type of anxiety suffer from frequent, unpredictable, and sudden instances of overwhelming fear, discomfort, or a sense of losing control. These feelings are referred to as a panic attack, and these could be so severe that many people who suffer panic attacks are rooted on the spot from sheer fear, are unable to even think, and could be prone to reacting blindly to some perceived fear.
Due to the unpredictable nature of panic attacks, many who suffer from it live with the daily dread of the next attack, as it could happen in the worst possible moment or place, such as inside the car while the person is driving, or during an important event like a business presentation. The fear of the next attack comes with the knowledge that they are absolutely helpless to prevent it and do anything until the attack subsides enough for them to move and think again.
A panic attack comes with several debilitating symptoms, such as:
- Pounding heart
- Profuse sweating
- Tremors or trembling due to great fear
- Chest pains
- Feelings of unavoidable and impending doom
- Feelings of loss of control
- Temporary paralysis
- Urge to curl into a ball or fetal position
- Manic crying
Social Anxiety Disorder
There are some people who might appear to be extremely antisocial most of the time, and there is a good chance that these people suffer from social anxiety disorder. This form of anxiety is characterized by a constant fear of being watched or being judged by others. Regardless if the people around the person appear to have taken notice of the person or not, the person will immediately perceive the people around to be looking and criticizing his or her every move.
This kind of anxiety makes it almost impossible for people who suffer from it to work in an office full of people, or go to a commercial center teeming with crowds. This anxiety is made worse by the nuances of crowds, such as loud talking voices and the occasional accident bump from someone passing. People with this type of anxiety find it immensely difficult to invest trust in other people, and only tend to trust a handful of people in their lives.
People who suffer from social anxiety disorder, when in the presence of people, could manifest symptoms such as:
- Profuse sweating
- Racing heart rate
- Difficulty in moving
- Inability to speak any louder than a whisper
- Inability to make eye contact
- Urge to move away from crowded places
- Immense aversion to being touched
- Intense urge to run away from people
A phobia is an intense and irrational fear of something quite specific. Some phobias have a logical basis, such as the fear of fire, drowning, animals that could kill a person, etc. Other phobias, however, are quite irrational, such as the fear of clowns, fear of imperfection, fear of books, and others.
What makes phobias particularly damaging is that many people in the grip of a phobia will lose all rational thought and simply do whatever it is that they think would save them, distance themself from whatever it is they are afraid of, or destroy the source of their fear. There are many instances where a person who suffered from aerophobia, or the fear of flying, appeared to be having a heart attack while inside the airplane.
While not as debilitating as most other forms of anxiety, this form does tend to affect people in subtle ways that later on have a profound effect. Separation anxiety was mostly thought to be something only children suffer from, as demonstrated by children in the play yard who cry when playtime is over and everyone needs to go home.
Separation anxiety in adults manifests as a subtle form of depression, where the person experiences a gradual building melancholy from being separated from someone they have an emotional connection with. In many cases, these people are in denial of the condition, as most would think it would be immature to feel it as an adult.
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How do People Cope with Anxiety?
The safest way to deal with any kind of anxiety is to see a professional or a specialist about it. Treatment or therapy could be suggested that would bring the condition to the point where it is manageable and negligible to some extent.
People who either could not see a specialist for some reason, or prefer not to, often turn to what they think is the next best thing: substance dependence. Some people turn to medications or drugs, others prefer to use alcohol to dull the sense of fear, dread, or whatever intense emotion is debilitating to them when in the grip of anxiety.
This decision to turn to substance dependence is not only useless against anxiety, but it also creates another, potentially greater problem than all the troubles anxiety could do to a person: addiction.
What Typically Causes co-occurring Anxiety and Addiction?
The most common reason for a co-occurring condition such as anxiety and addiction is typically associated with the individual not reaching out for help. Not seeking help will definitely make the problem much worse, and turning to drugs or alcohol will do nothing to fix it.
In other cases, there are specific reasons why a person with an anxiety disorder turns to drugs or alcohol:
Trauma that is not addressed will eventually worsen to the point where the person is simply unable to function because of it. This is most evident in combat veterans. A 2021 report from the Department of Veterans in the US states that one in every ten to fifteen veterans suffer from one form of substance abuse disorder or another.
This report also indicates that these soldiers who turn to substance or alcohol do so to cope with post-traumatic stress disorder, and that age is not a limiting or determining factor in the tendency to abuse substances. This points to deteriorating mental health as one of the main driving factors why people dealing with anxiety turn to substance abuse.
The joke about not wanting to go to a doctor because they only tell you bad things is no mere joke to many. There are people who, having already seen a doctor, developed an anxiety of hearing more bad news about other health issues that they simply preferred to self-medicate and feed a growing substance dependence.
This is particularly true with people who suffer from chronic pain. The irony of the human body is that it tends to develop a tolerance to pain medication, even as it fails to increase the pain threshold of a person. This results in the person deciding to up their dosage on their own without consultation, leading to a growing dependence on pain pills.
Is Dual Diagnosis the Answer to Co-occurring Anxiety and Addition?
Dual diagnosis is a specific form of treatment that could prove to be more effective for people who suffer from both anxiety disorders and a substance abuse disorder, regardless if the substance abuse arose as a coping mechanism for the anxiety.
This is because dual diagnosis allows both disorders to be addressed at the same time. There are instances wherein attending to one issue while putting the other on the back burner only led to none of the issues being resolved, as the two issues have become closely interconnected.
Dual diagnosis comes with specific benefits in dealing with two co-occurring conditions:
Identification of Cause
In medical practice, one of the first things done is to try to identify the possible cause of a condition. This way, the specialist could narrow down the possible treatments to be done, saving a good deal of time in multiple testing and speculation, and instigating treatment as soon as possible to prevent aggravating the condition.
Identification of the cause also reduces the chances of misdiagnosing the issue. There are cases wherein the wrong treatment would only prolong the suffering of the person, or even worsen the condition altogether.
Address the Actual Trauma
Both anxiety and substance abuse disorders often stem from trauma. Regardless if they are borne out of the same trauma or different ones, the important issue is that the actual trauma is addressed and dealt with. This includes allowing the person suffering from it to recognize it, arrive at the point where they accept or purge it from themself, and develop an appropriate coping mechanism to it that does not include addiction.
Improve Perception and Response to Anxiety and Addiction Triggers
The therapy involved in dual diagnosis treatment allows a person to better understand what it is that is causing them difficulty, what to do when they feel the effects, and how to move on with it so that they are brought to a manageable level.
In some cases, there are issues relevant to trauma or anxiety that could not be completely scrubbed from the person, but they are equipped with the proper mental response to it so that it does not control them, and instead, they control how they respond to it.
Achieve Wellness & Recovery Can Help With Anxiety and Addiction
We won’t say we know the best way to deal with the co-occurring condition of anxiety and addiction. What we will say is that we have helped more people than we can count through this condition, and we have learned a great deal about it, including what treatments help bring about a lasting and true recovery from it.
Let’s talk about it now.
Megan began her career working in substance use treatment at an inpatient setting where she found her calling for helping the young adult population. Megan has a Master of Science degree in Clinical Mental Health Counseling from Monmouth University with a specialty in Addiction Studies. She is currently a Licensed Associate Counselor and is awaiting her credentialing to become a Licensed Clinical Alcohol and Drug Counselor. Megan has a history working in the mental health and addiction field utilizing CBT and MI approaches within her clinical practices.