“… Research suggests that socially anxious people may be less likely to participate in group therapy or seek a sponsor. Also, higher levels of anxiety at the end of (treatment) have been shown to lead to a higher rate of relapse…” ~Dr. Julia Buckner, Louisiana State University Having anxiety is normal. Everyone suffers from some degree of social anxiety from time to time – meeting new people, speaking before large groups, going on a first date, etc. Having a social anxiety disorder – suffering from a debilitating fear of social situations – is NOT normal. When fear severely and negatively impacts the rest of a person’s life, then they need professional help for this diagnosable psychiatric condition. But this illness becomes EVEN MORE problematic when it leads to the development of or the worsening of a Substance Use Disorder (SUD) such as alcoholism, the misuse of prescription medications, or addiction to illicit drugs.
How Common Are Anxiety Disorders?
According to the Anxiety and Depression Association of America, anxiety disorders are the most-common mental illness in the United States:
- 40 MILLION American adults are affected by anxiety
- This represents 18% of the US population
- By far, the most common manifestation is social anxiety disorder, affecting up to 15 MILLION people
- Anxiety disorders account for $42 BILLION in healthcare costs annually
- Women are twice as likely to suffer with Generalized Anxiety Disorders or Panic Disorders
- Individuals with anxiety orders are up to 5 times more likely to see a doctor
- They are 6 times more likely to be hospitalized for psychiatric disorders
- Almost 50% of people with clinical depression are also diagnosed with anxiety disorders
What Are Some Common Symptoms of Anxiety Disorders?
There are several recognized types of anxiety disorders, with various symptoms:
- Overwhelming feelings of fear, panic, uneasiness, nervousness, or worry
- Loss of concentration or focus
- Extreme fear of crowds
- Inability to relax or sit still
- Insomnia and poor rest
- Excessive sweating
- Shortness of breath/hyperventilating
- Accelerated heartbeat
- Chest pain
- Choking sensation
- Muscle tension or soreness
Perhaps the best way to describe debilitating anxiety is an intense feeling of fear or panic for which there is no discernible, proportional cause – an actual feeling of imminent mortal danger within a normal social situation.
Co-Occurring Disorders – Substance Abuse and Social Anxiety
Everyone has their own “threshold” limit as to how much outside stimulus or “stress” they can handle. When that threshold is exceeded, we all deal with it by using our own personal coping mechanisms, some negative, and some positive. Most dysfunctional behaviors come from our inability to withstand this stress by coping in a healthy manner. Social anxiety will often cause people to do ultimately-unhealthy things to ease their discomfort. For example, many people struggling with a social anxiety disorder will try to “self-medicate” with alcohol or drugs to quiet their fears. Unfortunately, that coping method inevitably backfires. Chronic self-medication can increase the risk of dependency, abuse, and addiction, without ever addressing the underlying problem – the anxiety. And, when their dysfunctional addicted behaviors inevitably result in new difficulties – legal troubles, difficulties at work, embarrassment, problems with existing relationships – then the person’s anxiety only gets worse. More anxiety leads to more attempts to numb those feelings by drinking or drug use. It is a self-perpetuating downward spiral. The twisted connection between substance abuse and anxiety disorders is clearly indicated by their equal prevalence – one-third of substance abusers have an anxiety disorder, and one-third of those individuals with anxiety disorders also battle substance abuse.
How Alcohol and Other Depressants Can Affect Social Anxiety
Alcohol, barbiturates, and other depressants such as benzodiazepines – medications like Xanax or Ativan – may APPEAR to ease anxiety, but abuse of these substances can cause physical and mental impairment, and this impairment can be a significant source of stress. Withdrawal from alcohol and other depressants can also cause worsened anxiety, even to the point of panic attacks. In other words, a person who self-medicates with alcohol, benzodiazepines, or barbiturates can become so dependent on their effects that their anxiety worsens when the substance is not present. “Rebound anxiety” can be so severe as to trigger a relapse into substance abuse.
How Marijuana Can Affect Social Anxiety
Although some people believe in treating anxiety with marijuana, the drug can in fact exacerbate pre-existing anxiety symptoms in some people. The Alcohol and Drug Abuse Institute at the University of Washington has reported that marijuana use by adolescents can lead to an anxiety disorder by young adulthood – daily users are at the highest risk. Some studies have shown that adolescents with social anxiety may start to use marijuana as young as 10 ½ years old. Over 10% of individuals with a Cannabis Use Disorder will struggle with social anxiety severe enough to cause clinically-diagnosed social anxiety.
- When the two conditions co-occur, the anxiety disorder will precede the cannabis disorder 80% of the time.
- The cannabis disorder will precede the anxiety disorder 15% of the time.
How Stimulant Drugs Can Affect Social Anxiety
Approximately 40% of amphetamine/methamphetamine users have a lifetime history of anxiety disorders, and even more – 75% – have symptoms of anxiety, during both intoxication and withdrawal. Likewise, cocaine addiction often co-occurs with anxiety and other psychiatric disorders.
Overlapping Factors Create Shared Vulnerabilities
Psychiatric and substance abuse disorders share many common causal factors, including:
- Genetics—Up to 60% of a person’s predisposition to substance abuse, and there are several areas of the human genome that are associated with both mental illness and substance abuse disorders.
- Similar brain regions – The parts of the brain that use dopamine – a neurotransmitter – that are affected by substance abuse are also involved with other psychiatric disorders.
- Stress – extreme stress has long been identified as a risk factor for several psychiatric disorders, as well as a cause of increased vulnerability to substance abuse.
- Mutual support – When an individual has one type of condition, the resultant brain changes can affect other disorders
When a person abuses drugs, the changes in their brain function and structure can spark the development of an already-existent propensity for an un-manifested mental illness.
Likewise, when a person has a mental illness, the abnormalities in their brain activity increases vulnerability to addiction by:
- Enhancing the substance’s positive/pleasurable effects
- Reducing the person’s awareness of any negative effects/consequences
- Alleviating or reducing the anguish and discomfort of the mental condition
- Countering the unpleasant side effects of any medications given for the condition
What to Do When Anxiety and Substance Abuse Happen at the Same Time
The most important thing that a person with a dual diagnosis of anxiety and substance abuse disorders is that help is available. It is not necessary to continue to suffer in silence or alone. The best addiction recovery programs understand that co-occurring disorders are common, so they have established therapeutic protocols in place – comprehensive treatment strategies that address both disorders simultaneously. Treating both the addiction and the psychiatric condition as the primarily-presenting disorder is crucial, because it reduces the chance of cyclic relapse and allows the person to return to a stable, healthy life as soon as possible.