Anxiety, Depression and Drug Addiction
Estimates are that more than 40 million American adults are suffering from some degree of an anxiety disorder, including depression. For those that fit into this category, you have a double or even triple likelihood of also having a substance use disorder. Depression and substance abuse are inexorably linked, according to studies. “There’s a huge overlap between the two,” says Petros Levounis, MD, chair of the department of psychiatry at the Rutgers New Jersey Medical School and vice-chair of the American Psychiatric Association’s Council on Addiction Psychiatry. An estimated 18% of American adults suffer from persistent and life-draining anxiety disorders. Common types include:
- Acute stress disorder
- Generalized anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Social anxiety disorder
- Agoraphobia
- Specific phobias
Although anxiety disorders are generally considered to be highly treatable, only about one-third of people with these conditions ever receive medical treatment. Instead, they may choose to numb their anxiety to get through the day, and to try to get more or better sleep or by drinking alcohol, smoking and/or taking prescription and/or illicit drugs. Symptoms of any type of anxiety can make a person more likely to use substances like drugs or alcohol to cope with these fears. This is especially true for people who don’t have family or friends to whom they can turn in times of emotional difficulty. In many cases, people suffering from anxiety have never been checked for it and they often suffer in silence for years or decades before seeking treatment. To cope, many turn to substances to quell their pain and if the symptoms persist, they consume even more drugs and alcohol, in part because they are futilely chasing confidence and relief. What’s really happening though, it the chemical substances have started to change the way the brain is hardwired and it becomes a cycle of craving more and more of the substance to get past each episode or anxiety attack. Drugs work by targeting the centers of the brain that produce the chemicals that lead to a person feeling pleasure, rewarded, or anticipation of rewards. These centers of the brain are the same areas that influence other addictive behaviors that do not involve drugs, like gambling or a food addiction. In the case of chemical substances, though, those neurotransmitters within the brain that are responsible for the sensations of reward and pleasure are made to artificially bombard the brain, which creates a powerfully strong response that almost immediately digs their hooks into a person. For those who are taking certain drugs, whether for recreational or with a legitimate prescription, they’ll experience an powerful burst of euphoria that is very far beyond anything they have experienced before. People with any form of anxiety who are suffering from addiction are said to have co-occurring disorders. These co-occurring disorders aren’t coincidental, as they feed each other. As such, both must be treated when a patient enters an addiction treatment program. In such cases, this is called a “dual diagnosis” and identifying it is critical to ensuring a higher rate of success in recovery.
The Cycle of Substance Abuse and Depression
For someone with an anxiety disorder, the euphoria provided by drugs can seem immediately counteract the stress, dread, and fear they have been experiencing. The problem is that the euphoria doesn’t last, as the body breaks down the drugs, and the dopamine is reabsorbed by the brain. The person continues to use the substance to keep that amazing euphoric feeling from fading way and the cycle continues. What’s going on is that the body is craving higher and higher levels of dopamine and they’re turning to drugs to get what is no longer being produced by their own bodies naturally. A smarter approach would be to find ways to raise your dopamine levels without drugs. Anxiety and drug addiction fuel one another in menacing ways. Psychology Today calls it a “cycle of self-medication and rebound anxiety,” a process of the movement towards a deepening both the addiction and further escalation of the symptoms of anxiety disorder. Ironically, it becomes a sort of catch-22 because the drugs that are bringing a brief moment of relief (even if it’s just nicotine or caffeine) can also cause anxiety. It becomes a vicious cycle of trading one addiction for another. To fix it, the brain needs to be rewired and addiction treatment is the way. The Anxiety and Depression Association of America quotes a doctor as saying that social anxiety disorder “frequently travels in the company” of alcohol or drug abuse, as people with social anxiety disorder might try to make use of alcohol or cocaine’s reputation as a “social lubricant.” However, the anxiety robs these people of the perspective of knowing when too much is too much (or that cocaine is dangerous in any amount), or even that they have an anxiety disorder that needs treatment and therapy, not drugs and alcohol to get over their fear of talking to people.
Mood disorders, like depression, and substance abuse go together so frequently that doctors have coined a term for it: dual diagnosis. The link between these conditions is a two-way street. They feed each other. One problem will often make the other worse, according to the Anxiety and Depression Association of America (ADAA). About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder, the ADAA reports.
Compared with the general population, people addicted to drugs are roughly twice as likely to have mood and anxiety disorders, and vice versa, according to the National Institute on Drug Abuse (NIDA).
When it comes to substance abuse and depression, it isn’t always clear which one came first, although depression may help predict first-time alcohol dependence, according to a study published in 2013 in the Journal of Clinical Psychiatry. The conditions share certain triggers. Possible connections between depression and substance abuse include:
- The brain. Similar parts of the brain are affected by both substance abuse and depression. For example, substance abuse affects brain areas that handle stress responses, and those same areas are affected by some mental disorders.
- Genetics. Your DNA can make you more likely to develop a mental disorder or addiction, according to research published in 2012 in Disease Markers. Genetic factors also make it more likely that one condition will occur once the other has appeared, NIDA reports.
- Developmental problems. Early drug use is known to harm brain development and make later mental illness more likely. The reverse also is true: Early mental health problems can increase the chances of later drug or alcohol abuse.
The Role of Environment
Environmental factors such as stress or trauma are known to prompt both depression and substance abuse. Family history is another factor. A study published in the Journal of Affective Disordersin 2014 found that a family history of substance abuse is a significant risk factor for attempted suicide among people with depression and substance abuse. These types of dual diagnosis may also be traced back to a time in early life when children are in a constant process of discovery and in search of gratification, according to David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and president of the New York Institute for Psychoanalytic Self Psychology. Any interruption or denial of this natural discovery process can manifest clinically and lead people to believe that everything they feel and think is wrong, he explains. This idea, which Dr. MacIsaac says is based on the work of Crayton Rowe, author of the book Empathic Attunement: The ‘Technique’ of Psychoanalytic Self Psychology, challenges the idea that people dealing with depression try to self-medicate using drugs or alcohol. In fact, people with a dual diagnosis may be doing just the opposite, MacIsaac suggests. “Individuals who are severely depressed drink to feed this negativity,” he explains. “Initially it’s soothing, but only for about 15 minutes. After that individuals sink deeper and deeper and feel worse than they did before.” For these people, MacIsaac points out, negativity is “where they get their oxygen.” Any inclination that treatment is working will trigger a need to go back into the black hole of negative discovery, and alcohol will intensify their depression, he adds.
Why Simultaneous Treatment Is Important
Successful recovery involves treatment for both depression and substance abuse. If people are treated for only one condition, they are less likely to get well until they follow up with treatment for the other. If they are told they need to abruptly stop drinking, however, depressed people with a substance abuse problem may be reluctant to undergo treatment, MacIsaac cautions. “They cling to drinking because they are terrified of losing that negativity,” he says. People with dual diagnoses must understand the root of their issues on a profound level, MacIsaac says. Once they understand, he says, they may have the ability to change. Treatment for depression and substance abuse could involve therapy, antidepressants, and interaction with a support group. If you think you need treatment but are unsure where to start, the American Psychological Association provides the following suggestions:
- Ask close friends and relatives whether they have recommendations for qualified psychologists, psychiatrists, or other mental health counselors.
- Find out whether your state psychological association has a referral service for licensed mental health professionals.
- Ask your primary care doctor for a referral.
For Families Worrying About A Loved One
Knowing how to talk to a loved one about anxiety or addiction is never easy, but you must remember that people suffering from anxiety who are using prescription drugs to fight their anxiety are at extremely high risk of becoming addicts. Anxiety and drug addiction are inexorably linked as evidenced by scientific research. There is no shame in it and the patient should never be made to feel ashamed. When a loved one realizes that their loved one is suffering from anxiety and drug addiction, they can become overwhelmed as to which condition to treat first.Contacting a professional addiction treatment center can help you develop the best path of recovery.