In a co-occurring disorder treatment program, people come with a variety of mental health and substance abuse issues. The Journal of the American Medical Association reported that 37% of alcohol abusers and 53% of drug abusers are suffering from at least one serious mental illness. Twenty-nine percent of all people diagnosed as mentally ill abuse drugs or alcohol. In one study, 13% of the people who had consumed alcohol or drugs in the previous year said they done so to reduce anxiety.
Tolerance and Problems Quickly Occur
Anxiety management with drugs and alcohol is common in our population. At first glance, it is perceived alcohol has an anxiety-lowering effect, producing a state of relaxation and calmness. Continued alcohol use can lead to tolerance of the anxiety-reducing effects and quickly more alcohol is required to get the same level of anxiety reduction. What starts out as a quick fix quickly leads to chronic problems. Research has shown people with inherently high levels of anxiety are at an increased risk of becoming alcoholics. In addition, withdrawal from alcohol in chronic users is often accompanied by extreme anxiety.
Doubt and Insecurity
William is a 25-year-old single man with two children, ages four and two. His father passed away in a sudden and tragic car accident at the age of 40, when William was five years old. Growing up was difficult and stressful for William’s family. He recalls being anxious, worried, and stressed at a very young age. He was in and out of trouble early in high school and managed to stay until the 12th grade, but did not finish. William’s friends were using marijuana and alcohol, and upon experimenting, he quickly gravitated toward the relaxing and comforting feelings from being drunk and high.
By the age of 19 or 20, William was using increasingly more alcohol and was having trouble keeping a job. He spent a great deal of time drinking, looking for alcohol, or recovering from the effects. The relationship with his family members was quickly deteriorating and his drinking caused almost constant conflict with loved ones. Whiskey was his preferred beverage, and for several years he drank one-half liter per day, but had recently gone up to drinking a 1.75L bottle in a single day. Additionally, he would use pain pills, such as Percocet, when he could get them. He used alcohol to deal with withdrawal effects from an opiate addiction. He made frequent attempts to cut down his alcohol use, but almost immediately, his anxiety levels got worse.
William told me he spent much of his time ruminating and worrying, which constantly derailed his normal thought life. He had lost the ease and joy of life and worrisome thoughts continued to intrude into his mind. With every attempt to reduce his alcohol use, the apprehension, worry, and anxiety got worse. He described difficulty relaxing and the inability to feel at peace. He began avoiding things that made him anxious and he used increasing amounts of alcohol in order to escape the panicky feelings.
Before coming to treatment, William’s withdrawal effects had become severe. Keep in mind, many clients who experience these severe withdrawal effects are often highly motivated to escape their pain and anxious discomfort. They do so by increasing their alcohol use, thus perpetuating the problem. William had regular blackouts and his tolerance for alcohol was extremely high. He described shaking and feeling cold when he was withdrawing from alcohol. He had been hospitalized several times within the past six months for dangerously high blood-alcohol levels. When he arrived in our program, he was highly motivated to quit drinking, manage his anxiety, and begin a new life of recovery.
Upon arriving in treatment, William began addressing the alcohol addiction and severe generalized anxiety symptoms. Prescriptions used in the treatment were low addiction-risk medications which helped William feel less keyed up, sleep better, reduced irritability, and brought an increased ability to focus and concentrate on psychological and emotional management tactics presented in treatment.
Utilizing the following anxiety management techniques help to reduce anxiety and thus decrease the cues and triggers to use alcohol as an inferior anxiety management tool.
Take inventory of your anxiety. Learn about the specific types of anxiety. This can reduce the fear and stigma as symptoms begin.
Resist the urge to avoid. Temptation to avoid the thing causing distress goes up, along with anxiety. The more anxious and distressed you feel, the more you will want to avoid the stressor. In the short run, this may appear to be a good plan. In reality, it makes anxiety symptoms worse. It is better to learn to face your fear and overcome the thing causing the anxiety. Taking on small amounts of anxiety and reducing or managing the level of anxiety is a better long-term management.
Practice relaxation techniques in advance. Relaxation techniques include breathing exercises, meditation, and progressive muscle relaxation. These techniques must be practiced in advance to be effective. Waiting until you are having a panic attack to implement these techniques would be too late. I suggest experimenting with the three major types of techniques, pick one you like, and practice it intently until you feel you have some mastery of it. Practice your preferred techniques several times each day, confident that in the long run, it will be useful to you during periods of high anxiety. Additionally, as you develop expertise, you may find that your higher states of anxiety do not occur with the same frequency.
Recognize negative thoughts. Negative thoughts often come to us out of our awareness. As you grow in your recovery, you may be better able to recognize pessimistic and destructive thoughts as they come. Recognition of the negative and intrusive thought allows you to take it captive, weigh its validity, and accept or reject it. Following this recognition, refute and replace those negative thoughts. Develop a pattern where you rehearse positive substitutions using realistic and empowering self-statements.
Rest and relax. Set aside some time for relaxation and entertaining activities. Your body and mind are like a finely-tuned motor. If you push the motor too hard, under too great a load, you will burn it out. Regular intervals of downtime, rest, and relaxation will allow you to re-energize, de-stress, and reduce your overall load of anxiety.
Recovery is a journey. Enjoy the ride!