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The Overlap of Anxiety and Alcohol

Imagine you’re at work and, all of a sudden, a sense of dread washes over you. It comes out of the blue and bathes you in sweatiness, shortness of breath and a racing heartbeat. You couldn’t have predicted this – your work performance is good, productivity is at a maximum, and you have a well-established network of friends in the office and at home. Yet you feel unrelenting worry.

It’s all you can do to get through the day and finally make it home to relax. But even in your comfort zone, you still feel unsettled. A glass of wine helps at first, but over time, you need a few to reach the same sense of calm. Pretty soon, numbing yourself is the only way to manage the distressing emotions.

Anxiety and Substance Abuse

There is a strong correlation between anxiety and the abuse of drugs or alcohol. Anxiety is a healthy human emotion that is necessary for adaptation and coping, but pathologic anxiety is different. It’s a medical condition.

As in the example above, medical anxiety is marked by the lack of a trigger – it comes on out of the blue when things should be going just fine. Anxiety is intense and persistent; no matter how much you try to cope, it just won’t go away. The result is that you start avoiding situations or completely withdrawing from your ordinary life.

Anxiety manifests in a number of different ways:

  • Physically, symptoms occur because of autonomic arousal. What this means is a person can experience rapid heartbeat, shortness of breath, sweating, diarrhea and lightheadedness.
  • There are also affective symptoms – or signs of distress to one’s mood. These can be mild mood shifts, such as feeling irritable. At the other end of the spectrum, some people experience severe anxiety that feels like terror or a sense that they are “losing control.”
  • Behavior can also be impacted. Avoidance or compulsive actions to neutralize the distressing feelings or cognitions (i.e. worry, apprehension, obsessions) can arise. In many cases, people reach for alcohol to drink away the tension.

The Cause of Anxiety

The cause of anxiety is complex. Neuroscientists think that a lot has to do with structures in the central nervous system, including the amygdala. Neurotransmitters are also important modulators of the nervous system.

alcohol and anxietyPsychoanalysts have different theories about what causes anxiety. Freud, for example, described anxiety as a signal of threat to the ego. Anxiety could even be symbolic of a previously experienced trauma.

Alcohol use disorder can sometimes present with anxiety – the latter of which affects about one-fourth of the United States population. And that’s not just day-to-day jitters or worries during times of stress; it’s a pathologic anxiety that can be paralyzing and stunt someone’s individual development and progress in different areas of life.

There are several different forms of anxiety disorders. PTSD was discussed in a previous article – along with its unique overlap with alcohol use. Other anxiety disorders include panic, agoraphobia, specific phobias, obsessive-compulsive disorder, and acute stress disorder and generalized anxiety disorder. While not everyone with a primary anxiety disorder will turn to substances such as alcohol for temporary relief, many do.

The National Institute of Mental Health (NIMH) resources include everything from defining the various types of anxiety to its signs, symptoms, risk factors and treatment options.

Treatment Options

Strategies to help with anxiety – and subsequently reduce the temptation to numb with other substances – include everything from psychotherapy to meditation.

One of the most beneficial treatments is cognitive-behavioral therapy (CBT). Here, the focus is on information-processing and behavioral reactions that characterize the anxiety experience. By focusing on the interplay of maladaptive behavioral, emotional, and cognitive responses, people can work in tandem with their therapist to identify distortions and keep their thoughts rooted in reality. Feeling one’s feelings allows for healthy behavioral interventions that are geared towards distress tolerance, rather than numbing the feeling.

In the CBT model of care, the therapist and patient work together to determine the goals. And as a further benefit, the collaborative process of treatment is aimed at teaching patients to eventually become their own therapists.-Helen FarrellTreatment elements dealing with the interplay of anxiety and substance abuse include motivational interventions, functional analysis, self-monitoring and cognitive interventions, problem-solving skills, and contingency management.

Motivational interventions serve to enhance engagement in treatment, rather than persuading engagement. The functional analysis allows for retrospective processing and self-monitoring can be used to help patients identify cues in the moment leading up to substance use.

Cognitive interventions provide for the correction of all-or-none thinking patterns. In problem-solving skills training, patients identify alternative ways of dealing with the cues that trigger cravings. Finally, contingency management makes the consequences of alcohol use more salient in the moment.

CBT – extremely helpful for anxiety and alcohol use disorders – is problem and goal oriented. It uses a collaborative approach. In the CBT model of care, the therapist and patient work together to determine the goals. And as a further benefit, the collaborative process of treatment is aimed at teaching patients to eventually become their own therapists.

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