Substance abuse is a chemical dependency, characterized by the uncontrollable use of addictive drugs or alcohol. A dependency on addictive substances impacts the mind and body and can have serious, long-term consequences, and these risks are compounded by a dual diagnosis (e.g., depression, major depressive disorder, bipolar disorder, anxiety disorder, adult ADHD, etc.).
The National Institute on Alcohol Abuse and Alcoholism indicates that alcohol is one of the most commonly used substances among underage and adult individuals. This is attributed to its legal status and wide availability.
Symptoms of Substance Abuse
While only a physician or licensed mental health professional can diagnose addiction, there are warning signs and symptoms.
Changes to daily habits and routines, an individual’s appearance, behavior, and fluctuating moods may all be signs of substance abuse. Obvious physical symptoms may include things like insomnia, lethargy, tremors, shaking, skin discoloration, visible marks on the body (“track marks”), dramatic weight gain or weight loss, itching, and a decline in personal care, hygiene and physical health.
According to research, “anxiety and substance use disorders are among the most frequent psychiatric problems in the United States, with lifetime rates of 28.8% and 14.6%, respectively.” In a dual diagnosis, recovering addicts may have additional challenges in recovery because of their mental health issue, which must be worked on in conjunction with maintaining sobriety.
Substance abuse and mental illness are interconnected. Both are brain diseases, which are often treated at the same time. Brain diseases, like substance abuse or depression, share the same biology. “Addiction and mental illness involve the same pathways, molecules, and chemicals in the brain, and they share many similarities.”
Depression can cause substance addiction and vice versa. Depression is dangerous for a substance abuser to have, because it can trigger the need for drugs or alcohol. Many people who develop addiction problems often have depression (or another mental health illness) prior and they turn to substances to suppress pain or to escape reality completely.
Substance Abuse and Anxiety
When substance abuse co-exists alongside a mental health illness like anxiety, symptoms may become muddled and more difficult to understand. Anxiety symptoms like shaking, sweating, difficulty breathing, and increased heart rate may not be noticeable if a person is abusing alcohol. Their alcohol addiction may dull the appearance of those symptoms, making it challenging to uncover.
For generalized anxiety disorder, social anxiety disorder (social phobia), panic disorder, post-traumatic stress disorder (PTSD), or agoraphobia, people may turn to mood altering substances to help alleviate the pain. For sufferers with any severe anxiety disorder, substances like alcohol may dull the paralyzing elements of anxiety and allow them to function. For this reason, it is hard to tell the difference between the two.
While everyone will experience some aspects of anxiety during their lifetimes, serious anxiety disorders can interrupt people’s lives and stop them from living. For generalized anxiety disorder or agoraphobia, chest pain and rapid breathing may prevent them from leaving the house. For social phobia, people may be unable to attend school, be part of a group, or hold certain jobs.
Anxiety is a serious mental health illness and should not be minimized. Sadly, many people do not seek help when confronted with anxiety symptoms. They turn to quick fixes like alcohol, which provide temporary relief and do not address the bigger issues, leaving room for addiction to develop further.
Healing a Dual Diagnosis
Based on the severity of the addiction and mental health illness, physicians may choose to use medication as a method of healing at their discretion. Many studies have shown positive results. According to the US National Library of Medicine, the example of “the serotonin reuptake inhibitor paroxetine (Paxil) has been evaluated as a treatment for both social anxiety disorder (SAD) and an alcohol use disorder when they occur concurrently.”
For alcohol abusers who also suffer from anxiety, twelve-step programs may not be suitable due to the social nature of the program. Research has shown that twelve-step programs can be especially problematic for people suffering from social anxiety disorder (social phobia). They often have worse outcomes. However, psychotherapy is one of the best treatments for a person with a dual diagnosis of substance abuse and anxiety.
Cognitive behavioral therapy (CBT) is one of the most frequently used treatment approaches used in psychotherapy. It has a high effectiveness rate in dealing with a variety of mental health issues and symptoms. But for anxiety disorders specifically, cognitive behavioral therapy provides lasting results.
The cognitive element of CBT guides people towards addressing negative thoughts, which may be self-sabotaging or dangerous. For example, an individual with social anxiety might address why they don’t want to speak in front of a small group. The person might think, everyone will laugh at me. The cognitive element will help them break down those irrational thought patterns, where it originates from, and why it is incorrect. For recovering substance addicts, thought patterns will probably be more detailed and severe, possibly involving past trauma or shame. Thought patterns from those sources will be harder to break, in addition to maintaining sobriety.
The behavioral factor of CBT hopes to change a person’s reactions to anxiety. This is crucial for recovering addicts because prior to treatment, they might have turned to drugs or alcohol, but cognitive behavioral therapy helps them identify triggers, remain calm, and turn to new coping mechanisms.
Since substance addiction is a chemical dependency, the consequences of not confronting it are dangerous. But integrated dual diagnosis treatment is a collaborative process, which can help recovering substance abusers heal. Therapists will often work with treating the addiction and mental health illness at the same time in the best interest of the patient. Working on healing from addiction and a mental health illness is challenging, but it is never impossible.