“… 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 occasionally struggles with some level of social anxiety – public speaking, first dates, or meeting new people, for example.

However, struggling with a social anxiety disorder – the overwhelming fear of social situations – is NOT normal. When that fear disrupts all areas of your life, then you need specialized professional help for this recognized psychiatric illness.

Yet, as debilitating as anxiety can be, it creates even more problems when it plays a role in the development/ worsening of a co-occurring Substance Use Disorder (SUD):

• Alcoholism
• Illicit drug abuse (heroin, cocaine, methamphetamine, inhalants, designer drugs)
• Prescription medication misuse (opioids painkillers, benzodiazepine tranquilizers, ADHD stimulants, or sleeping pills)

Are Anxiety Disorders Common?

The Anxiety and Depression Association of America reports that anxiety disorders are the most-common type of mental disorder in the country:

• 40 MILLION US adults are affected by anxiety.
• This equates to 18% of the population.
• One subtype – social anxiety – occurs in as many as 15 MILLION
• Annually, anxiety disorders impact healthcare costs by $42 BILLION.
• Women are at DOUBLED risk of struggling with Panic or Generalized Anxiety Disorders.
• Anxiety sufferers are 5 times more likely to see a physician.
• They are also 6 times more at-risk of psychiatric hospitalization.
• Nearly half of patients with diagnosed clinical depression also have a co-occurring anxiety disorder.

Anxiety Disorder Symptoms

• Overwhelming, even debilitating, feelings of worry, dread, nervousness, uneasiness, fear, or panic
• Inability to concentrate or focus
• Dizziness
• Fainting
• Extreme fear of large groups or crowds
• Inability to relax
• Insomnia
• Excessive perspiration
• Shortness of breathing
• Rapid heartbeat
• Pain in the chest
• Sensation of choking
• Nausea
• Vomiting

These symptoms will occur within normal social situations, when there is no actual danger or cause for such an out-of-proportion response.

Co-Occurring Disorders – Social Anxiety and Substance Abuse

Everyone’s limit for how much stress they can handle is different. But when our limits are reached, each of us has our own coping mechanisms. Problems arise when we cope in unhealthy or destructive ways.

Without professional help, social anxiety sufferers often cope with their fears in a dysfunctional manner. For instance, they may try “self-medicating” with drugs or alcohol.

It doesn’t work.

Self-medication with alcohol or drugs only adds the potential problems of physical dependency, worsening abuse, and, eventually, addiction. And even worse, it never addresses the REAL problem – the anxiety.

Of special relevance, dysfunctional addiction-driven behaviors cause even more difficulties – relationship troubles, work difficulties, legal problems. The mounting consequences only worsens the person’s anxiety. And, of course, greater anxiety means more attempts to ease uncomfortable feelings via alcohol, drugs.

It is a tragic and self-perpetuating downward spiral.

The link between anxiety and substance abuse is highlighted by their mutual prevalence – 1 out of 3 substance abusers also struggle with anxiety, and 1 out of 3 people with anxiety also abuse alcohol and drugs.

How Alcohol and Tranquilizers Affect Social Anxiety

Alcohol, benzodiazepines , and barbiturates may appear to temporarily alleviate feelings of anxiety. However, chronic abuse causes mental and physical impairment. This leads to higher stress levels.

Withdrawal from alcohol or other depressants also causes severe anxiety – to the point of panic. Specifically, someone who is trying to ease their anxiety with barbiturates, benzodiazepines, or alcohol can instead become so dependent on these substances that their anxiety becomes unbearable.

How Marijuana Affects Social Anxiety

Despite what some individuals believe about the supposed calming effects of marijuana, the truth is quite different for people with pre-existing anxiety. In that case, using marijuana can make the anxiety symptoms much worse.

Additionally, the University of Washington’s Alcohol and Drug Abuse Institute reports that adolescents who use marijuana are at much greater risk of developing an anxiety disorder by the time they reach young adulthood. The greatest risk is among daily users.

How Stimulants Affect Social Anxiety

Around 40% of people who abuse methamphetamines/amphetamines will be diagnosed with an anxiety disorder at some point in their lives. 75% of stimulant abusers experience anxiety symptoms, both during active use, and during withdrawal.

Anxiety also often co-occurs with cocaine addiction.

Why Some People Are Vulnerable to Both Anxiety and Substance Abuse

Addictive disorders and mental illnesses share several common causal factors:

• Genetics— Over half of an individual’s vulnerability to substance abuse is determined by genetic factors. In addition, there are several mapped portions of the human genome that are linked to both addictive and psychiatric disorders.
• Dopamine production within the brain – Dopamine is the neurotransmitter associated with memory, learning, and motivation. Disrupted dopamine production caused by chronic substance can cause both uncontrollable drug cravings and impaired social function, leading to greater levels of anxiety.
• Stress – Chronic stress is a risk factor for both substance abuse and several psychiatric disorders.

Significantly, addiction and anxiety can reciprocally cause the other.

Drug and alcohol abuse causes changes in the structure and function of the brain, potentially triggering the development of a mental illness in a genetically-vulnerable individual.

Likewise, people with anxiety who abuse substances are at greater risk of addiction, because their condition causes abnormal brain activity. As a result:

• The substance’s pleasurable effects are enhanced.
• The person is less aware of any negative consequences.
• The substance temporarily reduces or alleviates their anxiety.
• The substance counteracts any unpleasant side-effects of the anti-anxiety medications.

When Anxiety and Substance Abuse Cooccur

Anyone with a dual diagnosis of an SUD and anxiety should be assured that they no longer need to struggle alone. Help is available.

The key to treatment is addressing both the anxiety and the addiction as the primary disorder, treating both at the same time. This reduces the risk of relapse and makes it possible for the person to return to a healthy, stable, and sober life.

Since 1978, Chapman House has been the premier recovery program in Orange County. If you are struggling with any behavioral or addictive disorder, contact Chapman House today.

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