The Nexus of Addiction and Anxiety

On Edge

An estimated 40 million American adults suffer from some type of anxiety disorder in any given year. The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists eleven different anxiety disorders. Journalist Andrea Petersen has experienced symptoms of four of them. She is not alone. One in three Americans thirteen or older will have at least one anxiety disorder during their lifetime. Most of them are women.

In her new book On Edge – A Journey Through Anxiety, Petersen uses her personal experience and her expertise as health reporter to explore the nature of anxiety and how it can be treated. The impact of anxiety should not be underestimated. As Petersen explains, it often strikes the young and can derail lives.

“Someone who develops an anxiety at a young age is less likely to attend college. Anxious people who work have lower incomes. They are less likely to marry and, if they do, more likely to divorce. Anxious women face a greater risk of getting into unhealthy relationships and being the victim of domestic abuse.”

Anxiety is also strongly correlated with substance use disorders. A new study revealed that people with anxiety and depression are consuming a disproportionate share of opioid prescription painkillers. Researchers at Dartmouth College and the University of Michigan found that nearly 19 percent of patients with those two mental health disorders received at least two prescriptions for opioids during a year. Adults with depression and anxiety receive 51 percent of the 115 million opioid prescriptions distributed each year in the United States, the study found.

In On Edge, Petersen recalls the example of her friend Mike who “turned to alcohol and drugs to try to ease his anxiety and depression.”

“For Mike, marijuana and narcotics like Vicodin were a revelation,” she writes. “They took away the worrying. They calmed his twitchy body.” It didn’t last, of course. “After a while, the marijuana turned on Mike. It started making him more anxious. His drinking and use of narcotics slid into addiction. He went to rehab. He relapsed. He kicked the drugs and alcohol again. Now he combats anxiety with an SRRI (serotonin reuptake inhibitor), daily exercise, and a strong spiritual practice.”

Mike’s story is not unusual. According to the Anxiety and Depression Association of America, about 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.

Petersen was able to avoid that trap. When she smoked marijuana in college, she experienced a psychotic episode and had a panic attack. She didn’t try to self-medicate with cannabis again. She avoided alcohol, too, realizing that her abstention was not typical. “Many people with anxiety disorder drink to relax, a way of self-medicating.”

Both anxiety disorders and addiction share a number of features. Patients suffering from either or both often have experienced trauma, are vulnerable to environmental triggers, and suffer from low self-esteem. Personal relationships are frequently stressed to the limit as well. “Struggling relationships fuel anxiety, and anxiety stresses relationships,” writes Petersen. The same could be said about substance misuse.  

There is another similarity. Just like addiction, “anxiety is often viewed as some kind of moral weakness,” explains Petersen. “But it’s just an illness like many others, only this one happens to affect the brain.”

All of this means that addiction treatment must assess whether co-occurring conditions like anxiety and depression are present and address them in therapy if they are. Many treatment methods such as cognitive behavioral therapy, mindfulness, meditation, trauma therapy and wellness programs work on both anxiety and substance use disorders.

It is troubling that the prevalence of both addiction and anxiety is currently escalating: “Rates of anxiety disorders—and depression—seem to be increasing among young people, particularly college students.” Anxiety is now the most common mental health diagnosis among college students, with depression on the rise as well.

“Are we facing some generational mental health apocalypse?” Petersen asks provocatively. At the same time, the US is struggling to contain the ongoing opioid addiction epidemic. But there is hope, too. New treatment methods are constantly developed while efforts to reduce the stigma of having a mental illness are intensified.

“Fear ambushed me,” is the first sentence in On Edge. Andrea Petersen hopes her book will contribute to a better understanding of the complexity and torment of anxiety disorders.

true