Dual Diagnosis: The Relationship Between Anxiety and Addiction, and Overcoming Anxiety in Recovery

The rate of co-occurrence of addiction and anxiety is staggering: of the millions of Americans who struggle with addiction, it’s estimated that 20 percent also have a mood or anxiety disorder. Additionally, about 20 percent of those with a mood or anxiety disorder also have a substance abuse disorder, or addiction. The two conditions not only occur together, they often reinforce and even strengthen each other. It’s crucial for those afflicted (and their loved ones) to understand the relationship between the two in order to address and overcome both issues.

Anxiety and addiction: The link

The relationship between anxiety and addiction is always complex, but it can develop in any number of ways. For some, substance abuse becomes a way to manage the symptoms of anxiety. People with anxiety often feel a constant sense of dread, never able to truly shake off any tension. It can cause increased heart rate, muscle weakness and twitching, digestive problems, rapid breathing, and even insomnia. These uncomfortable side effects may linger all day long, amplifying under high-pressure or stressful situations.

Drugs and alcohol disguise themselves as a way to ease the pain and stress of anxiety. One sip of a drink, one hit of a drug, and almost instantly the body loosens up. For someone with anxiety, it might be their first moment of peace all day. It can start as innocently as having a glass of wine each evening as an outlet to unwind. Particularly stressful days might mean increasing to a couple of glasses, maybe even an entire bottle. The more it becomes part of your regular routine, the more your body becomes dependent. From there, the line into addiction gets easier to cross.

A person’s social life can also play an important role in both anxiety and substance abuse. Going out and socializing with friends is a great way to blow off steam, but activities often involve — if not revolve around — drinking or using drugs, and it’s a slippery slope between innocent weekly revelry and addiction. People with social anxiety sometimes find a necessary confidence boost while under the influence, and eventually may depend on substances to get them through social functions. Indulging in a night of substance abuse is somehow easier to dismiss as “just having fun” when it happens in a group setting — especially when one or all members of the group are trying to cope with stress — but it can be just as risky in creating dangerous habits.

Some people may even consciously self-medicate with drugs and alcohol to lessen anxiety symptoms. If a hit of your drug of choice with your morning coffee seems to help you handle your work day better, it’s easy to convince yourself there’s little harm in it. Becoming a functional substance abuser often doesn’t feel like actual addiction, but that’s exactly what it is; you are in fact submitting yourself to the idea that you need a substance to get by.

But that “need” is the biggest lie drugs and alcohol can convince you of; not only are you creating a new problem with addiction, you’re likely making your anxiety symptoms worse. Even a person with no previous history of anxiety problems may begin experiencing symptoms once they start abusing drugs or alcohol. What’s worse is that these effects — which can range from cognitive issues like memory loss to physical issues like heart and respiratory problems — become almost impossible to escape. The more someone uses, the worse anxiety gets, but if they try to cut back on their use, symptoms can still worsen. It creates a vicious cycle: an addict gets anxious at the mere idea of not using (because even if their anxiety symptoms are in check, there’s still the threat of physical withdrawal), and the longer they abstain, the worse they feel. If they do use, at best they get temporary relief; ultimately, though, they only deepen their addiction. Additionally, some people will have the added stress of hiding their substance abuse from others, only increasing their overall anxiety. In the end, the longer they keep abusing their drug of choice, the greater their addiction and anxiety; even if anxiety only developed after the substance abuse began.

Healthier habits in recovery

In the event of co-occurring anxiety and addiction, seeking professional addiction treatment is the best way to overcome both. Not only will rehabilitation provide a safe place for detoxification, it’s an opportunity to take a step back and reevaluate your responsibilities and priorities. If your life has gotten to the point where you feel like you need substances to cope with everything, you owe it to yourself to take a break and really confront the issue.

Addiction treatment is also one of the few places you’ll be able to go where everyone will be able to relate to you. Family and friends will try to reach out, but the truth is it’s impossible to fully understand addiction as an outsider. Spending time with others who are going through the same challenges will give you genuinely valuable insight. More than that, though, it will give you the outlet you need to get to the root of your issues. In the non-judgmental walls of addiction rehabilitation, there’s nothing you can’t say. You won’t have to worry about hurting your loved ones’ feelings, getting in trouble with your boss, or saying something that might upset your partner. You can be truly honest about how you’re coping, which is perhaps the most important step in recovery, and your support system will be people who genuinely understand the difficulty of what you are going through.

When confronting your anxiety issues in addiction recovery, it’s important to really break things down. If you can’t pinpoint the exact sources of great stress, start by identifying the moments in your everyday life that stress you out the most. When do you start feeling anxious: is it from the moment you wake up in the morning, or perhaps not until you’re on your way to work? Are you more anxious during certain times of the day? Do certain environments (like a poorly-lit workplace) put you on edge throughout the day? At what point does the stress get to be too much to handle sober?

For some, it’s easier to create a general list of the responsibilities and events that cause the most anxiety in their lives. Your list might include:

  • Paying bills
  • Going to work
  • Upcoming deadlines
  • Finding child care
  • Tension with your partner

Unfortunately, there are going to be some stressors you won’t be able to completely eliminate from your life. The goal isn’t necessarily to prevent yourself from ever feeling anxious, but to understand why you get anxious. By getting to the root of the issue, you’ll figure out the best ways to prevent what you can overcome and what you can’t. Life will always throw challenges your way, so the goal is to find healthy ways to cope with the stress without drugs and alcohol.

Work with your recovery counselors to develop a plan for coping with your anxiety once you leave treatment. Include healthy strategies to incorporate into your everyday life like mindfulness, stress-busting workouts, meditation, and a healthier diet. Look for opportunities to make things easier on yourself throughout the day. If your partner offers to take the kids to school, for instance, dedicate that extra 20 minutes for a morning meditation or to get to the office early. Accept help when it’s offered and don’t feel bad about it — we could all use a hand sometimes. Your addiction recovery is especially precarious in the beginning, so don’t just accept help that’s offered, be ready to ask for help, too.

You’ll also need to make a plan for the extremely stressful times you’re likely to encounter. Some stress you might expect, like getting back into the swing of things at work and mending fences with loved ones, while other stress will be unpredictable. Your anxiety symptoms might try to rear their ugly heads throughout your recovery, even at times you expect to be totally in control. Your counselor may suggest practicing breathing exercises or mindfulness to handle in-the-moment anxiety crises. Though you might feel more self-conscious about employing your coping mechanisms outside of treatment, don’t get caught up in the worry. Your addiction recovery is certainly something that needs to be nurtured, but the truth is, most of us could benefit from a little extra self-care. However you think you might look to outsiders — and most people don’t pay nearly as much attention as we believe — there’s no shame or embarrassment in rebuilding your life for the better.

Your anxiety plan and coping techniques will likely evolve over time, especially as you become more confident and established in your addiction recovery. Remember, however, that those strategies will always be there if you need them in the future — just because you haven’t needed a breathing exercise in several weeks doesn’t mean you should never “revert” back. Employ the tools you know work for you, and talk to your sponsor, recovery counselor, or another anxiety specialist if your techniques are no longer working. Don’t wait until you become too overwhelmed to cope, and don’t write off lingering symptoms as a sign of failure. Unfortunately, addiction and anxiety are two conditions that don’t completely disappear. You’ll have to actively work against them each and every day, but some days will be much easier than others. Remember that on the tough days: today might be bad, but there’s a good chance tomorrow will be better. In the meantime, don’t hesitate to ask for help.

Overcoming your anxiety and addiction issues will inevitably be one of the most difficult challenges of your life, but also one of the most rewarding. The first step is to truly understand each issue individually, as well as the relationship they have in reinforcing each other in your life. Take your recovery day by day — and when anxiety is really crushing you, moment by moment — and ask for help when you need it. With the right understanding, planning, and coping strategies, there is a happier, healthier life ahead.