Why may anxiety be an issue in recovery?
People with alcohol and other drug use disorders often suffer from co-occurring mental health issues. If these go untreated, recovery may be more difficult.
For some people alcohol and drug use and withdrawal can cause symptoms of anxiety. In these cases, the substance-induced anxiety will subside with prolonged abstinence. For others the symptoms of anxiety persist and may even worsen with prolonged abstinence, thus making recovery more difficult. For these individuals, treatment options are available.
What is an anxiety disorder?
With any major life change, we feel some anxiety. You are making major changes now, moving from a life of addiction to a life free of addiction. With that comes changes in routines, relationships, thinking, feeling, spiritual growth, and much more. This can produce anxiety and can be a normal part of positive growth.
However, if you have been in recovery for a period of time and are still experiencing significant anxiety, or were diagnosed with an anxiety disorder before or during treatment, your symptoms probably go beyond the typical anxiety reactions we all have. Anxiety disorders are illnesses that fill people’s lives with overwhelming worry and fear. They are chronic and can grow progressively worse if untreated. If this is true for you, it will be helpful to learn more about the different kinds of anxiety disorders, their symptoms, and how to manage your disorder while you continue to manage your recovery.
If you have been diagnosed with an anxiety disorder, please understand that, like addiction, this is an illness, not a reflection of personal weakness, lack of willpower, or poor moral character. You are not responsible for the disorder, but you are responsible for getting help.
If you have an anxiety disorder, you can’t wish it away any more than you can wish away your substance use disorder. But there is hope. There are effective treatments. You don’t have to live with anxiety and panic. You can get help.
First let’s learn a little bit about the main kinds of anxiety disorders and their symptoms.
How common are anxiety disorders?
Anxiety disorders are among the most common mental illnesses in America today. An estimated 13 percent of adults ages eighteen to fifty-four in a given year (more than nineteen million people) are affected by them.
What are the different kinds of anxiety disorders?
People with panic disorders have unexpected and repeated experiences of intense fear accompanied by physical symptoms that may include chest pains, heart palpitations, shortness of breath, dizziness, or abdominal distress. They cannot predict when such a “panic attack” will occur, so they have a lot of anxiety between episodes, worrying about when and where the next one will happen. A panic attack may be accompanied by an unrealistic sense of impending doom or loss of control. They can occur at any time, even during sleep, and generally last about ten minutes, but some symptoms may last longer. As their frequency increases, the person often begins to avoid fearful situations where they think another attack may occur or where help may not be immediately available.
Obsessive-compulsive disorder (OCD)
Recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (com- pulsions) that seem impossible to stop or control are characteristics of OCD. Examples may include repetitive hand washing, counting things, or compulsive cleaning or checking (“Did I turn off the stove?”).
Post-traumatic stress disorder (PTSD)
This illness involves persistent symptoms that occur after experiencing a trau- matic event such as a rape or other criminal assault, war, child abuse, natural disaster, or accident. Nightmares, flashbacks, numbing of emotions, depression, being easily startled, feeling angry, irritable, or distracted are common with this disorder.
Generalized anxiety disorder (GAD)
Generalized anxiety disorder is characterized by six months or more of chronic, exaggerated, fear-based worrying that is much more severe than normal anxiety. People with this disorder usually expect the worst. They worry excessively about money, health, family, or work, even when there are no signs of trouble. They have difficulty relaxing and may suffer from insomnia. Many also have physical symptoms such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes.
For some, simply the thought of getting through the day provokes anxiety. People with GAD have difficulty letting go of their concerns, even though they might realize that their anxiety is more intense than the situation warrants. They may startle more easily than other people and tend to have difficulty concentrating.
What causes anxiety disorders?
Some research suggests that generalized anxiety disorder is hereditary and may run in families. It may also grow worse during times of stress. GAD usually begins at an early age and symptoms may develop more slowly than in other types of anxiety disorders.
The exact causes of panic disorders are unknown and are the subject of intense scientific investigation. Hereditary and other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder.
Do anxiety disorders coexist with other illnesses?
It is common for an anxiety disorder to co-occur with a substance use disorder, depression, eating disorders, or another type of anxiety disorder. Anxiety disorders can also accompany physical illness. All co-occurring illnesses must be appropriately diagnosed and treated.
What can you do to recover from or manage anxiety?
Just as with a substance use disorder, there are things you can do to recover from an anxiety disorder. You will need to practice acceptance, abstain from alcohol and illegal drugs, maintain an active recovery program, and develop strategies to take care of yourself. In addition, you may need to participate in psychotherapy or take anti-anxiety medication.
One of the first steps is accepting the fact that you have the disorder. Without acceptance, you are likely to deny the problem or blame yourself for not being strong enough to overcome your anxious feelings or panic attacks. Accepting your disorder is an important first step that can set you on the road to recovering a life that is healthy and whole.
Abstain from alcohol and illegal drugs
Another important step is to remain abstinent from alcohol and illegal drugs. Using these substances will only make both issues, substance use disorder and anxiety, worse. By using chemicals to avoid dealing with your anxiety, you will only delay getting the help that you really need. If you have been prescribed an anti-anxiety medication, make sure you are safeguarding your abstinence. Mixing these medications with alcohol or other drugs can be dangerous to your health.
Maintain an active recovery program
Stay active in a recovery program and take action to get some help. Waiting for your anxiety to go away on its own will only threaten your ability to stay sober. Reach out and get support from others. This can be hard when you are feeling anxious, but it is a key to recovering both from substance use disorders and anxiety disorders. Attending Twelve Step meetings is important. You are probably involved with Alcoholics Anonymous (AA) or a similar program for your addiction. Emotions Anonymous (EA) is an organization that addresses emotional issues such as anxiety.
You should find nonjudgmental support at your Twelve Step meetings. Occasionally you may hear someone in a meeting discourage the use of medications to treat mental health disorders. You should know that taking medications for a condition such as anxiety is not incompatible with Twelve Step philosophy. Look for those in the program who will support your efforts to deal with both your substance use disorder and anxiety. You should be able to find them.
Let your sponsor know that you are dealing with anxiety and ask for feed- back on the issue. Find a sponsor who understands that an anxiety disorder is an illness, accepts your need for medication, and can provide extra support in your recovery.
Realize that the Twelve Steps can be applied to anxiety as well as addiction. Step One teaches us to admit that we are powerless over addiction and anxiety. It’s realizing that no matter how hard we try, we cannot make ourselves feel better. Step Two and Step Three involve realizing there is hope and we can get help. Step Four and Step Five involve realizing ways in which anxiety has caused problems for us and for others. It also reminds us that some of our problems may be unfounded, due to our anxious thinking.
Be real in working a Twelve Step program. If you aren’t real about your struggles with anxiety, it will affect your recovery from substance use dis- orders as well. Be honest with your sponsor. Be honest with others in your Twelve Step group, and be honest with yourself. If you are struggling, seek the help you need. Make your recovery from both addiction and anxiety your number one priority.
Take care of yourself
Take these self-care steps to help manage anxiety and minimize stress:
- Get plenty of rest and build lots of relaxing activities into your day. Exercise regularly and minimize caffeine intake.
- Learn new ways to manage your feelings, particularly fear, anxiety, and worry. It may help to get some counseling from a licensed therapist. A therapist can teach you new ways to handle anxious thoughts.
- Learn assertiveness skills so you can say no to stressful situations, and maintain healthy ways to handle stress in relationships.
Participate in psychotherapy
Typically anxiety disorders for addicts are treated with behavioral therapy, psychotherapy, and often with anti-anxiety medications. Psychotherapy can help teach you ways to cope with your symptoms and overcome the anxious thought processes. Find a qualified psychotherapist familiar and comfortable working with recovering people who have both a substance use disorder and an anxiety disorder.
Consider an anti-anxiety medication
A variety of medications can be used to treat anxiety. A psychiatrist or other qualified person can determine if you need medication and prescribe an appropriate one based on your symptoms.
For panic disorder, the most common medications used are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and fluvoxamine (Luvox). Other medica- tions include tricyclic antidepressants (TCAs) such as imipramine (Tofranil) and nortriptyline (Pamelor), and monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate).
For generalized anxiety disorder, the most common nonaddictive medications used are the anti-anxiety agent buspirone (BuSpar), the SSRIs, and beta block- ers such as propranolol (Inderal). However, medications are not always used to treat GAD.
Are prescription medications safe for people in recovery?
Be aware that on rare occasions you may be offered tranquilizers as a medication to treat anxiety. Tranquilizers such as Xanax and Valium can be addictive. Some prescription medications can be addictive and should be avoided by people in recovery. Take responsibility for your own recovery. Make it clear to your doc- tor that you don’t want to be prescribed any medication that would be addictive. Anti-anxiety medications designed specifically for anxiety disorders are not addictive and are safe to use in recovery.
Most anti-anxiety medications take about two to six weeks to begin working, so if you don’t see results right away, be patient. It may also take a little while to determine the appropriate dose. While you are waiting for the medication to take effect, seek support from your sponsor, Twelve Step friends, and others. These medications may have side effects: ask your doctor for a list of these side effects, so you can be prepared to handle them.
The length of time that you take anti-anxiety medications depends on the type and severity of the disorder. If your anxiety seems situational, it may be recommended that you take it for at least four to six months after your symp- toms improve or go away. Otherwise, your symptoms may return. If you have had prolonged periods of anxiety, it is often recommended that you continue tak- ing medication even after your symptoms are under control. This reduces the chance of a future episode of anxiety or panic attacks.
If you do not respond to the prescribed medication after an adequate period of time, your doctor may change your medication or add a second one.
Take your medication only as prescribed, and take it consistently: never quit your medication “cold turkey” without a doctor’s approval. Many people mistakenly think they can quit the medication once they start feeling good. But the medication may be what’s making them feel better.
What should you do if your anxiety becomes significantly worse?
Some types of anxiety are chronic conditions in which symptoms return, even after periods of relief. Preparing for this possibility puts you in a position to take quick action and improves your chances of getting back on track quickly. Sadly, some people live with the recurrence for months before they get help.
You might have problem anxiety if you:
- feel increasingly anxious, nervous, agitated, or edgy
- start having sleep problems or eating troubles
- experience panic attacks or anxiety for no apparent reason
- withdraw from other people and isolate yourself
- have difficulty concentrating because of your racing thoughts
- experience extreme fearfulness or worry over basic life situations
- think drinking alcohol or using illegal drugs will help you feel better
- cancel or miss sessions with your psychiatrist or therapist
- quit taking your medication(s) without talking with your psychiatrist or therapist
- don’t take your medication(s) as prescribed
Anxiety may be affecting your recovery if you:
- don’t attend meetings
- don’t talk with your sponsor
- try to figure things out on your own
- deny that there is a problem
- wait and hope things will get better on their own
Recovery action Step
Identify and list some of the relapse warning signs related to your anxiety. What three strategies might reduce your risk of relapse when these warning signs appear? Write them down. Keep these notes in your Big Book or in a place that will remind you to monitor your progress regularly.
If your anxiety symptoms worsen or return, seek help right away from your therapist or psychiatrist. If you become severely anxious, hopeless, or suicidal, or cannot care for your basic needs for food, shelter, or safety, seek help from a psychiatric hospital.
Let members of your support system know how to help you if such emergencies occur. Put your plan in writing to serve as a reminder.
Use your journal to write down
1. The steps you can take if you have a psychiatric emergency or feel suicidal
2. A list of your family or members of your support network who can help you in an emergency
There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.
Freedom From Fear
Freedom From Fear is a national not-for-profit mental health advocacy associa- tion that seeks to improve the lives of people affected by anxiety, depressive, and related disorders through advocacy, education, research, and community sup- port. The organization’s website offers a search tool to find a support group in your state.
National Institute of Mental Health (NIMH)
NIMH is a U.S. government organization, an agency of the Department of Health and Human Services, dedicated to research and education in the field of mental health. Its website is a great resource of information about specific mental health disorders including ADHD, depression, and anxiety disorders.