An Introduction to Anxiety and Addiction

Both anxiety and addiction are large topics, and the science is constantly evolving, but I try to keep abreast of new developments, and here is my attempt to give an overview of each subject that can help you orient yourself.

ANXIETY

First of all, we need anxiety to survive - a degree of anxiety can be a good and necessary thing to focus our attention, on an exam, for example. Neurologically, our brains our primed to look for threats, they are survival machines if you will, not happiness machines (as you may have noticed). Anyway it worked, we're all here now, and we can chart a course towards making life a more rewarding experience, which in my personal and clinical experience is more than possible!

So we absolutely need anxiety, and fear for that matter. By the way, fear is defined more generally as regards a specific object, such as when we see a snake in the grass, whereas anxiety is more diffuse, we may not be able to put our finger on exactly what is bothering us, and that uncertainty may itself be a big part of the problem. But more of that elsewhere on the site.

Anxiety becomes a problem when subjectively it feels overwhelming and intolerable, and especially when it begins to interfere with our lives. Do we refuse to fly and see family and friends because we are anxious about flying? We can see here that there are two problems: the unpleasant anxiety itself, and how it might limit us living our lives, and sometimes this can become quite extensive.

Here are the most common types of anxiety, which exist on a spectrum that we are all on, from somewhat uncomfortable in our own skin, to completely overwhelming, at least for a while, or in certain situations.

Panic: The most dramatic form of anxiety. No-one who has ever experienced panic will forget it, it can be completely overwhelming and terrifying, often coming out of the blue, and accompanied by cognitions such as "I'm having a heart attack," "I'm going crazy", and many others. Fortunately panic itself is not dangerous, being a natural expression of our body's so-called "fight or flight response" but we fight it all the way, as soon as we believe one might be occurring, and addressing this cycle is part of relieving the panic. After a panic attack, we often become vigilant, watching our bodily sensations closely to make sure it doesn't happen again, which is called anticipatory anxiety. Fortunately it is very workable once we understand what is really going on.

Trauma: According to the most recent edition of the diagnostic manual used by mental health professionals, PTSD is no longer classified with the anxiety disorders. However, it clearly contains a significant element of anxiety, and underlies many other disorders, so we include it here. If we have trauma in out background, it needs to be addressed as best we can, with kindness and acceptance.

Generalized anxiety: This is a habit or pattern of excessive worry. It may not climb to the intensity of panic, but tends to be more chronic, in the background, and can affect our sleep, and make us more irritable and fatigued. It is often accompanied by a feeling or fear that one has lost control of the worry and that it will damage us somehow. Again, these thoughts are not accurate, but will increase our anxiety and long as we believe them.

Social anxiety: if you've ever been scared at the prospect of public speaking, like more of us are, you have some degree of social anxiety, which is the fear of negative evaluation from others. This too is treatable, in part by a technique called gradual exposure, and again more of that elsewhere on the site.

OCD: Obsessive compulsive disorder is an anxiety disorder involving various obsessive thoughts, often unacceptable and involving harming others, and the associated rituals that may be used to reduce anxiety from these thoughts, called compulsions.

Phobias: Specific phobias include fear of heights, spiders, and many others. They might not result on their own in the need for substance use, though some, like agoraphobia, where we avoid places ans situations where we feel trapped or where escape might be impossible, such as bridges and tunnels. This is often understood these days as a fear of having a panic attack where we can't easily escape. Extreme forms of this might result in not wanting to even leave one's home.

For our purposes, one of the most common sources of immediate relief for anxiety, whether it be a feeling of discomfort with ourselves in social situations, or medicating deeper traumatic memories, is of course addictive behaviors.

Further reading: The Anxiety and Phobia workbook

ADDICTION

Our understanding of addictions (or Substance Use Disorder, SUD, as it is called these days) has been revolutionized in recent years, and it now known to be a disorder involving the brain neurotransmitter dopamine, also known as the motivation chemical. I often say, despite the widespread occurrence of addictions, that I'm surprised there isn't more of it, given the way our brain works.

By way of example, an experiment has been done with dogs, whose dopamine receptors in the brain have been removed. If you leave a meal 3 feet in front of a hungry dog, it will not have sufficient motivation to get up and eat it, though if its put right in its mouth, it will eat it. This is how fundamental this chemical is, and we have all heard the stories, which may involve ourselves, of the addict that walks miles through the winter snow in the face of severe withdrawal symptoms.

Some addictions are simpler (though not necessarily easier) because we may not need them to live. Examples are alcohol, tobacco and opiates. On the other hand, food, shopping and sex are necessary for life, so the approach can't be complete abstinence, which may be recommended in the former cases.

A word of warning: when we point out that anxiety and additions are closely linked through the self-medicating, self-soothing model of addiction, it is important to point out that addiction has many causes, including a significant genetic component, as does anxiety, for that matter. This does not mean there is nothing that can be done - not at all - but simply that once established, the addiction then becomes an independent problem. It might be true that the underlying trigger to my drinking is trying to regulate my panic attacks, but this does not mean that when I come to grips with this issue, that I can thereby drink safely again: this is unlikely, and needs to be watched very carefully.

How do I know if I have an addiction? There are many diagnostic tools available for various addictions (see elsewhere on site), but broadly speaking, we are looking for increasing loss of control over the substance or behavior, combined with increasingly detrimental consequences in everyday life. This is complicated by the fact that people with addictions and compulsions often exhibit a degree of denial about these behaviors, in the face of negative effects on their lives that those around them find much easier to see.

This is well represented by the first step of Alcoholics Anonymous "We admitted we were powerless over alcohol - that our lives had become unmanageable." While it is true that recovery from addictions is more of a marathon than a sprint, and 12-step programs offer an effective, ongoing source of support, this does not mean that everyone gets sober (understood broadly) this way; what is true, though, is that it is extremely difficult to get and stay sober on one's own, not to mention lonely and potentially isolated. So take support and guidance from wherever you find it, be it church, meditation group, medication, psychotherapy, or some combination.

This is especially true of the more severe symptoms of both anxiety and addictions, a person may need professional help with addictions such as opiate addiction, or where any sort of potential self harming is present, please reach out for help. In the US, you can dial 988