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When anxiety and addiction intersect

April 1, 2008
by Nicholas A. Roes, PhD
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Like depression, anxiety has a complicated relationship with addiction. A drug lifestyle often involves illegal activities, mistrust, and suspicion, which certainly could be a causal factor in anxiety. In other cases, anxiety could be a causal factor in the decision to use alcohol or other drugs in order to ameliorate symptoms.

We can help sort out all this by helping our clients review the sources of their stress. There are environmental stressors that demand that we adjust to them. These include traffic jams, noise, weather, and so on. Social stressors include deadlines, financial problems, job interviews, family squabbles, and the death of a loved one. There are also physiological stressors related to adolescence, menopause, illness, aging, and lack of sleep that demand us to make adjustments.

Finally, our own thoughts can add to our stress. The way we interpret events can lead to an increase or reduction in the tension we feel. Over-personalizing and perfectionism are examples of thought patterns that can increase stress.

According to Margaret Wehrenberg, who has written a great deal about anxiety for the Psychotherapy Networker, these different sources of stress usually manifest themselves in one of three ways:

  1. Panic attacks—These seem to come out of nowhere and include a physical component that makes one's heart race. There also may be shortness of breath, dizziness, or tension in the entire body.

  2. Constant tension—This includes “butterflies” and feelings of tension less extreme than those referred to above. Though less severe, the symptoms are more constant.

  3. Rumination—This is more mental than physical, and includes the anguish of listening to one's own anxious thoughts for most of one's waking hours.

Clinical strategies

Each of these types of stress can be addressed in treatment. Many clients need to learn to manage their own bodies more effectively. Besides substances and lifestyle choices that contribute to anxiety, there also might be biologic factors. Monthly cycles and pregnancy are among these.

Proper rest, exercise, and nutrition might be all that is needed to effectively eliminate some types of anxiety. This is especially true for clients who don't sleep right, drink lots of coffee, smoke, love sugar, and almost never exercise.

Deep breathing is helpful to many clients. Some clients may never have tried deep, conscious breathing to help with symptoms of anxiety. Deep breaths are helpful not only during symptoms, but also as a way to prevent them. Have clients try one minute of deep conscious breathing 10 times a day.

Anger often provokes anxiety, especially when clients try to stifle angry feelings by denying them (see Road to Recovery column in November 2007 issue). The same cognitive techniques that help with anger and depression also have been successful in dealing with anxiety.

Clients might identify each anxious thought, then consider evidence that supports and contradicts it. They then would replace each unhelpful thought with a more helpful one and practice until the new thought was automatic.

Visualization techniques also might be helpful. These could include imagining the packaging and labeling of each worry, packing them into a truck, and driving them to the dump, then driving back with a clean, empty vehicle.

Thought-stopping techniques might be helpful, especially as an interim solution combined with other strategies that could take longer to work. The longer unhelpful thoughts hang around in one's head, the more they make themselves at home. One thought-stopping technique has clients yell “Stop!” silently to themselves whenever an anxious thought comes to mind. Then they relax for a few seconds and switch to a more helpful thought.

Nicholas a. roes, phd

Nicholas A. Roes, PhD

Some clients have reported success by scheduling a weekly “worry time” (for example, at 5 p.m. on Thursdays). Whenever anxious thoughts pop into their heads, they dismiss them by reminding themselves that they've set aside a specific time to worry and will do so then.

The generally anxious

Sometimes a search for the cause of anxiety is counter-therapeutic—it causes even more anxiety. Some anxious clients carry a generalized sense of gloom and doom without any specific worries. The identification of specific reasons for anxiety might even give them more validity in the client's mind. These clients can focus on dealing with the act of worrying, rather than any specific fear.

Having fun is definitely one way to address anxiety, and it's surprising how many clients are taken aback by the suggestion. Laughing discharges tensions by relaxing muscles and reducing stress hormones1 (see Road to Recovery column in March/April 2006 issue).

For legitimate concerns and fears, planning is always better than worrying. Teaching clients to problem-solve, set goals, and order priorities helps with anxiety and many other problems (see Road to Recovery column in November 2006 issue). Good plans don't require us to go over them again and again in our heads, as our worries often do.

Even for those times when client anxiety doesn't contribute to relapse, helping clients deal with anxiety can greatly enhance the quality of their lives.

Nicholas A. Roes, PhD, has written hundreds of articles and several books, including

Solutions for the ‘Treatment-Resistant’ Addicted Client (Haworth Press, 2002; reviewed in the January 2003 issue of