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Addiction and anxiety go hand in hand, unfortunately, sometimes with a third party in the mix in the form of depression. While not completely understood, the link between anxiety disorders, mood disorders, and substance abuse is clear. Drug addicts are about 20 percent more likely to struggle with anxiety and about 27 percent of people with depression also struggle with drug use. Yet what makes these health issues so much more complicated is the fact that they are often concealed by drug use.

Both depression and anxiety are complications of the brain, wherein errant thoughts and negative thinking cause a person to stress out, fear, worry, and feel bad over circumstances and issues that are either out of their control, or entirely irrational.

Depression is a deep and profound sadness with no clear origin and lasting side effects, while anxiety springs up from the same lack of clear origin, causing a person to feel perturbed, uncomfortable, and unsettled without the need for any external stimuli. However, drug use often quells or even temporarily stops these symptoms from occurring. Part of the reason why the correlation between mental illness and addiction is so strong is because of how many Americans with mental health issues consciously or unconsciously self-medicate.

When the ability to self-medicate goes away, what is often left behind is the dangerous fact that many addicts do not possess any effective coping mechanisms outside of more prolonged drug use. This makes them incredibly vulnerable to stress and stress-related mental health issues, of which anxiety is a prime example.

Anxiety and Addiction

Anxiety develops in the mind due to several factors, including internal ones (genetics) and external ones (trauma and stress). Anxiety disorders include generalized anxiety, social anxiety, paranoia, specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Addiction, on the other hand, is a physical dependence on a drug due to the way drug use affects and changes the pathways in the brain associated with reward. Drugs stimulate the brain’s cells and increase the amount of dopamine in a person’s system, causing the body to struggle and adapt to the sudden influx of neurotransmitters, normalizing and thus depending on addictive drugs for a variety of basic functions.

Combined, the two become very difficult to treat. Drug use not only masks anxiety, but it can greatly amplify it after the fact. Stimulants and depressants alike may temporarily soothe depressive issues, but in the context of an addiction, prolonged use will leave a person feeling more anxious, causing their condition to worsen. This can be seen in some people’s withdrawal symptoms, as they begin to exhibit signs of severe paranoia and, in some cases, drug-induced psychosis (perceiving reality in a flawed or false manner).

Dual Diagnoses and Concurrent Treatment

When a person is diagnosed with both anxiety and addiction, their treatment is adapted to handle both issues concurrently. While abstinence can help treat addiction, it can also cause a short amplification of anxiety symptoms. To help patients deal with this, some psychiatrists may temporarily prescribe medication to help ease the symptoms of anxiety during recovery. Antidepressants can be effective, but in severe cases, anti-anxiety medication such as Xanax may be necessary. Under the strict and watchful eye of medical professionals, the patient will undergo detox and rehab at a residential treatment facility, while their symptoms are monitored.

Once withdrawal symptoms cease, treatment can help address the challenge of surviving sobriety while experiencing anxiety symptoms. While ‘regular’ sobriety after addiction can be quite challenging, coupling that with the symptoms of a mental disorder further amplifies the challenge. However, a dual diagnosis can be treated. Treatments for anxiety during sobriety include continued medical attention and prescribed medication, talk therapy, group therapy, and a number of alternative therapies to help patients dissociate from their worries and calm themselves down in cases of stress and anxiety, including yoga, mindfulness, breathing techniques, and grounding exercises.

As the recovery program goes on, patients can choose either to transition into their everyday lives, or continue in a different program, ranging from partial hospitalization in severe cases of addiction and anxiety, to inpatient programs, sober living homes, and more. However, should a patient choose to complete their recovery program, they’re faced with another challenge – living a sober life.

Anxiety During Sobriety

After addiction programs are over, the recovery process continues in the sense that a person can choose to continue managing and maintaining their sobriety. Drug addiction programs are meant to act as a primer, helping a person prepare for the challenges that may lie ahead. But the nature and severity of those challenges is unknown. It’s impossible to tell how life might pan out over the years – making continued recovery important.

Whether through therapy, group meetings, or through a strict adherence to personal stress management solutions, the key to maintaining a grip over your addiction and your anxiety in sobriety after your recovery programs have ended is continuing to work on your recovery, but without the programs.

Dealing with Anxiety Without Drug Use

When you take away a person’s main coping mechanism, you need to help them replace it. As powerful as drugs are, they ultimately a flawed and ineffective coping mechanism, often making anxiety worse in the long-term.

Recovery programs focus on helping patients adapt to a sober world, often by introducing new and more effective coping mechanisms and forms of stress management, relieving anxiety symptoms through lifestyle changes and the use of various therapies. Examples include: an improved and patient-centric diet and exercise program, a schedule that encourages patients to spend more time outside and develop healthier hobbies, time spent with other recovering addicts with similar issues and different paths to success, and various forms of talk therapy to help patients individually adapt to their new circumstances.

Anxiety in a Post-Recovery Life

Long-term anxiety management requires an understanding of the disorder, both in the sense that a patient must understand how anxiety manifests, and how it manifests in them specifically. Managing anxiety symptoms is important because in recovering addicts, a bout or episode of anxiety can translate into a potential relapse. However, this is not something you need to do alone. The key to long-term recovery lies in seeking help from others, whether they’re family, friends, or professionals.

Mental health and addiction are intertwined. A person’s mental state is in constant flux, changing in reaction to different internal and external stimuli, much like a person’s physical health. Healthy reactions of the mind are, like healthy reactions of the body, both pleasant and unpleasant. Sadness and pain are normal, and important.

But when the mind goes into one extreme, or when you respond unnaturally, something might be amiss. It’s not normal to feel bad for weeks at a time, with no real change. It’s not normal to feel fear and anxiety in the face of no imminent threat, being scared or worried every waking minute. Not only can our own minds terrorize us, but they can have a serious and negative effect on the human body. The reverse is true as well – the body can have an impact on the mind.

Because drug use affects the mind and the body, things can get very complicated very fast. Drugs like alcohol, cocaine, and opioids heavily affect dopamine, a neurotransmitter associated with reward systems in the brain, and with other functions. Different drugs also interact with different neurotransmitters and systems, such as alcohol and Xanax’s interactions with GABA, an inhibitory chemical. Alcohol can negatively affect the liver, stomach, throat, heart, and kidneys, just to name a few organs. Opioids can cause brain damage, both due to overuse and due to the damage dealt to the brain after an overdose. Powerful stimulants like methamphetamine can damage serotonergic pathways in the brain and make it harder to feel content or pleasure. Many of the behavioral and emotional changes people go through before, during, and after recovery tie back to the effects that drugs have on the mind and body.

Mental Health During Addiction

Many people who end up becoming addicted already have a history of struggling with mental illness. Self-medication is one of the main reasons why people overuse drugs, as a way to dull emotional pain. It doesn’t have to be anything tied to the person’s genes or environment – specific circumstances, such as a highly-stressful job or a sudden onset of extreme stress through an abusive relationship or sudden fame can push a person to seek out ways to dissociate, numb out, and generally put an end to their internal conflict as efficiently as possible, consequences be damned. Younger people are even more susceptible to using drugs as a way to cope, because they’re less likely to comprehend or care about long-term consequences and risks.

Sometimes, addiction can also cause mental health issues, rather than exacerbating them or being a result of them. Someone who can’t get out of a cycle of relapses and addiction might quickly feel worthless and hopeless, developing a depression and thoughts of self-harm. Drug use also leaves the brain more vulnerable, and more likely to develop other illnesses such as an anxiety disorder. Under specific circumstances, memories of drug use and addiction in general can be traumatic, especially when coupled with highly stressful circumstances, causing panic attacks and other anxiety-related mental health symptoms during and shortly after addiction.

Because the incentive for drug use is the quick elimination of pain and the introduction of euphoria, many use drugs to numb any attempt by the mind to process these negative experiences and deal with them appropriately. Attempts to overcome trauma or therapeutically approach depressive thoughts are overridden by a brute force high. This makes recovery much harder, as any potential negative mental health symptoms are effectively ‘bottled up’, ready to be released when sobriety becomes the new norm.

Mental Health During Recovery

Early recovery is the hardest point in terms of mental health, as recovering addicts are tasked with dealing not only with a potentially long list of mental health issues, but the emotional turmoil of early recovery, including mood swings, irritability, powerful cravings, recurring withdrawal symptoms, and much more. Support is critical at this stage, both from professionals as well as friends and family. Each experience is individual, and it’s hard to gauge how difficult it would be for any one person. It depends on the nature of the addiction (its length and severity) and the person’s overall mental health.

Approaching a dual diagnosis of addiction and a mental health issue (often a depressive disorder or an anxiety disorder) requires a multimodal approach that takes both into account. It’s impossible to treat one or the other – treatment has to consider symptoms from both problems, and how they might feed into one another and complicate recovery. Therapy is crucial, especially in helping recovering addicts combat negative thinking and successfully commit themselves to a positive vision for the future.

Continuing to Benefit from Mental Health Treatment

One of the major problems plaguing the United States in its approach to mental health issues is the attitude and understanding regarding mental health as a whole. We generally understand that annual checkups are ideal for continued good health, especially as we age, but no one seems to value the idea of regular checkups with a professional psychiatrist. Visiting a ‘shrink’ is often considered a last resort, and anyone who needs one is clearly not completely sane.

Mental health is just as important as physical health, yet it’s often neglected. Although this attitude is slowly shifting for the better, there’s still this misunderstanding that tools like therapy and counseling are only there to be used when they’re needed and, like some form of prescription medication, going to therapy if you don’t really ‘need’ it is just a waste of money or, worse yet, it potentially does more harm than good.

The opposite is true in both cases. People should be encouraged to look after their mental health and be more proactive when it comes to approaching psychiatrists and mental health professionals about day-to-day worries and issues they struggle with outside of any real diagnosable condition. You don’t need to be diagnosed with a disease to visit a doctor, and you don’t need to be diagnosed with a mental illness in order to go see a mental health professional.

People who have at some point in their lives struggled with any of the many different mental health issues that tend to be chronic and recurring – such as trauma-related issues, depression, and addiction – would do good to regularly visit a therapist or a psychiatrist. Even if you’re several years past your first recovery program and have been abstinent and content, scheduling a session with a therapist every now and again can help give you better insight into some of your smaller worries or personal issues, help you work through problems at home or at the office, and let you find ways to deal with issues that might not even relate to your addiction, but simply have to do with other stressors and challenges in life. To be more relevant, making a habit of taking care of your mental health also gives you the opportunity to be more proactive if and when you feel like your addiction is becoming a problem again. There are times when people are faced with the urge to use after years of abstinence due to a completely overpowering sense of stress, or because things are just overall slowing down, and life is getting harder to deal with. Guidance in your weakest moments, even years into recovery, is critical in preventing a relapse.