Sober Synthesis

What is the Prevalence and Recovery Impact of Co-occurring Anxiety and Substance Use Disorders?

• Anxiety disorders can precede the development of alcohol use disorders (AUDs) in up to 80% of cases.
  • There is evidence that people with anxiety disorders transition from initial use to substance dependence significantly faster. 
• People with significant anxiety have a higher rate of relapse.

What is a Neurobiological Basis for an Anxiety Addiction Cycle?

• This image summarizes emerging information about the anxiety/addiction cycle. To summarize:
  • Anxiety can prompt people to drink and/or use drugs, which temporarily activates positive valence systems (positive emotions) and increases incentive salience (craving) over time. 
  • During withdrawal, negative valence (negative emotions/anxiety)  increases rapidly. 
  • In the preoccupation and anticipation phase, cognitive system changes, including increased cue reactivity and interoception (internal radar) impairment lead to decreased cognitive/behavioral control. 
• In summary: while use of alcohol/drugs provides temporary anxiety relief, healthy/functional neural pathways to relieve/ manage anxiety are replaced with dysfunctional/addiction neural pathways (neuroplasticity run amok). 

Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives – PMC

The Limbic System in Co-Occurring Substance Use and Anxiety Disorders: A Narrative Review Using the RDoC Framework

What are Important Principles to Support Co-morbid Anxiety and SUD Recovery?

• The most effective intervention to reduce anxiety is exposure to anxiety, using tools to manage the discomfort (very similar to managing cravings). 
  • Doing so activates new neuronal pathways: neurons that fire together, wire together.
  • We are unable to selectively numb emotions. So when we numb ourselves from feeling anxious and depressed, we also numb from feeling happiness and joy.
• Self-compassion, rather than self-criticism, supports incremental progress.

What are Evidence-based Practices that Help Build New Neuronal Architecture (neuroplasticity) to Decrease Anxiety?

• Activities to relieve/decrease baseline neurobiological stress/anxiety (“flight or fight”) 
  • Sleep, healthy nutrition (especially healthy gut microbiome)
  • Mindfulness/meditation/yoga
  • Moderate exercise 
  • Play, creative activities (arts and crafts, music, cooking, writing)
  • Minimize exposure to news, social media, or other stress inducers, especially before sleep.
  • Acupuncture
  • Massage

• Activities to raise anxiety threshold (building stress tolerance muscle).
  • Stress Inoculation: Using cognitive/behavioral skills while experiencing physical discomfort. Rewiring the anxiety response without exposure to personal anxiety cues. 
    • Cold shower
    • High intensity exercise
  • Direct Exposure: Using cognitive/behavioral skills while in presence of personal anxiety activating cues.
    • Example: Sharing and/or showing self on video if one has social anxiety.

Facing your Fears – How to Do Exposure (anxietycanada.com)

• Group and/or individual psychotherapy may be very helpful, especially for anyone with a trauma history.  
• Medications may be helpful, especially short term, for acute and/or complex anxiety symptoms. 
  • It is important to include exposure for longer term anxiety reduction/management. 

Proposed Questions:

1. Was anxiety a factor in your addiction process? 
2. Has your overall anxiety level changed with sobriety? How?
3. Has this information sparked any ideas for your recovery?

Disclaimer

This summary is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed.