Substances that suppress central nervous system functioning, such as alcohol or pain medications, are commonly abused by people with anxiety disorders like GAD. These substances numb feelings of anxiety, helping people to cope with everyday life. While these substances may temporarily alleviate symptoms of GAD, they worsen the symptoms over time and complicate the problem.
What Is GAD?
Generalized anxiety disorder is a specific type of mental health disorder where the primary feature of the disorder is dysfunctional anxiety.
Anxiety disorders are driven by dysfunctional anxiety that is out of proportion to what would be expected of most people in similar situations. The anxiety affects the person’s ability to function and causes them significant distress.
Some anxiety is normal in everyday life. Anxiety disorders are not diagnosed when someone is experiencing typical nervousness or jitteriness that occurs in most people in these situations.
The anxiety must be disproportionate to what would be expected of most people in a similar situation. It must cause the person significant distress and issues with normal functioning.
What Are the Features?
According to the American Psychiatric Association (APA), these are the features of generalized anxiety disorder:
- The person displays excessive anxiety and worry more days than not for at least six months. The anxiety is related to a number of different activities or events.
- The person finds it very difficult to control their worries.
- The anxiety and worry are associated with at least three of six specific symptoms in adults (only one of the six in children). The symptoms are feeling on edge or constantly feeling restless; becoming fatigued easily; having difficulty concentrating; irritability; significant muscle tension; and having problems with sleep (either problems falling or staying asleep or being restless during sleep).
- The person’s worry or anxiety cannot be due to the effects of taking some type of drug, some other type of mental health disorder, or some medical condition (for example, hyperactive thyroid gland).
How Do I Know if I Have It?
Anxiety disorders like GAD can only be formally diagnosed by a trained clinician who specializes in these types of diagnoses. A psychiatrist, clinical psychologist, or qualified social worker or counselor must diagnosis GAD.
You cannot diagnose the disorder in yourself. If you suspect you have it, see a professional for an official diagnosis.
What Are the Causes?
The potential cause of generalized anxiety disorder is not well understood, as is the case with many of the different forms of mental health disorders listed by APA. The best guess is that there is an interaction between genes (heredity) and experience (environment) that leads to a person being more vulnerable to experiencing clinically significant anxiety than others.
Many of the types of worries that people with GAD express are the same as what people without the disorder express from time to time. The difference is that people with GAD express a significantly more intense type of anxiety over a longer period of time, and their anxiety leads to problems with their ability to function or significant distress.
People experiencing normal levels of anxiety and worry typically recover and are able to function well. People with GAD tend to constantly worry about things that may seem minor to most of us. This worry significantly affects how they are able to fulfill their normal personal responsibilities.
What Is the Prevalence?
The National Institute of Mental Health and reports that in adults over the age of 18, an estimated 2.7 percent had a GAD diagnosis. GAD is generally diagnosed more among women than men (3.4 percent in females compared to 1.9 percent in males).
It is estimated that about 5.7 percent of adults in the United States will be diagnosed with GAD at some time in their lives.
GAD & Substance Abuse
According to APA, generalized anxiety disorder will often be diagnosed with other types of psychological disorders. When a person has two or more different disorders at the same time, this is known as comorbidity.
GAD is most often comorbid with depressive disorders, other types of anxiety disorders, and substance use disorders (addictions). Alcohol is the most commonly abused substance by people who are diagnosed with GAD, but other substances are often abused, including prescription pain medications, benzodiazepines, cannabis products, tobacco products, and stimulants like cocaine or methamphetamine.
The comorbidity rate between anxiety disorders and substance use disorders is relatively high. Some estimates suggest that more than 20 to 30 percent of people who have an anxiety disorder will also have some type of substance abuse issue.
If you have generalized anxiety disorder, you are more likely to abuse substances. Likewise, if you have a substance use disorder, you are more likely to struggle with anxiety.
What Is Self-Medication?
Self-medication is the use of any type of strategy to treat something that is ailing or bothering you. The self-medication hypothesis proposes that people decide to use drugs or alcohol to soothe or manage the symptoms of their mental health disorder.
According to APA and other sources, the research does not always support this notion of self-medication. In fact, it is well-known that a risk factor to develop an anxiety disorder like GAD is prior substance abuse. Thus, the substance abuse issue occurs in these cases before the generalized anxiety disorder, which means the substance abuse didn’t occur as a reaction to GAD symptoms.
However, individuals who do self-medicate their anxiety with drugs or alcohol find that they get temporary relief from their uncomfortable sensations. This reinforces the continued and even increasing use of drugs or alcohol, leading to a potential substance use disorder.
Other Related Factors
There are some other interesting factors regarding the link between GAD and substance use disorders.
- While the overall prevalence of GAD is higher in women than it is in men, men with GAD are more likely to develop a substance use disorder than women with GAD.
- People with GAD and a comorbid substance use disorder are more likely to have a family history of drug or alcohol abuse than people who are only diagnosed with GAD.
- People with comorbid generalized anxiety disorder and substance use disorders often report that their GAD is more severe. They experience more impairments in their daily functioning than people with GAD and no substance abuse issues.
- People with comorbid GAD and substance abuse are more likely to have cognitive problems (problems with attention), problems in interpersonal relationships, and problems fulfilling daily obligations.
- People with GAD and comorbid substance use disorders also have higher rates of other co-occurring psychological disorders — such as depression, eating disorders, and personality disorders — than people who only have GAD.
Treatment for GAD
Some research studies suggest that almost half of people diagnosed with generalized anxiety disorder do not get treatment. Even among those who do get treatment, many don’t get that care for at least two years after their disorder has been diagnosed.
GAD is typically treated with a combination of psychotherapy and medications. The medications used to treat GAD are often anti-anxiety medications, like benzodiazepines, or antidepressants.
Therapy attempts to help the person understand how their belief systems and expectations exacerbate their worries and anxieties. In sessions, they learn to restructure their beliefs and expectations of the world. This type of therapy is referred to as cognitive behavioral therapy (CBT).
The use of medications alone is not the preferable way to address GAD because the core issues that are driving the individual’s anxiety are not addressed. Therapy must be part of the treatment plan.
Treatment for Dual Diagnoses
If a person has a dual diagnosis (a co-occurring mental health disorder and substance use disorder), the preferred treatment approach is to address both disorders at the same time. Attempts to only treat one disorder will not be fruitful.
Substance abuse and GAD exacerbate each other, so if only one disorder is treated, relapse is likely. If the addiction is treated without addressing GAD, it’s likely that the person’s chronic anxiety will serve as a trigger to relapse to substance abuse. If only GAD is treated, ongoing substance abuse will likely trigger episodes of anxiety. Ultimately, the conditions are too intertwined to separate them for treatment purposes.
When an individual has a dual diagnosis of GAD and addiction, treatment is commonly performed by a team of individuals with different specialties (a multidisciplinary team). If the patient needs medical detox, they will be treated by an addiction medicine physician or psychiatrist who specializes in addiction treatment while they are in the detox program. Later, the person may see another psychiatrist or receive therapy from a psychologist or counselor. The patient may also get involved in group therapy or attend 12-step groups or other types of peer support groups that are run by different people.
Issues related to both substance abuse and generalized anxiety disorder will be addressed in therapy. The patient is treated as a whole person, and all co-occurring issues are addressed simultaneously. This ensures the most robust recovery on all fronts.
When there is a co-occurring substance use disorder and anxiety disorder like GAD, treatment providers must be very careful about the types of medications they use to address the person’s anxiety. Benzodiazepines can be addictive and have serious withdrawal syndromes that can be potentially fatal, in the same way that alcohol withdrawal can be fatal.
Less addictive medications may be used to manage acute anxiety. Alternative methods of managing anxiety will also be introduced, such as meditation, breathing techniques, and other mindfulness activities.
There isn’t a cure for addiction or generalized anxiety disorder. Both are long-term conditions that may ebb and flow throughout their duration. It may be more difficult to manage both disorders during periods of high stress, so added help may be needed periodically even once full recovery is achieved.
Aftercare is crucial to long-term recovery, and this will be part of any solid treatment program. Patients work with treatment providers to create a long-term plan for success in recovery. They’ll then know where to turn when times get tough and their disorders get more difficult to manage.
With the right plan in place and a good support system, long-term recovery is possible.