Research has shown that addiction and anxiety are intimately linked. The National Institute on Drug Abuse estimates that people with an anxiety disorder are nearly twice as likely to suffer from substance abuse issues. Clearly, we cannot properly understand addiction without looking at its relationship with anxiety, but does anxiety cause addiction?
What is Addiction?
Before we can understand if anxiety causes addiction, we first need to know what addiction is. As we have covered in another blog post, addiction is a very complicated phenomenon. However, according to most experts, addiction is best understood as a disease, much like any other mental illness.
The main reason for seeing addiction as a disease is the way in which it changes the physiology of the brain. Of course, addicts do not have a mental illness before they begin using addictive substances. However, drugs change the brain on a physical level over time. Once someone is addicted, their brain behaves in abnormal ways even when they are not on drugs.
Understanding addiction as a disease may not be the full picture, but it has helped many addicts to get the medical treatment that they need.
Understanding addiction as a disease may not be the full picture, but it has helped many addicts to get the medical treatment that they need. It has also allowed for a greater understanding of the comorbidity of addiction with other mental health issues. Comorbidity refers to the presence of one or more chronic conditions occurring alongside another condition in the same patient. One of the most consistent comorbid disorders for addiction is anxiety.
What is Anxiety?
Grouped together, anxiety disorders represent the most common mental illness in the United States. Approximately 31% of people will experience some form of anxiety disorder in their lifetime, and ~18% of adults in the USA are living with anxiety. These are huge amounts of people, many of whom are not seeking treatment and are seemingly more susceptible to substance abuse disorders. So, what is anxiety?
Anxiety is the body’s natural response to stress. The upset stomach you get before an important job interview, or the tremors before a big game. ‘Anxiety disorders’ is an umbrella term that refers to a selection of mental health disorders that all manifest, in some way, as feelings of anxiety or fear that are not based on reality.
Types of Anxiety Disorder
There are several kinds of anxiety disorders, each with its own unique set of symptoms. However, all of them share similarities in the way they trigger feelings of irrational fear in the people that live with them. Below is a list of the different types of anxiety disorder.
Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder is what most people think of when they hear ‘anxiety’. GAD is characterized by consistent feelings of exaggerated anxiety and fear, even when there is seemingly nothing going wrong.
Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder is characterized by feelings of unfounded anxiety that can be temporarily relieved by performing certain repeated actions or rituals. Sufferers feel compelled to perform these actions, and not performing them increases their feelings of anxiety.
Most people may not be familiar with Panic Disorder, but they will have heard of ‘panic attacks’. Sufferers of Panic Disorder may feel fine for extended periods of time, but then experience sudden periods of incredibly intense fear and anxiety, coupled with shortness of breath, dizziness, heart palpitations, and more.
Post-Traumatic Stress Disorder (PTSD)
PTSD is perhaps one of the most famous anxiety disorders, often featuring in films about war. Sufferers of PTSD develop the disorder by surviving an intensely traumatic experience. These experiences usually involve serious physical or emotional harm. Sufferers may experience more generalized anxiety, have intense episodes due to triggering of memories, or both.
Social Anxiety Disorder (SAD)
Social Anxiety Disorder is characterized by feelings of excessive self-consciousness and acute anxiety in normal, everyday social situations. Sufferers of SAD might only experience their anxiety in specific groups or situations, or they may have a broader response to all social interaction.
Each one of the above disorders comes with its own signs and symptoms. Anxiety disorders may also manifest in slightly different ways from person to person, and sufferers of one can experience symptoms of another. However, there are some symptoms that can be common to all anxiety disorders.
- Experiencing a sense of impending doom
- An increased heart rate for no reason
- Feeling tired all the time
- Being irritable or quick to anger
- Feeling constantly tense
- Difficulty controlling feelings of worry
- Obsessing about things that are out of your control
- Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
- Consistent gastrointestinal (stomach) problems
- Using drugs or alcohol to relieve anxiety
Does Anxiety Cause Addiction?
People with anxiety are much more likely to have some form of substance abuse disorder, and people with substance abuse disorders are much more likely to have an anxiety disorder than the general public. The question is, how are the two linked? Does anxiety cause addiction, or is it the other way around?
Does anxiety cause addition, or is it the other way around?
The most common explanation offered for why people with anxiety disorders are more likely to also suffer from substance use disorders is that they are self-medicating. Self-medicating is when people use some kind of substance to treat their symptoms without consulting a doctor or getting a prescription. Many people do not even realize that they are self-medicating. People with anxiety disorders may not realize they have one. If they do, they may not realize at all that their substance abuse is connected to their anxiety.
Everyone experiences pleasant feelings when using addictive substances, which is why they are addictive. Not all drug addiction is about self-medicating. So, clearly anxiety does not directly cause addiction. The question remains, though. Why are people with anxiety disorders more likely to become addicted to drugs or alcohol?
A Vicious Cycle
The problem with anxiety and substance use is that it helps to reinforce the patterns of behavior that underpin addiction. Addictive drugs work by releasing dopamine into the brain, producing feelings of happiness, calmness, or euphoria. Over prolonged use, the brain begins to develop a tolerance. It produces less and less dopamine in response to the substance.
For most people, they are just looking for the pleasurable feeling that an addictive substance provides and, in many cases, that alone is enough to produce addiction. For people with anxiety, not only does the substance produce a high, but it also produces a sense of relief from their feelings of anxiety. It makes them comfortable around people, or worry less about things they can’t control. So, they use the substance again, unconsciously self-medicating, and help the process that produces tolerance and addiction.
Addicts will experience withdrawal when they can’t use their preferred substance. Those feelings of withdrawal can actually make their anxiety worse. This is very dangerous because then they use more to relieve those feelings, speeding up the process of addiction. It also makes treatment incredibly difficult. Addicts with an anxiety disorder will not only be experiencing withdrawal during detox. They will also be experiencing the return of intense anxiety symptoms.
So, does anxiety cause addiction? Clearly, we can’t understand addiction without understanding anxiety. To have a nearly double likelihood of being addicted due to your pre-existing anxiety disorder is hugely significant. However, to say that anxiety causes addiction would not be correct. There are lots of people with anxiety that do not suffer from substance use disorders. There are also lots of addicts with no anxiety issues.
Rather, it is more accurate to say that anxiety disorders serve to accelerate and exacerbate the process that causes normal substance use to become a disorder. Working in tandem with the drug’s own mechanisms of addiction, anxiety disorders reinforce the habit-forming behavior that leads to tolerance and addiction.