Alcohol Abuse is a difficult condition to treat; it involves physical and psychological dependencies. When alcohol abuse occurs along with an anxiety disorder, then each problem becomes worse. The anxiety triggers excessive alcohol intake, and the effects of intoxication can intensify anxiety. In the past, many treatment providers identified one or the other problem and treated it only to see the patient relapse over and again. Dual diagnosis recognizes that there are two conditions and that there are connections between them. The safe and effective approach is to identify the co-occurring conditions and treat them at the same time. We cannot just treat the addiction or the disorder; the treatment must address the whole person.

What is Dual Diagnosis?

Dual diagnosis describes a substance abuse problem and a mental health disorder that exist simultaneously in one person. Some estimates place the occurrence of the condition in the range of one-third of all individuals struggling with alcohol abuse also have a mental illness. Alcohol does not appear to cause mental disorder, but the two conditions affect each other for the worse. Alcohol abuse can intensify anxiety, and both conditions can spiral to the point of a loss of control.

Alcohol abuse takes a mental and physical toll on the abuser, and it has a similar devastating effect on family and loved ones. Treatment must carefully follow the situation of the individual. Effective treatment must treat the whole person; addressing either the alcohol abuse or the mental disorder alone will not likely succeed.

Symptoms of Dual Diagnosis

Mental disorders and alcohol abuse can have obvious or little-noticed symptoms. Many people show symptoms that involve poor hygiene, shabby appearance, and missing appointments. People may notice they isolate themselves from friends and family. The physical signs include change or loss of appetite, irritability, and quick anger. Symptoms can reveal low energy and low motivation. The person can show emotional swings. A common trait is to find rationalizing events and causes to justify excessive alcohol usage.

What is Anxiety?

The term ‘anxiety’ has a common meaning and people often self-diagnose by determining that they have anxiety when they feel nervous or afraid. Anxiety is a normal feeling when it is measured and in response to certain situations. A new employee might be anxious on their first day at work; a student might feel anxiety about going to a new school. Anxiety disorder is a different thing completely. They are dangerous conditions that often lead sufferers to take even more dangerous steps to relieve the feeling; many people turn to alcohol and dangerous drugs. When considering anxiety disorder, experts remind us that it is into a single thing or a single cause and effect. There are some distinct types of anxiety disorder. The most commonly diagnosed types of alcohol-associated anxiety disorders are social, generalized, and panic disorders.

  • Social Anxiety Disorder is a recurring condition that has a trigger in social settings. Far beyond awkwardness, or nervousness, this disorder has symptoms like an acute illness. For many people, the condition expresses deep fears of separation from home or other places of comfort and safety. Panic Disorder sufferers are likely to have severe panic attacks. They can be frequent, and then the person can live in dread of the next attack. The attacks have physical and emotional effects including rapid heartbeat, palpitations, and shortness of breath. Many people have mistaken severe panic attacks for heart attacks.
  • Generalized Anxiety Disorder causes a nearly constant level of stress. Ordinary days at home can be overwhelming to persons with general anxiety disorder. The mental illness shows symptoms such as disconnected fears, various phobias that trigger the anxiety attacks. The sense that there is no escape can drive the individual to find comfort in drugs or alcohol, and these, in turn, become sources of anxiety when a dependence leaves them in withdrawal.

Some experts group Obsessive Compulsive Disorder (OCD) and Post-Traumatic-Stress Disorder (PTSD) as part of the anxiety disorders that can co-occur with alcoholism. There is little reason to doubt this idea, as thousands of veterans and first responders have fallen to alcoholism and also required treatment for the stress injuries from combat or civil disasters.

Effect on Drinking

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The border between a normal amount of alcohol usage and uncontrolled drinking is easy to cross. We accept that people can use small amounts of alcohol to relieve the stress of a difficult day. When that person has an anxiety disorder, the alcohol takes on the role of self-medication. It is an attempt to silence the mental situation. The pattern of self-medicating with alcohol makes that person more likely than others to develop alcohol abuse and addiction. A similar pattern occurs in reverse when a person with a confirmed alcohol dependency develops and anxiety disorder. This can come from the social difficulties and physical pain of withdrawal symptoms. It may be difficult for the individual to recall the way the dual diagnosis developed- which came first. Some therapists believe that the solution to the cause is a key to long-term recovery.

  • Self-Medication

    Many people suffering from anxiety disorders use alcohol to find a sense of relief. Anxiety works through the central nervous system, and alcohol can reduce those sensations. Evidence shows that alcohol works in the same way as medicines that treat anxiety. These chemicals depress the central nervous system. When anxiety sufferers are left to their own devices to find a cure, many of them turn to alcohol. The problem is that alcohol only works temporarily, and the constant use of alcohol can cause alcohol dependence.

Compliance with Disease Management

Professionals engaged in the treatment of dual disorder patients consistently report the problem of non-compliance with the medication and treatment planning. Some studies show as many as 70 percent of patients do not comply with their regimens. The idea is not new or divorced from the difficulty of treating either anxiety disorder or alcoholism. Both conditions have long histories as resistant to treatment, high rates of failure and relapse. Successful treatment requires a plan of treatment that can include medication and testing. Some experts feel that the treatment must prioritize the disorder in order to prevent relapse into substance abuse. The therapeutic alliance is the relationship between the health service providers and the patient; studies show that this relationship is a key to compliance.

The agents in the treatment situation that reinforce compliance include the therapist's influence or relationship, and family support. In plain words, the task of sticking with an alcohol or mental health treatment plan is difficult. The motivation to succeed is a powerful influence and n determine success or failure. The therapist, family, friends, are all part of the motivation and support needed to succeed.

Alcoholism is a severe addiction, and it is more complicated when combined with a co-occurring physical or mental disorder. There are many long-term successful cases of sobriety that had failures and relapses along the way. In a sense, it does matter far more than when the patient fails, that they try again. The response to failure is just as important as the failure itself. One must learn from all of the circumstances including relapses. The things that can trigger a mental disorder or an alcohol addiction are not known; and part of the process of recovery is to uncover the causes, the underlying conditions, and the trigger points.

Unique Issues Faced by People with Anxiety

Many people can face their addiction and mental disorder as diseases and proceed to make the best of the available treatment resources. Most do not make that connection easily, and one common barrier is the social stigma of addiction and mental illness. The Affordable Care Act changed national policy on mental illness when it treated it like other diseases for purposes of health insurance and access to medical care and treatment.

Many people associate alcohol dependence or mental disorders as personal failings or weaknesses. The enlightened view that they are diseases and treatable conditions is an important benchmark for some people. It can free them from guilt and inhibition and let them accept the benefits of medical care and counseling therapy. When the idea of alcoholism or mental illness is a sensitive subject, then the individual can benefit from counseling.

Treatment

Effective treatment is not a one-size fits all situation. There is no pill for it, and unfortunately, there is no App for that either. Today, the most effective approach based on evidence is a comprehensive treatment plan carried out by highly skilled and experienced medical care providers and therapy counselors. The key is to combine the several types of medical interventions and therapies into an effective plan for the individual. It is also important to assess the plan and adapt it as the individual’s circumstances change. The standard approaches involve an initial assessment and a preliminary plan, detoxification, a period of inpatient treatment, and long-term rehabilitation.

Detoxification

Depending on the combination of alcohol and other drugs, the individual may need varying levels and duration f detoxification. The detox process can be dangerous as the body and mind have adapted to the presence of drugs or alcohol, and withdrawal creates tremendous amounts of stress in some patients. Some patients need high levels of supervision and counseling during rehab. Some situations require medical intervention. All of these are more manageable in a medically-supervised inpatient facility than outpatient care. Detoxification sets the stage for the decision to use inpatient or outpatient modes of treatment.

Inpatient Treatment

Medical supervision is a key ingredient, and inpatient settings offer continuous medical observation and related care. The inpatient setting can provide intensive counseling, medications, and physical therapy. Diet and nutrition are also important as the patient often must rebuild physical strength and begin to adjust to the absence of alcohol or chemical substances.

Outpatient Rehab

This type of treatment affords the patient freedom to include daily activities like work and school. It seeks to help the patient re-enter normal family and social life while developing new skills to stay sober ad gaining the benefits of treatment for the mental disorder. Outpatient therapy can be rigorous and intense; it can also involve a large number of sessions and frequent contact with treatment providers.

The Decision

Whether for yourself, a family member, or loved one, the decision to start treatment is a critical step. It can be compelled by law in some cases, but ultimately the meaningful decision is personal. There are many sides to the situation of every alcohol-dependent person that suffers from anxiety disorder. One thing that is true of every case is that delay makes thing much worse.

Family support and the support of friends and loved ones create a system that can reinforce the decision to get help and recover. Once the person decides to seek help, then it is vital that they enter quickly into a program and begin the assessment process. It is also important to move directly into detoxification and begin treatment. The decision to get help is the key; that choice is the vital first step to recovery and getting control of mental disorders.

Sources:

  • https://medlineplus.gov/dualdiagnosis.html

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034926/

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