Anxiety Disorders and

Addiction

Thinking Outside the Medications Box

I. Anxiety Disorders

II. Influence of Substance Use

III. Treatment
I. Anxiety Disorders?

include “symptoms of anxiety,

fear, avoidance, or increased
arousal”
 Major Anxiety Disorders
1. Generalized Anxiety
Disorder
2. Panic Disorder &
Agoraphobia
3. Specific Phobia
4. Social Phobia
5. Obsessive-Compulsive
Disorder
6. Posttraumatic Stress
Disorder
 Generalized Anxiety Disorder
A. Excessive worry (apprehensive
expectation), occurring more
days that not for at least 6
months, about a number of
events or activities (such as
work or school performance).

B. The person finds it difficult to

control the worry.
 Generalized Anxiety Disorder
C. The anxiety and worry are associated with three
(or more) of the following six symptoms (with at
least some symptoms present for more days
than not for the past 6 months).
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying
asleep, or restless unsatisfying sleep)
Panic Disorder & Agoraphobia
A. Both (1 ) and (2):
(1) recurrent unexpected Panic Attacks
(2) at least one of the attacks have been
followed by 1 month (or more) of the
following:
(a) persistent concern about having
additional attacks
(b) worry about the implications of
the attack or its consequences (losing
control, having a heart attack, “going
crazy”)
 Panic Attack
• A discrete period of intense fear or discomfort,
in which four (or more) of the following
symptoms developed abruptly and reached a
peak within 10 minutes:
(1) palpitations, pounding heart, or accelerated
heart rate
(2) sweating
(3) trembling or shaking
(4) sensations of shortness of breath or feeling
smothering
(5) feeling of choking
(6) chest pain or discomfort
Agoraphobia

A. Anxiety about being in places or situations from

which escape might be difficult (or embarrassing)
or in which help may not be available in the event
of having an unexpected or situationally
predisposed Panic Attack or panic-like symptoms.
Agoraphobic fears typically involve characteristic
clusters of situations that include being outside
the home alone; being in a crowd or standing in a
line; being on a bridge; and traveling in a bus,
train, or automobile.
Agoraphobia

B. The situations are avoided (e.g.,

travel is restricted) or else endured
with marked distress or with anxiety
about having a Panic Attack or panic-
like symptoms, or require the
presence of a companion.
 Specific Phobia
A. Marked or specific fear that is excessive or
unreasonable, cued by the presence or
anticipation of a specific object or situation (e.g.,
flying, heights, animals, blood)
B. Exposure to the phobic stimulus almost
invariable provokes an immediate anxiety
response, which may take the form of a
situationally bound or situationally predisposed
Panic Attack.
 Specific Phobia
C. The person recognizes that the
fear is excessive or
unreasonable.
D. The phobic situation is avoided
or else endured with intense
anxiety or distress.
E. The avoidance, anxious
anticipation, or distress in the
feared situation interferes
significantly with the person’s
normal routine, occupational
functioning, or social activities
or relationships. Or there is
marked distress about having
the phobia.
 Social Phobia
A. A marked and persistent fear of one or more
social or performance situations in which the
person is exposed to unfamiliar people or to
possible scrutiny by others. The individual fears
that he or she will act in a way (or show anxiety
symptoms) that will be humiliating or
embarrassing.

B. Exposure to the feared social situation almost

invariably provokes anxiety, which may take the
form of a situationally bound or situationally
predisposed Panic Attack.
Obsessive-Compulsive Disorder
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and persistent thoughts, impulses, or
images that are experienced, at some time during the
disturbance, as intrusive and inappropriate and that cause
marked anxiety or distress
(2) the thoughts, impulses, or images are not simply
excessive worries about real-life problems
(3) the person attempts to ignore or suppress such
thoughts, impulses, or images, or to neutralize them with
some other thought or action
(4) the person recognizes that the obsessional thoughts,
impulses, or images are a product of his or her own mind
 Obsessive-Compulsive Disorder
Compulsions are defined by (1) and (2):
(1) repetitive behaviors (e.g. hand
washing, ordering, checking) or mental
acts (e.g. praying, counting, repeating
words silently) that the person feels
driven to perform in response to an
obsession, or according to rules that
must be applied rigidly
(2) the behaviors or mental acts are
aimed at preventing or reducing distress
or preventing some dreaded event or
situation; however, these behaviors or
mental acts either are not connected in
a realistic way with what they are
designed to neutralize or prevent or are
clearly excessive
Obsessive-Compulsive Disorder
B. At some point during the course of the disorder,
the person has recognized that the obsessions
or compulsions are excessive and unreasonable.
C. The obsessions or compulsions cause marked
distress, are time-consuming (take more than 1
hour a day), or significantly interfere with the
person’s normal routine, occupational (or
academic) functioning, or usual social activities
or relationships.
 Posttraumatic Stress Disorder
A. The person has exposure to a traumatic event.
B. The traumatic event is persistently re-
experienced
C. Persistent avoidance of stimuli associated with
the trauma and numbing of general
responsiveness (not present before the trauma).
D. Persistent symptoms of increased arousal (not
present before the trauma).
E. Duration of the disturbance is more than 1
month.
F. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
II. Influence of
Substance Use
 Stimulants
• Use of Nicotine, Caffeine,
Cocaine, Amphetamine can:
– Trigger or worsen anxiety and
panic
– Disrupt a regular sleep
schedule
– Trigger a starvation state
when not eating regularly
– Contribute to gastrointestinal
problems
 Depressants

• Use of Alcohol, Opiates, or

Benzodiazepines can:
– Initially reduce anxiety, but
cause anxiety to increase over
time (“Rebound Effect”)
– Contribute to gastrointestinal
problems
 Hallucinogens

• Use of Marijuana,
mushrooms, mescaline, or
LSD can:
– Induce panic-like sensations
(rapid heart rate,
fear/paranoia)
III. Treatment
 Pharmaceutical Treatment
• Benzodiazepine class of medications:
– Are fast acting, potentially addictive
– Can lead to development of tolerance, and the
experience of withdrawal symptoms when
stopped

• SSRI class of antidepressant medications:

– Block serotonin re-uptake, and are non-
addictive
 Pharmaceutical Considerations

• Medications can mask symptoms

temporarily, without helping to
permanently manage or resolve them

• Short-term relief can take away the

motivation to do the work and discipline of
learning & practicing either resolution or
long-term management strategies
Psychosocial Treatments

1. Stress Management

2. Cognitive Restructuring

3. Exposure Therapy
 Stress Management

Lifestyle Analysis
- sleep routine
- reduce ETOH and caffeine
use
- eat regularly (a state of
starvation can mirror anxiety
symptoms)
- exercise!!!
 Stress Management

Life Problem Analysis (finances, raising

children, relationships, etc)
1. identify problem
2. brainstorm solutions
3. evaluate brainstorm list
4. develop an action plan
5. re-evaluate plan in an ongoing manner
 Stress Management

Relaxation Training
- Progressive Muscle
Relaxation
- Meditation or Deep
Breathing
 Cognitive Restructuring
1. Identify distortions in thinking
a) “Catastrophizing”
b) “Magnification”
c) “Fortune-Telling”
2. Education that events not likely
to happen (reality checking)
3. Counter thoughts with evidence from
history, other experiences, and
behavioral tests
 Exposure Therapy

• Exposure of an individual to the

specific fearful situation or object
stressor, as able to be tolerated
• Gradually activate the anxious
feeling
• The individual gradually gets
used to (habituates to) the feared
situation or stressor
Questions or Comments?