Self-Medicating Anxiety: Not a Long-term Solution

5 Ways to Evaluate a Substance Use Problem

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Learning to manage the worry that is characteristic of Generalized Anxiety Disorder (GAD) – by taking time worry more productively, by challenging negative beliefs and predictions, by integrating breathing/relaxation techniques and mindfulness into your lifestyle – can sometimes feel daunting, or exhausting. It’s therefore not uncommon for people with GAD and other anxiety disorders, as well as those with lower-grade stress, to want to “take the edge off” or “blow off steam” by indulging in a drink, a cigarette, or recreational drug use.

 

Using these substances to cope (i.e., to “self-medicate”) with anxiety, however, can have a paradoxical effect. That is to say, the substances to which you turn when you’re anxious or worried can actually make your anxiety worse, either as a direct biological result of the drug or because of other consequences of your substance use. And in adults with anxiety disorders, research has shown that the use of alcohol or drugs to cope with symptoms of anxiety can put you at risk of developing a full-blown substance use disorder.

Just how concerned should you be about your use of alcohol and other substances to manage anxiety?

Here are 5 ways to begin to assess your substance use:

  1. Know the facts. Consider keeping track of your substance use for a week or two. Note when, where, why and with whom you are using substances, as well as what and how much you are using. If you are spending a lot of time using (or trying to obtain) substances, if you are using them alone (and/or hiding it from others), if you are regularly drinking more than others when out socially, if you are arguing with friends and family about it, or if you are finding yourself unable to function in the wake of your substance use, then there is cause for alarm.
  1. Understand your reasons. Ask yourself why you typically use drugs or alcohol. Is it to overcome anxiety, to dull worry, or to combat shyness? Is it to alleviate psychological or physical pain? Is it perceived as the only way, or the best way, to really have a good time? If the answer to any of these questions is “yes,” then you are beginning to understand the function or purpose of your substance use and how closely tied it might be with your anxiety disorder.
  1. Critically evaluate these reasons. Once you’ve identified the purpose of your substance use, consider (1) whether or not using drugs or alcohol actually helps you to achieve your purpose in a meaningful way, (2) if there might be another means to that end, and (3) if there’s a price you’re paying for your substance use. The costs to you might include aftereffects of substance use – feeling so lousy that you cannot get to class or work the next day, experiencing rebound anxiety or mood changes – or more conflict with loved ones (e.g., arguments with friends and family).
  2. Ask others for input. Consider asking a trusted friend or loved one for their thoughts and feelings about your substance use. It’s a brave step, but one that may help clarify the costs and consequences of your substance use that may otherwise be murky to you. Close friends and family can offer insight into the ways in which you – your anxiety, and even your personality – are impacted by substance use.  Talk to your physician or mental health professional about your pattern of drug and alcohol use (and its benefits and costs) for further insight into the distinction between normal and problematic patterns of behavior.
  1. Choose a goal for change. Substance use disorders can be resistant to change. To assess how problematic you current pattern of use is, you might try setting a goal, making a detailed plan, and setting a date to evaluate the outcome. Goals for change in alcohol use, for example, might include drinking more safely, drinking less, or abstaining entirely. Let someone know about your plan for change – ideally a clinician, or at least a family member or friend – so that you don’t have to problem-solve through the tough parts, or enjoy your successes, alone. If you find that it’s very hard to change your relationship to alcohol and drugs, then you are likely to benefit from some specialized attention to it. There are many types of support that might be helpful.

For more information about substance use disorders and local resources for treatment, check out the following organizations: Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Alliance on Mental Illness (NAMI). To learn more about the relationship between anxiety and substance use disorders, learn about findings from recent research on this topic and see a helpful information sheet on dual diagnosis.

References:

Anderson, K. How to Change Your Drinking: A Harm Reduction Guide to Alcohol. 2nd Edition. New York: The HAMS Harm Reduction Network, 2010.

Robinson J, Sareen J, Cox BJ, Bolton JM. Role of self-medication in the development of comorbid anxiety and substance use disorders. Arch Gen Psych 2011; 68:800-807.

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