Over the years a substantial body of evidence has emerged showing that stress can lead to substance abuse relapse; a review by Sinha (2001) summarizes some of this research. There are many theories as to how stress leads to relapse, such as the Stress-Coping Model of Addiction (Wills and Shiffman, 1985) which states that substance abuse not only reduces negative feelings and actually increases “feeling good”. Therefore, substance abuse can be seen as a self-medicating strategy for dealing with negative emotions. Sinha’s review also discusses the Relapse Prevention Model (Marlatt and Gordon, 1985) which proposes that individuals who have difficulty coping with stress are even more at risk. So not only does abusing substances reinforce the maladaptive behavior by reducing stress and increasing mood, it is also more likely to happen in those who are unable to cope with stressful situations. The cycle of addiction itself can add stress to one’s life (e.g. Kushner, Abrams and Borchardt, 2000; Parrott, 1999), resulting in a vicious cycle where the stress of substance abuse results in more alcohol or drug abuse to occur. Not only does this mean that the addiction will be harder to treat, but excessive stress could also be a sign of an anxiety disorder.
Ssubstance abuse and addiction are frequently found in individuals who also suffer from anxiety disorders (Kushner, Abrams and Borchardt, 2000). When two disorders occur together, they are referred to as co-occurring disorders, comorbid disorders or dual diagnosis disorders. For instance, strong links have been found between alcohol abuse and Post-Traumatic Stress Disorder, and it is not always clear which disorder triggered the other (Stewart, 1996). In other words, the PTSD may have triggered the substance abuse as a form of self-medication, or the substance abuse may have made the individual more susceptible to developing an anxiety disorder. Not only does this cause a problem for the individual as they have to learn to cope with two distinct disorders, but they can each exacerbate each other. For instance, Schneider et al (2000) found that female alcoholic patients with anxiety disorders began their drinking behaviour earlier in their lives, and drank more excessively than patients without the comorbid anxiety disorder.
The comorbidity of these two disorders can also cause significant problems for treatment. Drissen et al (2000) assessed the association between comorbid anxiety and depressive disorders in alcoholics who had been treated, and the course of both the comorbid disorders and drinking behaviour. Patients participated in a detox, and then took part in three weeks of a motivational therapy course for alcoholism using CBT, group therapy and other methods. Their other disorders were not treated.
The researchers found many interesting results of this intervention; first, after the three week course, both anxiety and depression decreased significantly. However, anxiety levels remained high in both groups (those with depression and anxiety, and those with anxiety alone). Six months after the treatment, patients were asked to report on their drinking behavior. The study showed that anxiety levels were still not significantly different than they were before abstinence from alcohol or drugs, and that 69% of the patients with an anxiety disorder had relapsed. Additionally, 12% of those with both anxiety and depression had also relapsed. This study shows how untreated anxiety and depression can be very detrimental to the treatment of alcoholism. Therefore, substance abuse treatment needs to focus not only on the substance abuse problem, but also the anxiety and depression that are typically comorbid with substance abuse.
Because our treatment center relies on evidence based practices, our Substance Abuse Intensive Outpatient Program shares many common methods with other successful rehab programs. The foundations of our treatment program for substance abuse also rely on the principles of harm reduction, motivational interviewing, stages of change and cognitive behavioral therapy to promote recovery from alcohol abuse and drug treatment along with comorbid depression and anxiety. In fact, our Intensive Outpatient Program in Memphis, TN that has been proven to be effective in the treatment of alcohol abuse and drug abuse treatment in peer reviewed treatment outcome studies. Our treatment center provides services to those who need more treatment than one hour a week, but less than 24 hour care, by providing three hours of treatment per day, three to five days per week, in an intensive outpatient setting. If you or a loved one is showing signs of alcohol abuse or needs drug treatment rehab, and is also experiencing anxiety or depression, they should be assessed by a trained mental health professional who can help design a treatment plan that can result in recovery. Substance abuse treatment can be highly successful. Call us at 901-682-6136 to schedule an appointment.
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