Sunday, July 13, 2014

Anxiety and Substance Abuse

The self-medication hypothesis says that individuals in distress will utilize drugs and other substances to relieve the effects of their psychiatric disorder (Bovasso, 2001). However, some research has criticized the underestimation of the role of substance abuse in inducing anxiety and depression (Bovasso, 2001). Substance abuse and dependence precedes a variety of anxiety disorders, and was particularly significant in panic attack disorders, social phobias, and agoraphobia (Goodwin & Stein, 2013; Ham & Hope, 2003). On the other hand, in half of substance abuse cases, 40% of PTSD cases, and 30% of general anxiety disorder, the anxiety disorder began prior to the onset of substance abuse.

Because of the co-morbid relationship between psychiatric disorders and substance abuse, establishing the sequence of onset may be an essential component of a successful intervention. This may be an especially salient issue in the discussion of anxiety in adolescents, because adolescent substance abuse has been linked to psychiatric disorders later in life (Bovasso, 2001).

When substance abuse is co-morbid with anxiety, it is important to understand which disorder precedes the other, especially since treating the preceding disorder may prevent or reduce the risk of the secondary disorder (Robinson, Sareen, Cox, & Bolton, 2011). Other research has shown a common etiology, but in that case, too, treating the psychiatric disorder that appears first may reduce or prevent the risk of subsequent morbidity (Goodwin & Stein, 2013).


From a common sense standpoint, when an adolescent has frequent anxiety, she may have an opportunity to experiment with alcohol (for example). When she realizes how much better and more relaxed she feels after drinking, this would reinforce her desire to continue the drinking behavior. People tend to self-medicate when they are experiencing unpleasant symptoms and they believe, or learn from experience, that their choice of medication (in this case, alcohol) is the best way to resolve the problem of the unwanted symptoms (Piotrowski, 2013). Three things contribute to self-medication: access to the drug, understanding the dose and effects of the drug, and being part of a culture that encourages and accepts the use of the drug (Piotrowski, 2013). For adolescents, these criteria can be fulfilled easily.

For adolescents with anxiety, self-medicating can lead to substance abuse, although it may alleviate their anxiety. Another consideration of adolescents self-medicating is that without being properly addressed by a mental health professional, the anxiety may increase over time, or eventually become exacerbated by the drug of choice. Self-medicating will provide short-term relief for anxiety, which makes it difficult for the adolescent to understand why this method of unsupervised treatment is unsafe and ultimately, ineffective.

Anxiety disorders are common during childhood and in adolescents. I believe psychoeducation is important for families with children or adolescents with anxiety and/or substance abuse issues. Especially when younger children suffer with anxiety, it would be important to intervene prior to the child nearing adolescence. When families are educated on anxiety and substance abuse, a better chance exists for early robust interventions that may decrease the typically subsequent morbidity (Goodwin & Stein, 2013).

Bovasso, G. (2001). The Long-Term Treatment Outcomes of Depression and Anxiety Comorbid with Substance Abuse. Journal Of Behavioral Health Services & Research, 28(1), 42.

Goodwin, R., & Stein, D. (2013). Anxiety disorders and drug dependence: evidence on sequence and specificity among adults. Psychiatry And Clinical Neurosciences, 67(3), 167-173. doi:10.1111/pcn.12030

Piotrowski, N. (2013). Self-medication. Magill’S Medical Guide (Online Edition),

Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders. Archives of General Psychiatry, 68(8), 800–807.

Ham, L. S., & Hope, D. A. (2003). Alcohol and anxiety: Subtle and obvious attributes of abuse in adults with social anxiety disorder and panic disorder. Depression & Anxiety (1091-4269), 18(3), 128-139. doi:10.1002/da.10130

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