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Anxiety

How to Deal with Anxiety Without Turning to Drugs

And why you may turn to drugs to manage your anxiety in the first place.

When I was 14, I was incredibly anxious, especially around girls. It all stemmed from an experience I had when I was 12 and a disastrous attempt at asking a girl out. It blew up in my face, caused me a lot of embarrassment around school for months, and became a monkey on my back that would take me down some pretty awful paths…

Anxiety is a normal human experience. It’s an emotion that drives us to study hard, work hard, and do better in our lives. But it can also make us overthink situations and paralyze us when we're faced with important decisions. An anxiety disorder may develop when the anxiety persists and interferes with daily life.

Anxiety is an uncomfortable, sometimes terrifying emotion, and it's no wonder people try to find ways to minimize, avoid, or shut out those feelings. While alcohol and drugs may lessen anxious feelings in the short term, do they actually make the anxiety worse in the long run?

I actually started drinking exactly because of that anxiety… At a sleep-away camp, when some guys pulled out vodka and passed it around, I drank because I didn’t want to stick out, but the near-immediate effect I felt when the alcohol started taking its effect was a substantial reduction in my level of nervousness. This was especially true around girls. All of the sudden, I didn’t care so much about making a food of myself. It felt good to relax for the first time in years that way.

Do you currently drink or use to overcome social anxiety or to fit in? Do you use alcohol or drugs to cope with stress? Have you tried to quit drinking or drugs and felt so anxious you've started using again? If you answered yes to any of these questions, you might be self-medicating to manage your anxiety.

As it turns out, there are far better ways to deal with anxiety than through substance abuse. For example: mindfulness, biofeedback, yoga, CBT, and healthy lifestyle choices. We’ll look at these in more detail shortly, but first, I want to explore anxiety, addiction, and how they impact the brain.

What is anxiety?

Anxiety can affect the way you feel physically and emotionally, the way you think, and how you behave. It’s something we all feel from time to time, but it can become a problem when it is so overwhelming that it starts to get in the way of your daily life. It may impact your work, study, physical health, and relationships.

Anxiety is commonly seen as a combination of:

1. Physical symptoms (increase in blood pressure and heart rate, shallow breathing)

2. Neurological patterns (increased amygdala and hypothalamus activity)

3. Chemical changes (HPA axis activation and Cortisol release, along with reduced GABA activity)

4. The interpretation of all of these by the brain (anxiety and excitement have been shown to have somewhat similar activation patterns, but wholly different subjective experiences)

What are the symptoms of anxiety?

These are some of the most common symptoms of anxiety generally, and are incredibly common among individuals who struggle with pathological anxiety or an anxiety disorder:

  • Sweating
  • Trembling
  • Shortness of breath
  • Tightness in the chest
  • Accelerated heart rate
  • Dizziness or nausea
  • Muscle tension
  • Sleeping difficulties
  • Irritability
  • Feeling like something bad will happen
  • Problems concentrating
  • Ruminating about the same thought over and over

Often times, if you experience these feelings, you may also behave in unhealthy ways to escape, avoid, or reduce the anxiety, such as:

  • Avoiding situations that make you feel anxious (including work, family gatherings, and other outings)
  • Withdrawing from others (could include close friends and family)
  • Using alcohol or drugs to cope

These ways of addressing anxiety, while often somewhat helpful in the short run, can lead to long-term problems as they disconnect individuals from potential support networks and can exacerbate the underlying issues leading to the anxiety in the first place, instead of solving them.

Why do people turn to drugs to cope with anxiety?

What happens in your brain when you feel anxious? The key players in the regulation of emotions are the amygdala and the HPA axis. The amygdala is the center for fear and anxiety-related memories and has been shown to be overactive in people with persistent anxiety. The amygdala works closely with other brain structures, like the hippocampus, hypothalamus, and thalamus. The HPA axis is related to stress and in charge of cortisol release, which readies the body for its fight-or-flight response.

Gamma-aminobutyric acid (GABA) is the key inhibitory neurotransmitter that counterbalances the excitatory neurotransmitter glutamate. This may sound a bit technical, but what’s important to know is that GABA is known to suppress thoughts, emotions, and behaviors, while glutamate tends to have an excitatory effect. The balance between these two chemicals has a lot to do with whether you're feeling relaxed or alert and anxious/excited. But these aren’t the only relevant chemicals — serotonin, dopamine, and norepinephrine also play an important role in the development of emotional states such as anxiety and depression.

Pharmaceutical drugs address this chemical balance issue by using chemical agents that target and modulate the GABA system to reduce anxiety. GABA is also something that is accentuated by drugs which are often associated with problems, such as alcohol and benzodiazepines.

People turn to drugs to cope with anxiety, because the increased GABA activity makes them feel calm. Initially.

Unfortunately, it's only short-term relief from stress.

Why is this a problem? Because relying on substances to cope with anxiety does not resolve the underlying problem, and ongoing reliance on a substance essentially assures that it will eventually become less effective at solving it.

Some people develop an alcohol or drug addiction, because they need to drink or use greater amounts of drugs more frequently to cope with their anxiety. This creates tolerance and physiological dependence. The reason for the anxiety is ignored, and it perpetuates a cycle of anxiety and addiction. Not only that, but long-term alcohol and drug abuse can actually make the anxiety worse. People often feel anxious when they are experiencing cravings or are withdrawing from alcohol or drugs.

I know this from personal experience, using alcohol and meth to cope with ADHD and social anxiety. In spite of — or perhaps because of — all the drugs and using, I walked around with a constant stream of self-doubt and anxiety that would fill my head at any quiet moment ... So I made sure to have as little quiet as possible. At 25, I was going nowhere fast. Then I got arrested, and things got really bad.

That's when I knew something had to change. I wanted to understand why I turned to drugs, what impact it had on my brain, but more importantly: How could I treat those underlying issues without turning to drugs?

5 ways to cope with anxiety without relying on drugs

We know that anxiety has an effect on our brain, and that drugs can target GABA and minimize anxiety. But alcohol and drugs aren't the only options. There are many self-help measures that you can try that target the same mechanisms in the brain, only without the negative impact that alcohol and drugs bring to your life.

1. Mindfulness & Meditation

Mindfulness is a focusing technique that helps you become more in tune with your thoughts, emotions, and body. There are many ways to introduce mindfulness into your life (we focus on this quite a bit with clients and IGNTD Recovery Course members), but here's one simple way to get started: Sit or stand in a relaxed posture, and breathe deeply. Take a slow in-breath, holding for four seconds, and then release it gradually over five seconds. Bring your attention to your breath, and when you notice your mind wander, acknowledge the thought without judgment and then release it. Return your focus to your breath.

When you first start out, you may find your mind wanders every few seconds, and that's okay. Mindfulness is a skill to be learned, one that requires patience and practice. The benefits of mindfulness are twofold: Firstly, it relaxes your body and mind. Secondly, it helps your mind focus on what’s happening right now. When we feel anxious, we're often ruminating about the past, or worrying about the future. Mindfulness helps you stay in the present. It has also been shown to increase inhibitory control in the brain, which is exactly the antidote to anxiety!

2. Biofeedback

Biofeedback (and its brain-centric version known as neurofeedback) is a very effective, research-based treatment for anxiety that teaches you how to respond to your anxious thoughts and feelings appropriately. It uses an electronic instrument to display involuntary physiological processes so you can learn to influence those processes by changing your thought processes voluntarily. Biofeedback is a very visual and experimental process where you are an active participant in the treatment. It gives you the opportunity to view your physiological responses to stress and learn how to manage and control them without the use of medications or drugs. I love using biofeedback with clients to help them learn how to control their anxiety and train their brain to produce less of it.

3. Cognitive-Behavioral Therapy (CBT)

Trained psychologists and health professionals often use cognitive-behavior therapy to identify, challenge, and alter thought processes to reduce anxiety symptoms and avoidant behavior. CBT generally involves a structured treatment plan within a specified timeframe. It is goal-oriented and often requires the participant to engage in homework activities to practice outside of therapy. As mentioned earlier, part of feeling anxious has to do with the interpretation of the biological and chemical changes (is it anxiety or excitement?), and so CBT works a lot on reframing negative beliefs and thinking patterns to help people reduce their subjective experience of anxiety. There is a long history of research into CBT and its positive effects on anxiety and depression.

4. Yoga

Like mindfulness and meditation, yoga is another practice that reduces a state of alertness through breathing and focused attention on the body. Yoga requires deep breathing through uncomfortable positions and teaches you to breathe through stress using only your body and mind. How does it help anxiety, exactly? It taps into the GABA I mentioned earlier. Yoga increases GABA levels which enables you to relax. Interestingly, yoga has been found to be more relaxing (higher GABA) than other forms of exercise, such as walking.

5. Healthy Lifestyle Choices

There are many ways you can look after yourself to reduce anxiety and increase your emotional well-being. Try the following:

  • Eat healthily and get regular exercise. Good nutrition is good for mental health, while exercising releases pent-up stress and energy in the body.
  • Have a sleep routine. Sleep deprivation can make anxiety worse, so try to go to bed and wake at the same time every day. Good quality sleep will help you deal with everyday stress far better than a tired mind.
  • Make time to rest. There are many ways to relax such as mindfulness, walking, listening to music, or reading a book. These techniques can also help you manage cravings for alcohol or drugs.
  • Reduce your caffeine intake. Did you know that coffee, tea, and energy drinks can exacerbate anxiety? Caffeine is a stimulant drug that can make you feel on edge, jittery, and even cause heart palpitations. In other words, it makes you feel anxious! Try to cut down by avoiding high doses, particularly in the afternoons (as this will affect your sleep).
  • Take your medication as prescribed. Avoid mixing medication with alcohol or other drugs, as this can be a dangerous combination not only for your mental health, but your physical health too.
  • Seek support. Talk to friends, family or a professional about your anxiety and addiction. Sometimes we just need someone on our side before we can believe in ourselves and make positive changes in our lives.

Commit to your recovery

You will find that most of these strategies involve relaxation, increased self-awareness and being better informed about your anxiety to find ways to cope with it. When we know how our brain works, and how anxiety develops, then it can help us handle it, by feeling more in control of our mind and body.

By learning how to manage your anxiety better, you can learn to manage your alcohol and substance abuse better. I feel strongly about dealing with the underlying emotional difficulties before the addiction and have made that the central tenant of all the work I do nowadays.

So, don’t wait until tomorrow to try out one of these strategies. Choose something that you can do today. What will it be?

Copyright 2018 Adi Jaffe

References

Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology. The Psychiatric Clinics of North America, 32(3), 549–575. http://doi.org/10.1016/j.psc.2009.05.004

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