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Anxiety and Substance Abuse

Anxiety is commonly linked to many other ailments. Anxiety can be the cause of a myriad of other concerns, such as seclusion and delusion, or can be a symptom of another issue entirely, such as an issue within the gut. Certain foods and drinks can exacerbate the symptoms of anxiety, while others can aid in quelling anxious feelings. Alcohol falls within one of these categories and may be a key factor in understanding your anxiety.

Can alcohol cause anxiety? Some pre-existing conditions may contribute to anxiety developing. Someone who experiences both Obsessive Compulsive Disorder and anxiety, for instance, may be more likely to latch onto the relief alcohol brings. Similarly, an individual with ADHD and anxiety might crave the (albeit temporary) relief brought on by consuming alcohol in stressful situations or following a high-stress event. Conversely, someone who has an anxiety disorder, but has systems in place to vent and relieve that anxiety may be less likely to turn to the soothing effects of alcohol, and will not be at risk of falling into a dangerous cycle of consuming alcohol for anxiety and creating even greater stress as a result.

Individuals who consume alcohol as a relief for anxiety are more likely to abuse alcohol. As tolerance grows, the need for greater levels of alcohol increases, leading to increased quantities being consumed in a single setting. Over time, tolerance to alcohol can grow, and you may require greater and greater quantities to achieve the same sedative effect. Consuming alcohol in this way can create a dramatic rewiring of the brain, which links alcohol consumption and anxiety on a molecular level. Trying to pull away from the start of addiction can lead to more consumption, as symptoms of anxiety and symptoms of withdrawal can mimic one another, and may create literal panic in the body and mind of an anxious person moving away from alcohol.

As if the biological function of alcohol were not reason enough to avoid imbibing if you experience anxiety, the mental distress created by alcohol consumption can also be problematic. Because alcohol can create a disconnect in your brain, leading to legitimate memory loss and confusion, a night of heavy drinking can often create alcohol-induced anxiety the next day, as you work to replay what happened during your drinking session and determine whether or not you need to take action based on your previous behavior.

This is particularly true of individuals who indulge in heavy drinking; although they are far less likely to engage in foolish or otherwise troublesome behavior if they do not overindulge, people who drink to the point of passing out, or drink until inebriated are more likely to experience the fear and anxiety produced by alcohol-fueled behavior. Existing social concerns can make this particular fear enormous, and could be reason enough to avoid drinking altogether whenever possible.

Alcohol and anxiety can go hand in hand, but should not be mixed. Alcohol may initially seem to be a useful tool in an arsenal designed to combat anxiety and mitigate its symptoms, but can gradually become an even greater liability. Over time, its consumption can create mental and physical barriers to wellness, including the onset of actual mood disorders and difficulty maintaining a state of peace and well-being. If anxiety is already present, it can worsen due to an imbalance within your brain. If anxiety was not previously a concern, it could develop.


STEP 1: Learning about anxiety and GAD

No matter what type of anxiety problem you are struggling with, it is important that you understand certain facts about anxiety.

FACT 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger. This means that dealing with your anxiety NEVER involves eliminating it, but rather managing it.

FACT 2: Anxiety can become a problem when our body tells us that there is danger when there is no real danger. That is, when we think or perceive that we are in danger (even when we aren’t), our body reacts as if it really is in danger.

As an important first step, you can start by understanding that all of these worries and uncomfortable physical feelings in your body have a name: ANXIETY. Once you can identify and name the problem, you can begin dealing with it.

The next important step is to understand your GAD. Like all other anxiety disorders, adults with GAD get anxious when they are faced with a trigger for their worries. But what is the trigger in GAD?

Adults with GAD get anxious whenever there is uncertainty in a situation or if they are not 100% sure about something.

This is why, if you have GAD, you worry about almost anything: almost everything in life is uncertain, so there is always something to

worry about!

STEP 2: Identifying and recognizing your worry

If GAD is the problem that you are struggling with, then you are someone who worries excessively. It is this worry that leads you to feel anxious. This means that one of the best ways to manage your anxiety is to learn how to manage your worry.

To manage worry, you first need to become an expert at recognizing it. You probably think that you are already a “worry expert” since you do it everyday. However, when most adults are asked what they worried about during the week, they either can’t remember or they can only recall one or two “greatest hits” (most common worries), and forget about the rest.

The best way to start noticing and recognizing your worries is to begin recording them in a worry diary. Write down what you are worrying about at set times 2-3 times a day, along with the trigger for your worry and your anxiety level.


STEP 3: Classifying your worries

There are two general types of worries:

1. Worries about current problems (for example, “what if I don’t have enough money to pay the bills?”, “what if I don’t finish my report on time?”, “what if my argument with my friend means we never speak again?”)

2. Worries about hypothetical situations (for example,“what if the f ight I’m taking next month crashes?”; “what if I get a serious disease when I’m older?”)

One of the main differences between these two types of worries is the amount of control you have over the situation:

o With worries about current problems, you have some direct control over the situation. For example, you can manage your finances, work on your report- writing, or resolve an argument with a friend.

With worries about hypothetical situations, you have almost no control, so there is very little, if anything, that you can do to change the situation. For example, unless you are the pilot, you have no control over how a flight will go, and you cannot control (beyond basic good health, exercise, and nutrition) whether you will contract a serious disease years from now.

Since these worry types are different, you need to manage them differently. A good way to keep track of which type of worries you have is to classify your worries in the worry diary as being either about current problems or hypothetical situations.

REMEMBER: Many people with GAD are afraid that recording and classifying their worries will make their GAD symptoms worse. This is not true. You are simply becoming an expert at catching and recognizing your worries. They are already there, you are merely observing them with greater attention. This is important if you want to be able to manage your worries.


STEP 4: Building your Worry Management Toolbox

The best way to begin managing your worry and anxiety is to start building a toolbox of strategies that you can use instead of worrying. The following is a list of tools that you can use to manage GAD.

Although the feeling of anxiety in GAD is due to your worries, it can be uncomfortable to experience anxiety in the body. Therefore, these first two techniques are designed to help you to get a feeling of control over the anxiety in your body, and “turn the volume down” on those anxious feelings.

TOOL #1: Learning to calm anxiety by slowing down your breathing

Calm breathing involves slowing down your breathing by breathing in deeply through your nose, and exhaling slowly through your mouth. It is a quick and easy way to reduce some of the physical feelings of anxiety in the body.

For more information, see How to do Calm Breathing

TOOL #2: Learning how to calm your anxiety by relaxing the muscles in your body

Another helpful strategy involves learning to relax your body. This involves tensing various muscles and then relaxing them. This strategy can help to lower your overall tension and stress levels that can contribute to feelings of anxiety.

For more information, see How to do Progressive Muscle Relaxation

TOOL #3: Learning to become comfortable with uncertainty

Research shows us that a major trigger for GAD worry is uncertainty. That is, whenever you are not 100% sure of something, you are likely to worry about it. For example, if you aren’t sure of a decision (even a small one, like picking a movie to watch), you are probably going to worry about it. The problem is that almost everything in life is uncertain because no one can predict the future.

If the trigger is uncertainty, then the best way to deal with it is to learn to become more comfortable with it. The other option – trying to have 100% certainty – is what you are trying to accomplish when you worry. But you already know that this tactic is not very successful. If it were, you wouldn’t have a problem with worry!

So how do you become comfortable with uncertainty? The best way to do this is by changing your behavior to act “as if” you are comfortable with it. Examples of this strategy might be:

Not re-reading e-mails before sending them

Going to the grocery store without a list
Going to a new restaurant without reading a

Completing a task at work without asking

someone else to look it over and give their opinion on it
Delegating a task to someone else (and then not checking whether it was

done correctly)

TOOL #4: Rethinking the usefulness of worry

If you have GAD, you probably realize that you are worrying too much, and that this is not a good thing. However, what most people with GAD don’t realize is that they also often believe that worry is actually useful or helpful.

As long as you think that worrying is helpful or useful in some way, you are going to want to keep doing it.

In order to help you manage your worry, it is important to recognize and rethink any beliefs you might have about the usefulness of your worry. After all, your worries might not be as helpful as you think

What are the positive beliefs that people with GAD have about worry? 1. Worrying shows that I am a caring person.

If you believe this, you might think, “because I worry about my family, it proves that I love and care about them”, or “people know me as the worrier; I’m the one who worries and cares for people”.

TIP: You will probably feel anxious when you try these exercises. That is a sign that you are on the right track!

Worrying helps me to be prepared and to problem solve.

Examples of this belief include: “I do well at my job because I worry about things getting

done right!”, and “when I worry about my problems, I am more likely to solve them well”.

Worrying motivates me.

If you believe this, then you might say to yourself, “worrying about my job motivates me

to do well”, or “if I didn’t worry about my health, I would never go to the gym or eat right!”


Worrying protects me from negative emotions.

If you believe this, then you probably think that worrying about bad things is like “money in the bank”; that is, if you worry about bad things now, you won’t be so upset if the bad thing actually happens. An example of this type of belief is, “If something bad happened to my family and I didn’t worry about it, it would come as a surprise, and I wouldn’t be able to handle it”.


Worrying prevents bad things from happening.

If you have this belief, you might think, “I always do well at my job because I worry about it; if I stopped worrying for a day, I would do very badly at my job”, or “if I worry about my family being in a car accident, then they won’t be in one”.

How can you rethink your worries?

Trying to change your beliefs about the usefulness of worry is not as simple as saying “worry is bad”. In order for you to change your beliefs, you need to look at your beliefs and think about whether your worries are doing what you think they are doing.

Here are some questions that you can ask yourself about the worries that you think are helpful:

Questions to Help you Rethink Your Beliefs

Another way that you can rethink the usefulness of your worries is to ask yourself how much you have lost because of worrying. For example:

Has worry affected my friendships or relationships with others? Are people annoyed with me for worrying?

How much time, effort, and energy have I spent worrying? Is it worth it?

How has worry affected me physically? Am I tense all the time, often tired, or do I have trouble sleeping because of my worries?

Worry shows that I am a caring person

Do I know caring people who don’t worry as much as I do? What else besides worry shows that I care?

Worry helps me to be prepared

Am I confusing worrying (in my head) with actually doing something (for example, actually solving problems rather than worrying about them)?

Do I know people who are organized and prepared who don’t worry as much as I do?

Worry motivates me

Am I really more motivated when I worry?

Has worrying ever actually prevented me from doing the things I want to do? (for example, worrying so much about being healthy that you actually avoid the gym?)

Worry protects me from negative emotions

If something bad did happen, would I really not be as upset?

Has anything bad ever happened in my life? Did I really feel more prepared to deal with it because I worried about it?

Worry prevents negative outcomes

Has anything bad ever happened in my life even though I worried about it?

Is there a way that I can test out my theory, by worrying one day and seeing what happens, and then not worrying another day?

If you find that your worries are not so helpful, that they are not doing what you think they are, and that they have cost you a lot in your life, then you can choose to learn new skills to manage your worry.

If you still believe that your worries can be helpful from time to time, ask yourself the following question: is it possible to gain the benefits I get from worrying in a way other than through worry? For example, can I be a caring person and not worry? Can I be organized, prepared, and motivated without worrying all the time? If you think that it is possible to get the benefits without the worry, then you too can choose to learn new skills to manage your worry.

Improving your problem-solving ability

Remember when you started classifying your worries as being about current problems or hypothetical situations? One of the reasons you did this was because we manage these two worry types differently.

The best way to deal with worries about current problems is to use problem-solving skills and solve the problem!

Many people with GAD think that they are problem solving when they are worrying; in fact, the opposite is usually true. That is, when you worry, you are going over a problem in your head...but problem solving is active! It involves getting out of your head and carrying out a solution. Often, when people with GAD worry about a problem they will get so anxious about the problem that they avoid actually solving it, or they procrastinate.

Learning ways to improve your problem-solving ability will help you in two ways:

  1. You can start solving your problems, rather than worrying about them. This will likely make you feel less anxious, and for every problem you solve, you have one less thing to worry about.

  2. Because finding a solution to real-life problems almost always involves some uncertainty, you will also be learning to become more comfortable with uncertainty each time you use your problem-solving skills.

Writing a worry script

Unlike worries about current problems, using problem-solving skills is usually not very effective in dealing with worries about hypothetical situations. For example, no amount of problem solving will help you to deal with worries about developing a serious illness later on in life.

For these types of worries, the best technique is to write a worry script every day for a week or two.

What is a worry script?

A worry script is like a journal entry, where you write about your worry, and what you are afraid will happen. For example, if you are afraid of developing a serious illness, you might write in your worry script about how afraid you are of becoming sick, what you fear might happen, such as being in a hospital, being forgotten or abandoned by family, and missing out on all the great opportunities in life.

What will a worry script do?

Writing a worry script will help you to experience the negative emotions associated with your fears and worries, rather than avoid them. Although this will feel uncomfortable at first, research shows us that when you face your fears in this way, your anxiety and worries will go down over time. A worry script also helps you to imagine what your feared outcome would actually look like, rather than thinking about it in “fuzzy”, “blurry”, or imprecise ways.

REMEMBER: The only way to get over anxiety is to go straight through it! Most of these skills will probably make you feel more anxious

when you first try them. Whenever we try something new or different, we

usually feel anxious. This does not mean that you are doing something wrong. It means that you are starting to face your fears and get over them.

Building on bravery

Remember that any progress you make in managing your worry and anxiety is due to your own hard work. If you are noticing improvements, take the time to give yourself some credit: reward yourself!

The best way to see your progress is to record all the work you do using your worry management skills. For example, write down the problems you solved, and record

whether you are worrying less about that topic afterward. If you have been practicing becoming more tolerant of uncertainty, write down all of the exercises you did, and rate how anxious the exercise made you (on a scale from 0 to 100). If you practise regularly, you will notice these anxiety ratings go down, and what was once hard will start becoming easier.

How do you maintain all the progress you made?


The worry management skills presented here are designed to teach you new and more effective ways of dealing with your worry. If you practice them often, they can become new habits that are a part of your daily routine.

Like an exercise program, it is important to “keep in shape” even when you are feeling better and have reached your goals.

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