×

Overcoming fear, anxiety in long-term aftercare

Editor’s note: This is the second installment of a three-part series that addresses the emotions that those in recovery come to experience once their brains are free of chemicals and begins to heal, and why long-term aftercare is essential to avoiding relapsing.

The number of long-term members, “Oldtimers” as they are referred to, of 12-step programs demonstrates that long-term sobriety is possible; many Oldtimers count their years of sobriety in decades. They all share the statement that there is no cure for addiction.

Even after decades of sobriety, however, many still struggle with bouts of depression and anxiety.

American Addiction Centers’s article, Long-Term Drug Addiction Effects, by Lauren Brande, states that there is a clear association between substance abuse and depression.

This relationship could be attributed to preexisting depression that led to drug abuse or it could be that substance use caused changes in the brain that increased depressive symptoms, the AAC website states.

Addiction is also associated with anxiety and panic disorders, Brande continues. Again, the cause is difficult to discern and can be different among individuals. For one person, they could develop a pattern of abuse after using drugs (e.g., benzodiazepines like Xanax) to cope with their symptoms. Another person could have a longstanding pattern of drug abuse and consequently develop anxiety problems. Many substances, particularly stimulants like cocaine, can cause anxiety as a dose-dependent side effect.

This is that scary term “comorbid.” It simply means that addiction and depression or anxiety (sometimes both) are occurring at the same time.

That is not as bad as it sounds. In fact, psychGuides.com, and American Addictions Center resource, states:

“Depression and addiction are complex and can feel impossible to manage–especially if someone is dealing with them simultaneously. Fortunately, help is available for both disorders.”

In August 2013, the National Center for Biotechnology Information published “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview.”

The article states that there are many paths to recovery from alcohol and SUDs, and one that has been travelled by many and is associated with positive long-term outcomes is involvement in 12-Step and mutual/self-help groups, including Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA) and a number of others), have served as the primary, if not only, source of behavior change for many, as adjuncts to formal treatment, or as a form of continuing care and community support following treatment. These groups are highly accessible and are available at no cost in communities throughout the world, thus serving as important and readily available resources in substance abuse recovery.

Several institutional studies long-term aftercare such as 12-step programs have concluded that those programs are very effective in maintaining long-term freedom from drug or alcohol use. One of the reasons for their success is because they teach people in recovery how to face fears without substances.

One of the things that people in recovery are almost certain to face is fear, states the Alcoholics Anonymous of Cleveland website’s article Fear in Recovery. It is unavoidable. Those who are emotionally sober are no longer interested in hiding from fear. Their focus is on learning to manage it effectively. The website goes on to state:

It is natural for people to experience a bit of fear in their life. It can make them cautious and ensure that they make better decisions. Excessive fear in recovery can be problematic for the following reasons:

Too much fear prevents people from taking needed action. This can easily lead to relapse.

Excessive fear prevents people from thinking clearly, leading them to make poor decisions.

Fear can lead to stress (anxiety), and this can damage people physically and mentally.

Fear can be used as a justification for a relapse.

A person who is full of fear will feel unsatisfied in recovery.

Fear can stop the individual from developing emotional sobriety.

Ned H. Kalin, M.D.’s May 2020 article, The Critical Relationship Between Anxiety and Depression, published on the American Journal of Psychiatry’s webpage Psychiatry Online site, stated:

Based on statistics from the Substance Abuse and Mental Health Services Administration, the 12-month prevalence of major depressive disorder in 2017 was estimated to be 7.1% for adults and 13.3% for adolescents.

It’s also possible to have both depression and anxiety at the same time, Kimberly Holland and Crystal Raypole wrote in their article Depression and Anxiety: How to Identify and Treat Coexisting Symptoms, posted on healthline.com A worldwide survey from 2015 found that 41.6% of people reported having both major depression and an anxiety disorder during the same 12-month period.

The National Institute of Health Sciences reported that an estimated one-third of people with depression also have an alcohol problem.

“For those struggling with depression who feel there is no end in sight, drugs and alcohol may sometimes appear to be an easy solution to their problems,” states the Addiction Center’s article, Depression. The article goes on to state that many elements of depression overlap with the signs of addiction, making it essential that people get the appropriate care and treatment for both disorders.

“In 12-step programs, recovery addresses many areas of concern including relief of the depression, anxiety, or panic attacks often by using medication; recognition of how one’s behavior has contributed to the problem,” reported Arnold Chanin, M.D., in his article, Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology, posted in August 2000, on the website of the National Center for Biotechnology.

“In meetings, core problems are shared with others who have direct experience,” Chanin wrote. “When this is done in a group context, the burden is significantly reduced.”

Twelve-step programs strive to go far beyond acutely painful problems and achieve lifelong growth and health, Chapin wrote. Consequently, this is not “band-aid” work. It takes years of regular attendance and participation. There are workshops, retreats and regional, national and world conferences.

“For a patient who has never been able to openly share with others,” he explained, “attending a weekend retreat or conference, speaking to a large group about their recovery and articulating and summarizing their life story in a 20- or 30-minute presentation, is quite an experience.”

Resources

• The article “12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview is available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/

• The article Fear in Recovery is available at: https://www.aacle.org/fear-in-recovery/

• The article The Critical Relationship Between Anxiety and Depression is available at https://ajp.sychiatryonline.org/doi/10.1176/appi.ajp.2020.20030305

• The article Depression and Anxiety: How to Identify and Treat Coexisting Symptoms is available at https://www.healthline.com/health/mental-health/depression-and-anxiety

• The article Depression is available at https://www.addictioncenter.com/addiction/depression-and-addiction/

• The article Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181125/#:~:text=In%2012%2Dstep%20programs%2C%20recovery,commitment%20to%2012%2Dstep%20principles

Newsletter

Today's breaking news and more in your inbox

I'm interested in (please check all that apply)
Are you a paying subscriber to the newspaper? *
   

Starting at $4.62/week.

Subscribe Today