Dual Diagnosis

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Social Anxiety Disorder and Alcohol Use: I’m SAD! I need a drink!

Being sad is one thing, but suffering from social anxiety disorder (SAD) is a totally different ball game. This is the same way that “wanting” a drink differs from “needing” a drink. When joined with problem drinking, this forms a lethal combination.  For a long time, experts have witnessed that people with anxiety disorders are susceptible to substance abuse and vice versa, but determining which one is the preceding problem has been a stumbling block for diagnosis.

More than just shyness

An individual suffering from social phobia, also known as social anxiety disorder (SAD), has a distinct and sometime irrational fear or anxiety about specific circumstances. According to WebMD, some of these situations include:

  • Speaking in public
  • Eating or drinking in front of others
  • Writing or working in front of others
  • Being the center of attention
  • Interacting with people (i.e. dating, attending parties, etc.)
  • Asking questions or giving reports in groups
  • Using public toilets
  • Talking on the telephone[1]

What causes SAD? Many researchers believe that it might be related to the abnormal functions of the brain circuits that regulate fear and anxiety. Genetics is also thought to play a part in its roots, since social phobia occasionally runs in a family. Other factors include stress and environment.[2]

The fear of making a mistake or humiliating oneself in front of others can be debilitating to a person with SAD. Taking a drink to calm one’s nerves is often used as a coping mechanism.

More common and costly than you think

Anxiety disorders, which affect over 40 million adults (or approximately 18 percent of the population), are the common mental illnesses in the United States.[3] According to the Anxiety and Depression Association of America, an estimated 15 million Americans suffer from SAD.

The disorder often surfaces during the teenage years or early adulthood and is more prevalent in women than men. Although highly treatable, sadly, only one-third of those suffering seek professional treatment.[4]

The economic costs associated with anxiety disorders in the United States are overwhelming. In the 1990, the costs were estimated to be around $46.6 billion. The majority of the expenditures was tied to the loss and reduction of productivity and other indirect costs, instead of treatment.[5]

Symptoms and signs

The symptoms that a person who is suffering with SAD experiences can vary and be difficult to distinguish from other health issues, such as depression and obsessive compulsive disorder. These individuals tends to have negative thoughts about themselves and what will happen to them in social situations. According to the National Institute of Mental Health, some of the common signs are:

  • Anxiousness – especially about being with other people
  • Self-consciousness – worried about how they are perceived by others
  • Extreme fear of embarrassment
  • Excessive worrying – sometimes for days and weeks before an activity
  • Avoidance of places where people hang out in crowds
  • Difficulty establishing and maintaining relationships

Physical signs, which include:

  • Blushing
  • Heavy sweating
  • Increased heart rate
  • Trembling
  • Nausea
  • Hard time talking[6]

Self-medicating

Even after diagnosis, individuals are often leery about seeking professional help. They underestimate the seriousness of their condition and believe that they can fix the problem themselves. Instead of seeking mental health treatment, alcohol and other substance are often used for self-medicating an anxiety disorder. Researchers are investigating just how frequently people are using and abusing self-destructive alternatives to deal with SAD and other anxiety-based disorders.

Individuals self-medicating an anxiety disorder are two to five times more likely to develop an alcohol or drug problem within three years.

A 2011 longitudinal study that includes almost 35,000 U. S. adults revealed that 13 percent of those who had consumed alcohol or drugs during the previous year had done so in order to relieve anxiety, fear or panic. It also found that individuals with a diagnosed anxiety disorder who were self-medicating at the beginning of the research were two to five times more likely to develop an alcohol or drug problem within three years than people who did not self-medicate.[7]

Other results from the three-year study showed that the number of people with an anxiety disorder who developed a substance problem varied depending on the self-medicating substance:

  • With alcohol use – 13 percent developed an alcohol problem
  • With recreational drugs use -“ 10 percent developed a drug problem

A drink won’t help

One of the most frequent self-medicating techniques is alcohol consumption. Individuals turn to alcohol because it help them feel more in control of a given situation or encounter. It also lowers inhibitions and reduces self-consciousness.  In some social gatherings, such as parties and mixers, alcohol is available in abundance.

A 2012 study at Emory University investigated the relationship between SAD and the motives for drinking. The researchers believed that the reasons for drinking are based on the fact that people drink in order to achieve an outcome that is of value to them. The motives can be categorized as:

  • Social: Drinking to aid camaraderie
  • Enhancement: Drinking to have more confidence or to enhance the impact of another drug
  • Coping: Drinking to cope with or escape from stress

The results showed that 13 percent of the participants met criteria for SAD at some point during their lives. It was determined that SAD was a predictor of coping drinking motives, but was not a predictor for social or enhancement motives. The research also revealed that other mood disorders (i.e. depression, panic disorder, and generalized anxiety disorder) also lead to coping drinking motives. [8]

Short-term solution, long-term problems

Self-medicating anxiety with alcohol makes things worse in the long term.Drinking alcohol is only a short-term solution for suppressing anxiety. Initially, drinking may make an individual suffering from SAD have less tension and feel more confident in social situations. However, once the “buzz” wears off, the old anxiety returns. Dr. James M. Bolton, lead researcher in a 2011 study about the effectiveness of alcohol in treating anxiety, stated: “People probably believe that self-medication works. What people do not realize is that this quick-fix method actually makes things worse in the long term.” [9]

Alcohol is a depressant and has an overall detrimental effect on the central nervous system. According to the National Institute on Alcohol Abuse and Alcoholism, regular alcohol use can lead to long-term health problems such as:

  • Stretching and drooping of heart muscles (cardiomyopathy)
  • Irregular heartbeats (arrhythmias)
  • High blood pressure
  • Liver disease/inflammations
  • Certain cancers (mouth, esophagus, throat, liver and breast)
  • Weaken immune system [10]

Additionally, alcohol can interfere with the thinking process. Drinking a couple of glasses wine before a presentation may seem like a way to lessen tension. However, that consumption can lead to making errors and possibly fumbling through the talk, which could increase the anxiety for any future communications. Thus, this compels the anxiously-minded individual to drink even more alcohol and starts a vicious cycle that is difficult to break.

Alcohol is not the answer

If you suffer from SAD, don’t make the mistake of trying to eliminate your problems with alcohol SAD is a psychological disorder and should be treated by medical professionals.  Treating SAD with alcohol leads to additional problems that can destroy relationships with families and friends.

If you or a loved one has already started self-medicating with alcohol, the experts at Behavioral Health of the Palm Beaches can help. With nearly 20 years of experience, our doctors can develop a treatment program that gives you better options to deal with your anxiety issues. Alcohol is not a safe and healthy way to deal with anxiety. Call us at (888) 432-2467 for healthier possibilities.

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The Myth of Drugs and Creativity: Mental Illness’ Role in the Using Artist

Drugs and CreativityThe writer sits at his table, a drink in hand and ready for the downing. The painter stands at her canvas, having recently smoked a bliff, and contemplates the pigments on the surface of her latest work. The musician runs on stage, revved up on coke and ready to wow the crowd.

Whether touted as an emblem of counter-cultural freedom from the restrictive thinking of mainstream society or reputed to stimulate the imagination, drugs and alcohol have been linked with the artistic process for some time now. Both celebrated and aspiring creatives often dabble in drugs at one point or another in their lives. Though emerging from different walks of life, many artists fall into a tradition that began well before the 20th century and that has been maintained by legends like Pablo Picasso, The Beatles, and most recently Prince. Cocaine, methamphetamines, marijuana, alcohol – these are all part of the artist’s toolkit, right?

Not exactly.

A Myth That Enables Addiction

This common trope of drugs as elixirs of creativity is misleading and, when taken too far, irrevocably harmful. America’s favorite horror author Stephen King, who famously struggled with alcoholism and a number of drug addictions throughout his life, has no patience for those who claim that drugs inspire creativity.[1] As he states in On Writing: A Memoir of the Craft, “The idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.” The mystique that drugs hold in society is just that — an illusion.

the idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.

When it comes down to it, King goes on to argue, artists who claim to use illicit substances to stir their creative juices are more-or-less trying to justify their inclination toward such self-destructive behavior. “But I need it to write!” or “I can’t express myself artistically without it” are not valid excuses but are instead symptomatic of a larger problem at hand: abuse and/or addiction. Drugs don’t make artists — they break them.

Stress and its Many Sources

Connection between drugs, alcohol and creativityThough those who abuse and become addicted to drugs are not one in the same and range in socioeconomic status, race, gender and other qualities, what they often do share is stress. Unstable households, physical pain or the pressures from school or work are stressors that can drive individuals to self-medicate through available drugs.

However, mental illness is one of the most prominent sources of stress that pulls people toward abusing substances in attempt to relieve or cope with their conditions. In fact, approximately a third of all individuals who experience a mental illness and about half of people living with severe mental illnesses also have substance abuse issues, according to the National Alliance on Mental Illness (NAMI).[2]

For reasons not yet fully understood, rates of mental illness are also high among artists, and understanding this link may help explain why so many artists are drawn toward drugs.

Mentally Ill or Creatively Inclined? The Two Often Go Hand-in-Hand

bipolar disorder and creativityWhile the belief that creativity is dependent on drugs is, as King put it, just a “pop-intellectual myth,” the stereotype of the tortured artist does have some credence (though is certainly not all-defining). A body of research suggests that there is a strong link between mental illness and creativity. In 2012, Sweden’s Karolinska Institute found that, “People in creative professions are treated more often for mental illness than the general population.” [3]

In one of the most comprehensive studies conducted in this field, the researchers used a registry of psychiatric patients listed for over the past 40 years, containing data on nearly 1.2 million Swedes and their relatives. Analyzing patients with a variety of diagnoses, ranging from schizophrenia and depression to ADHD and anxiety syndromes, they saw that bipolar disorder was the most prevalent among people with artistic and scientific professions, including dancers, researchers, photographers and authors.

The creative figure of the author, however, seemed to be especially burdened by mental disorders more-so than other individuals, artistic or otherwise. The study stated that ‘authors suffered from schizophrenia and bipolar disorder more than twice as often as the general population.’ [4] They were also more likely to be diagnosed with depression and anxiety disorders, and they also had a greater tendency to commit suicide.

Abusing Drugs to Cope with Mental Illness

emotional pain and artSo, we know the facts: a considerable number of artists experience mental illness. Since those who are mentally ill often abuse substances or have substance use disorders, according to the NAMI statistics, it stands to reason that many artists also have drug problems. Though some try to convince themselves that their lingering, preoccupying desire for another hit is a testament to their creative genius, the real story is that many artists cling to substances for a false sense of stability. They want to relieve the distress of their mental disorder left untreated, and too often they turn to drugs as a way of coping. But this only harms them in the long run.

What starts out as a casual experiment can quickly turn into abuse when an illicit substance temporarily dulls emotional pain or provokes euphoric feelings of delight in the user. Eventually, the body and mind can become so dependent on the drug that the user continues to abuse it in order just to function. This is when addiction sets in.

Case Study: Eminem’s Descent into Drug Addiction and His Sober Awakening

Take Eminem, one of the most versatile and provocative artists of the rap and hip-hop world. Though only revealed later in his career in 2008 that he has been grappling with bi-polar disorder for most of his life, his feelings of raw anger and emotional instability were exceedingly clear in his lyrics.[5] He also suffered from prescription pill addiction and even nearly died from an overdose at one point, according to MTV News.[6]

“It’s no secret I had a drug problem,” he was quoted admitting. “If I was to give you a number of Vicodin I would actually take in a day? Anywhere between 10 to 20. Valium, Ambien, the numbers got so high I don’t even know what I was taking.”

Eminem drug addictionAnd how did he get so hooked? Through the psychological and physical relief that the substances instilled in him, countering the near-constant emotional instability that he experienced from his mental illness. “When I took my first Vicodin, it was like this feeling of ‘Ahh.’ Like everything was not only mellow, but [I] didn’t feel any pain,” Eminem says in the documentary How To Make Money Selling Drugs, quoted by MTV News.[7]

“I don’t know at what point exactly it started to be a problem. I just remember liking it more and more. People tried to tell me that I had a problem. I would say, “Get that f____g person outta here. I can’t believe they said that sh_t to me.”

As Eminem’s addiction worsened, his motivation, physical health, and even his ability to string words together deteriorated. MTV News writes that at his lowest the drugs shut off his brain and made him so lazy he preferred watching TV to making new tracks.[8]

After seeking treatment and remaining sober for a year, Eminem came back to the recording studio. In 2009, he released Relapse: an album that openly discussed his struggle with addiction. But he comments that during Recovery, an album released a year later, is when he really began to repair the damage that the drugs took on him despite how impossible it felt at times.

“I had to learn to write and rap again, and I had to do it sober and 100 percent clean,” Eminem told MTV News. “That didn’t feel good at first. I mean it in the literal sense. I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them. I was relearning basic motor skills. I couldn’t control my hand shakes. I’d get in the [recording] booth and tried to rap, and none of it was clever, none was witty and I wasn’t saying it right.”

Yet he did it, creating an award-winning album that stands as a testament to how only sobriety can unlock the true potential of an artist.

Let Our Treatment Help You Find Your Creative Flow Again

Eminem\’s Recovery is dedicated, “Anyone who’s in a dark place tryin’ to 2 get out. Keep your head up… It does get better!”[9] We couldn’t have said it better ourselves.

I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them.

Though the confusion, frustration and emotional agony that can come along with an untreated mental illness and drug addiction can seem insurmountable, there is a way out. Behavioral Health of the Palm Beaches’ dual diagnosis program is sensitive to the hardships unique to both mental health and substance use disorders, and our professionals are experienced in treating both conditions simultaneously.

At our facilities, artists can also continue creatively expressing themselves as a way of working through their conditions. We offer art therapy, music therapy, and expressive writing therapy for those who want to discover what it means to be creative while sober.

Don’t let drug addiction get in the way of what’s important in your life. Contact us at 888-432-2467 to learn more about our addiction help and mental health treatment options and how we can help you or a loved one find the courage to recover.

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