James Donaldson on Mental Health – Parents Guide to Co-occurring Substance Use and Mental Health Disorders (Pt.4)

It’s perfectly normal for young people to have some amount of anxiety. We start calling it an anxiety disorder when anxious feelings escalate to a point that they interfere with a young person’s ability to handle everyday situations, and can prevent them from enjoying “normal” activities.

Here are some types of anxiety in teens and young adults:

• Generalized anxiety is when children worry excessively about everyday things. Youth with generalized anxiety often struggle with perfectionism.
• Separation anxiety causes excessive worry when young adults are separated from their caregivers, including fear of losing parents and fear of being alone. This is more common in younger children, but can also affect tweens and teens.
• Social anxiety causes teens and young adults to be excessively self-conscious in social situations. Often, social anxiety will inhibit their ability to engage with peers.
• Specific phobia is a fear of a particular thing, like dogs, heights, blood or needles.
• Panic disorder is characterized by sudden, unpredictable panic attacks. A young person experiencing a panic attack may have feelings of impending death or doom and symptoms similar to a heart attack.

Until recently, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) were classified as anxiety disorders. Young people with OCD have unwanted thoughts that they try to get rid of by practicing ritualized behaviors, such as obsessive hand-washing, counting, or lining things up. PTSD symptoms develop after a disturbing event and can include detachment, difficulty sleeping, irritability and reliving the event. While not technically considered anxiety disorders, young people with OCD and PTSD do struggle with feelings of anxiety.

Signs of Anxiety Disorders

Some symptoms of anxiety disorders are:

• Trouble sleeping
• Complaining about stomachaches or other physical problems
• Avoiding situations
• Exhibiting clingy behavior around parents or caregivers
• Trouble focusing in class or being very fidgety
• Disruptive behavior and explosive outbursts
• Overly self-conscious behavior

Anxiety disorders are often difficult to spot in young people. Some experts call anxiety the “great masquerader” because the symptoms can seem like something else. Disruptive or antisocial behavior can be a cover for anxiety. Kids who constantly seek reassurance, are overly hard on themselves, or who cope by escaping into social media or video games may be dealing with severe anxiety.

Treatment for Anxiety Disorders

Anxiety disorders can be treated with behavioral therapy, medication, or a combination of the two.

Most often, anxiety disorders are treated with cognitive behavioral therapy (CBT), which addresses a young person’s worries and patterns of distorted thinking. Exposure and response prevention is one type of CBT often used to treat anxiety. In this type of therapy, young people are exposed to anxiety triggers gradually, in a safe setting. As they become accustomed to each of the triggers, the anxiety fades.

Medication can alleviate symptoms of anxiety and may make behavioral therapy more effective. SSRIs, or selective serotonin reuptake inhibitors, have proven effective at managing anxiety. Fast-acting medications called benzodiazepines (e.g. Xanax, Klonopin) are sometimes used to treat acute anxiety but are not helpful for reducing symptoms in the long-term. They also carry a risk of dependence and are generally not recommended if someone has a co-occurring substance use disorder due to the risk of addiction or overdose if used in combination with alcohol or opioids.

Anxiety Disorders & Interaction With Substance Use

Adolescents with anxiety disorders may use drugs and alcohol to temporarily alleviate anxious feelings associated with socializing, having to present in class, or living up to other expectations. When anxious feelings become too much to handle, alcohol and drugs allow them to feel better for a short period of time.

However, using substances can complicate the treatment of anxiety. Because the effects of the substance cover up or mask the anxiety symptoms, it becomes that much more difficult to assess the disorder and provide appropriate treatment.

Additionally, adolescents who use alcohol or drugs to alleviate anxiety symptoms may feel their anxiety is more intense when they aren’t using. This can lead to a pattern of increasing use that can lead to dependence and addiction.

Untreated, anxiety disorders also present long-term risks for substance use or misuse. The good news is that identifying and treating anxiety early can help cut the risk of future substance use disorder in half.