Anxiety May Not Need A Pill For Relief
By Barbara Schrodt
Drug Addiction Treatment:
We live in a society that sells a pill for each time we are the least bit uncomfortable. Therefore,
it is not unusual that patients in chemical dependency treatment centers arrive addicted to all kinds of pills.
One fairly common class of medications is those prescribed to treat anxiety symptoms.
Although medication can help reduce anxiety symptoms, it comes at a cost. Many of the medications used to treat anxiety
symptoms are addictive and anxiety medications do not fix anxiety problems, they simply manage the symptoms temporarily.
A number of patients who are prescribed addictive medication to treat anxiety become addicted to that medication and eventually find
themselves in treatment, perhaps even for an addiction to another substance.
While in treatment, the staff has choices in helping reduce the patient/client’s anxiety:
- Continue the anxiety reducing medication that the patient has become addicted to.
Certainly, the patient is already familiar with that drug and may experience less anxiety staying on it rather than anticipating a medication change.
This is likely the least common option… trying to help a person who is addicted resume taking their addictive medication as prescribed by their physician.
Let’s use Xanax, a common anti-anxiety medication, as an example. The generic name for Xanax is Alprazolam and it is classified as
a “benzodiazepine tranquilizer, a central-nervous system depressant….[that] can be addictive….and drug withdrawal may develop if you stop taking it
after only 4 weeks of regular use. (a)” For some individuals, it is difficult to use the medication only as prescribed. For some patients, this
medication also appears to whet the appetite for other addictive substances, such as alcohol. As one might guess, addictive
medications are rarely continued once a patient enters chemical dependency treatment. They are also very risky to use when a patient is in recovery,
since using these types of anxiety medications can significantly increase the risk for relapse to not only other benzodiazepines,
but also other addictive substances (e.g., alcohol).
- Switch to a non-addictive medication to treat the anxiety.
Giving a new patient a different medication which is non-addictive can ease the initial concern the anxious patient experiences in a treatment setting.
A medication that will sometimes be prescribed is Vistaril, also known as Hydroxyzine. Sometimes prescribed for allergy symptoms or nausea,
Hydroxyzine is an antihistamine “with antianxiety, muscle-relaxing, antiemetic (antivomiting) bronchial-dilation, pain-relieving, and antispasmodic properties.
Hydroxyzine has been used to treat a variety of problems including…acute emotional problems, anxiety associated with stomach and
digestive disorders,...(b).” Other non-addictive anxiety medications used for treating anxiety symptoms include Buspar, some antidepressants,
and beta-blockers. As noted above, these medications generally do not “cure” the anxiety disorder, but instead treat the symptoms.
If a person with anxiety stops taking these medications, often the anxiety symptoms return.
- Teach the patient Behavioral Modification Techniques.
This strategy involves helping a patient learn to manage and reduce the anxiety symptoms by changing the way they think
about those symptoms and react to them. A more comprehensive look at this strategy may be beneficial.
First, it is imperative to validate the anxiety the patient feels. The patient will not trust the clinician to
offer solutions if the anxiety he/she feels is minimized or treated casually by the clinician.
Finding out how long the anxiety has been a problem and when it began may offer a therapeutic clue.
Discovering the beginning of this problem may disclose an event or a trauma that has never been fully worked through.
Helping the patient have a safe place to fully discuss this event or trauma can offer some resolution for what kicked
off a response that has now become problematic on its own! Helping the patient identify how long the anxiety has been
occurring offers a chance for the Clinician to offer comfort to the patient for how long he/she has been suffering and attempting to deal with this condition.
Education about addiction can be extremely important. For instance, many of the new patients in a drug-alcohol treatment facility do
not yet realize that mounting anxiety can be one of the results of progressed addiction or detox
In assessment quizzes many years ago, the questionnaire asked, “Do you suffer from indefinable fears?” When addiction
is the root cause of the anxiety, the condition tends to begin to recede as withdrawal completes and the patient finds
himself/herself in a safe and supportive environment.
Offering the patient another word for anxiety can sometimes help. Replacing the medical/psychiatric term “anxiety” with “fear”
can allow the patient to have a regular feeling word that begins to normalize the condition.
Then, it may be easier for the patient to discuss what it feels like for him/her. Helping the patient discuss whether
the things he/she fears are likely to occur, may give him/her some perspective, even though the fear can yet remain very high at this point of the therapy.
It is helpful to give the patient permission to sit near an exit and to be able to excuse himself/herself and leave the gathering if the fear mounts too greatly.
This permission often reduces the fears sufficiently so that the person rarely leaves the group therapy or the treatment lectures after
receiving permission to do so. In fact, it empowers the individual so much that frequently the patient will soon report he/she feels strong
enough to move forward in the setting, abandoning the need to sit near the door now.
Teaching the patient positive self talk can help. “This, too, shall pass” is an AA Slogan that has helped many people realize this awful
feeling is not going to last forever. “God is bigger than my fear” is another statement that can become reality to the person repeatedly murmuring it.
A simple sturdy rubber band has been known to have a calming effect on some anxious individuals.
When the loose band is placed upon the patient’s wrist, the instructions can be simple,
“When you are tense or anxious, grasp this band and toy with it, placing your anxiety in this rubber band.”
A patient whom I worked with successfully completed treatment, and still sober, returned three months later to report
to me that he hadn’t taken off the rubber band, and that he uses it as a reminder he doesn’t have to be that anxious again.
Helping the patient to be empowered is an important part of the clinician’s task.
Empowering the patient to learn to reach out and touch something real, such as the rubber band, or even the surface of one’s desk,
or the nearby tree while crossing campus, can help the individual make contact with something even more real than the feelings he/she fears.
It is not a surprise to the practiced clinician when the originally very anxious patient approaches the clinician to report,
“I’ve decided I don’t need to take the Vistaril anymore. I am really doing fine on my own now!”
When the patient learns to manage his/her tension and anxiety, there comes the freedom to believe that perhaps he/she can also
deal with other life stressors without the need to resort to another drink or addictive drug. Recovery has begun.
- The Pill Book, 11th Edition, Production CD Publishing, A Division of Current Directions, Bantam Books, 2004, pp. 55, 56.
- The Pill Book, 11th Edition, Production CMD Publishing, a Division of Current Medical Directions, Bantam Books, 2004, pp. 547, 548.
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