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2 Illustration of the vicious cycle at play between anxiety disorder and substance use disorder symptoms in co-morbid individuals. Note: This model is also referred to as the 'mutual maintenance' model
Source publication
In this concluding chapter to the volume, we first provide a theoretical integration of the material contained in the initial two sections of the book. We review models, theories, and mechanisms to account for the high co-morbidity of anxiety and substance use disorders including notions involving self-medication, substance-induced anxiety, and thi...
Citations
... Experiencing alcohol use problems and anxiety during early adulthood has been linked to a range of serious negative consequences, including educational and employment setbacks (early school leaving, reduced educational attainment, unemployment, absenteeism), strained relationships (professional, peer, intimate) and elevated risk of self-harm and suicide [11,12]. Concerningly, alcohol use and anxiety disorders commonly co-occur [13] and exacerbate each other in a self-perpetuating cycle [14][15][16], resulting in more severe symptoms and greater impairment than either disorder alone [14,17]. The co-occurrence of these disorders can also hinder treatment and recovery, as clinical trials indicate that standard single-disorder treatments are less effective for individuals with this comorbidity [14,[18][19][20][21]. ...
Background and aims
Alcohol use and anxiety often co‐occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and cost‐effectiveness of a web‐based, self‐guided alcohol and anxiety‐focused program, compared with a web‐based brief alcohol‐focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects.
Design
This RCT will be conducted with a 1:1 parallel group.
Setting
The study will be a web‐based trial in Australia.
Participants
Individuals aged 17–30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety ( n = 500) will be recruited through social media, media (TV, print) and community networks.
Intervention and comparator
Participants will be randomly allocated to receive a web‐based, integrated alcohol‐anxiety program plus technical and motivational telephone/e‐mail support (intervention) or a web‐based brief alcohol‐feedback program (control).
Measurements
Clinical measures will be assessed at baseline, post‐intervention (2 months), 6 months (primary end‐point), 12 months and 18 months. Co‐primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge‐drinking frequency; alcohol‐related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post‐intervention), health‐care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention‐to‐treat framework. The economic evaluation will analyze individual‐level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change.
Comments
This will be the first trial to test whether a developmentally targeted, web‐based, integrated alcohol‐anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol‐anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost.
... Substance use and its impact on the neurotransmitter can make them vulnerable to other organic changes that have clinical signs and symptoms similar to anxiety disorders [9]. The particular pathway anxiety disorders that happen in the central nervous system varies based on the type of substances [10]. Determining the occurrence of anxiety disorders unrelated to substance use is crucial because substance use has complicated physiological and psychological effects that make it challenging to distinguish from the symptoms of anxiety disorders [3,11]. ...
Introduction
Anxiety disorder is an unpleasant emotional feeling with symptoms related to psychological and autonomic symptoms such as headache, perspiration, palpitations, dizziness, and stomach discomfort. The use of substances become a worldwide problem among youth which brings situation that leads to serious social and health-related problems. Anxiety disorders with substance use have a huge impact on their high prevalence, therapeutic issues, and poor prognosis on clinical effects. Although the prevalence of anxiety disorders is significant among young people who use substances, limited studies were conducted. Therefore, this study revealed the burden of anxiety disorders among youth with substance use and associated factors in Ethiopia.
Method
A community-based multi-stage with a simple random sampling technique was conducted. A total of 372 substance users study participants were recruited for this study. Alcohol, Smoking, and Substance Involvement Screening Tests, Depression Anxiety Stress Scales, and other tools were used to assess anxiety disorders with substance use and associated factors. Data were entered into Epi-data version 4.6, and exported to SPSS version 20 for further analysis. Bi-variables logistic regression analysis was employed to identify variables with a p-value of < 0.2 and associated factors were determined in multi-variables logistic regression analysis with a p-value < 0.05 with AOR and CI.
Results
From a total of 372 respondents the overall prevalence of anxiety disorders with substance use was 48.1%. Male sex [AOR = 1.99; 95% CI: (1.01–3.93)], low educational status of the father [AOR = 6.38 95%CI: (1.50–7.08)], and the presence of stress [AOR = 2.48; 95% CI: 2.48(2.43–4.40)] were significantly associated factors with anxiety disorders with substances use.
Conclusions and recommendations
The prevalence of anxiety disorders with substance use was 48.1% therefore; it is recommended that the zonal administration give collaborative work with the health bureau and facilitate awareness creation about the impact of substance abuse. Clinicians are recommended to mitigate anxiety disorders with substance use to get a good prognosis for clients with controlling their stress.
... Background Social anxiety and alcohol use disorders are 2 substantial public health issues and are among the leading causes of the global burden of disease [1,2]. When they co-occur, there is typically a mutually reinforcing relationship between the disorders that maintains and exacerbates both conditions in a vicious feed-forward cycle (ie, people drink to reduce anxiety in the short term; however, the consequences of drinking, such as shame, guilt, and alcohol withdrawal, lead to greater social anxiety in the long term) [3][4][5]. This cycle continues and compounds, leading to a greater severity of symptoms, functional impairment, and poorer response to standard treatments [3,[6][7][8][9]. ...
Background
Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample.
Objective
This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU).
Methods
The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline.
Results
Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes.
Conclusions
Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world.
Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131
International Registered Report Identifier (IRRID)
RR2-10.2196/28667
... In addition, the RI-CLP models can examine if the influence of time-invariant variables (such as distress tolerance) varies across different time points (Mulder & Hamaker, 2021). Because somatic symptoms might be correlated with substance use (Stewart & Conrod, 2008), the current study also included the association between somatic symptoms and substance use. Because perceived stress is associated with aggression, substance use, and somatic symptoms, stress has been included in the current study as a timevarying covariate. ...
The current study examined the state- and trait-level associations of psychological and physical aggression to somatic symptoms, and alcohol and drug use and tested the influence of distress tolerance on these associations, while controlling for stress, sex, and minority status. A naturalistic observation was used to collect data with a sample of 245 college students at three time points with 2 weeks apart. Random-intercept cross-lagged panel models were used to disaggregate within-person effects (autoregressive and cross-lagged effects) from the between-person (latent trait-level) associations. The findings revealed that there were autoregressive effects of psychological aggression between Time 1 (T1) and Time 2 (T2) and of physical aggression between T1 and T2. There was a bidirectional association between psychological aggression and somatic symptoms at T2 and Time 3 (T3), in which T2 psychological aggression predicted T3 somatic symptoms and verse vera. T1 drug use predicted T2 physical aggression, which in turn predicted T3 somatic symptoms, indicating physical aggression being a mediator between earlier drug use and later somatic symptoms. Distress tolerance was negatively associated with psychological aggression and somatic symptoms, respectively, and such an influence did not differ across time occasions. The findings indicated the importance of incorporating physical health in the prevention and intervention of psychological aggression. Clinicians may also consider including psychological aggression in the screening of somatic symptoms or physical health. Empirical-supported therapy components for enhancing distress tolerance may help mitigate psychological aggression and somatic symptoms.
... Based on the negative reinforcement model (Baker et al., 2004), the prepotent motivation of addiction may include escape and avoidance of negative affect (e.g., social anxiety and FoMO), which may be the key factor for the occurrence, maintenance, and relapse of addictive behaviors (Melodia et al., 2022). In addition, the interaction model of anxiety and addiction posits a vicious cycle when anxiety triggers individuals' addictive behaviors and then addiction further intensifies the anxiety (Stewart & Conrod, 2008). The network of GD, risk factors (i.e., social anxiety and fear of missing out), and protective factors (i.e., resilience, authenticity, and family closeness) also provided support to the I-PACE model (Brand et al., 2019), in that low family closeness, low level of resilience and authentic living (i.e., individual's core characteristics), and high social anxiety, FoMO, self-alienation, and accepting external influence (i.e., negative affective and cognitive responses) may cause GD and further become a vicious cycle. ...
Unlabelled:
Research has demonstrated that some risk and protective factors of gaming disorder (GD) have been identified. However, the interaction of GD with risk and protective factors has rarely been examined from a network analysis perspective. Therefore, the present study examined the relationships between GD, risk factors (i.e., social anxiety and fear of missing out), and protective factors (i.e., resilience, authenticity, and family closeness) utilizing a network analysis approach among a sample of Chinese university students. A cross-sectional study with 1364 participants was performed using the Gaming Disorder Test, the short version of Social Interaction Anxiety Scale (SIAS), the Chinese Trait-State Fear of Missing Out Scale (T-SFoMOSC), the Brief Resilience Scale (BRS), the Authenticity Scale, and a single item assessing family closeness. Social anxiety, FoMO, and two factors of authenticity (i.e., self-alienation and accepting external influence) had positive relationship with GD, while resilience, authentic living, and family closeness had negative relationship with GD. Social anxiety was identified as the core node in the domain-level network. The item "continuation or escalation of gaming" (gd3) and the item "gaming problems" (gd4) constituted the highest edge weight in the facet-level network. The network comparison demonstrated there were no significant differences in relation to network structures and global strengths between gender. The findings suggest bivariate relationships among GD, risk factors (i.e., social anxiety and fear of missing out), and protective factors (i.e., resilience, authenticity, and family closeness). Interventions for GD must be considered through preventing risk factors and increasing protective factors including improving the gaming motivation and maladaptive cognition to decrease negative emotion (e.g., social anxiety and FoMO), enhancing resilience, authentic living and parent-child relationship, as well as decreasing self-alienation and accepting external influence.
Supplementary information:
The online version contains supplementary material available at 10.1007/s11469-023-01049-3.
... McEvoy and Hyett et al. (2022) observed significant within-treatment effect sizes on "social interaction anxiety" in a sample taken from a community health center studied in two treatment groups: "imagery-enhanced CBT" (N = 53) or "verbally-based CBT" (N = 54). Conrod et al. (2008) found that CBT techniques are effective in lowering anxiety sensitivity as a preventative measure for alcohol use disorder (Schmidt et al., 2004;Watt et al., 2006). Buckner et al. (2007) discovered that anxiety sensitivity is positively associated with emotional disorders and SUDs, while distress insensitivity and various aspects of emotion dysregulation moderate their associations (Wolitzky- Taylor et al., 2015Taylor et al., , 2022 and may increase the risk of substance use to avoid or alleviate frustration. ...
The present research was carried out to find out impact of Cognitive-Behavioral Therapy or CBT on "alexithymia and anxiety" scores in heroin (opioids) addicts. Heroin is a lab-produced, higher-level substance that is made from raw opium, a dried, tar-like black substance that is a dried form of a milky chemical of poppy fruit. The chemical bond between opioids and dopamine receptors in the brain and throughout the central nervous system (CNS) has an immediate effect. A sample of 60 male heroin addicts (mean age: 27.2) was taken from two Substance Dependency Counseling Centres in the Punjab, India. After the subjects took a pre-test and signed a consent form, they were randomly put into one of two groups: I, a control group with 30 people, or II, an experimental group with 30 people. The subjects in the control group were on medications only and did not receive CBT or other interventions. Subjects in Group II, who were also on medication, were given 3 sessions of CBT per week for 30 days (total sessions = 12). Both groups were tested for alexithymia and anxiety symptoms before and after a 30-day period. The results were calculated using a t-test. The findings revealed that heroin addicts in the experimental group experienced a significant (p value, < 0.01) reduction in anxiety and alexithymia mean scores when compared to the control group.
... The associations between social distancing stress and e-cigarette use may be linked to e-cigarettes being used to cope with this stress [60][61][62]. Similarly, respondents with depression/anxiety may have increased e-cigarette use as a form of self-medication [63]. ...
... Furthermore, the pandemic itself has shown to increase psychological distress and contracting COVID-19 can also lead to neuropsychiatric symptom manifestation (e.g., depression, anxiety, insomnia, post-traumatic stress disorder) [69]. The concurrent use of e-cigarettes and alcohol and/or cannabis may therefore lead to downstream adverse mental health outcomes, which can in turn increase substance use as a form of self-medication-creating a cycle of substance use and mental health symptoms [63]. Improving interventions or efforts geared toward reducing the use of these substances may help decrease the associated health risks, including the risks for COVID-19 and its immediate and long-term effects. ...
Background:
Although several studies examined the association between e-cigarettes, substance use, and mental health conditions, there is limited research on whether COVID-19-related stress and health outcomes, mental health symptoms, and substance use differ by the frequency of e-cigarette use during the COVID-19 pandemic. We assessed the association of past 30-day frequent use of e-cigarettes with alcohol, cannabis, anxiety/depression, and COVID-19 impact.
Methods:
We conducted a national online cross-sectional survey among a random sample of US adults aged 18 years or older (N = 5065) between 13 May 2021, and 9 January 2022. A multinomial logistic regression analysis was performed to assess the study aims.
Results:
Of the participants, 7.17% reported once to several times per month (OSTPM), 6.95% reported once to several times per week (OSTPW), and 6.57% reported every day to several times per day (ESTPD) use of e-cigarettes in the past month. Alcohol and cannabis use ESTPD and once to several times per week/month (OSTPW/M) were associated with a higher likelihood of e-cigarette use ESTPD and OSTPW/M, respectively. Anxiety/depression was associated with e-cigarette use ESTPD and OSTPW. Individuals who considered social distancing to be stressful were more likely to use e-cigarettes ESTPD and OSTPW/M compared to those that considered social distancing as not stressful.
Conclusion:
Individuals who engaged in the frequent use of alcohol or cannabis, had depression/anxiety, and considered social distancing to be stressful were more likely to engage in frequent e-cigarette use. Improving efforts geared toward reducing the use of substances may help decrease the health risks associated with e-cigarette use.
... In order to reduce negative emotions such as anxiety and depression, individuals with SUD are prone to more frequent drug use behaviors, and drug use and withdrawal reactions further increase negative emotions. This "vicious cycle" is an important reason for high relapse rate (Stewart & Conrod, 2008). Under the influence of gender norms, men are more likely to suppress "soft" emotional expressions such as sadness and anxiety, externalizing internal emotions into behavioral problems such as substance abuse and aggression (Cole et al., 1994;Cole et al., 2003). ...
Individuals with substance use disorder (SUD) tend to have attention bias to drug and negative emotions, which leads to drug craving and relapse. This study examines attentional bias from the time dimension, and adopts the rapid sequence visual presentation (RSVP) paradigm to study the attentional blink effect of individuals with SUD towards different types of negative words. A total of 55 males with SUD were recruited from a compulsory drug rehabilitation center in Jiangxi Province. The results indicated that the following: (1) The accuracy of T2 recognition when T1 was correctly recognized (T2|T1) increased with the increase of the time interval, indicating that the attentional blink was successfully induced. (2) When T1 was addictive vocabulary, compared with the neutral vocabulary, the attentional blink effect of males with SUD was enhanced. When T2 was negative addiction vocabulary or negative vocabulary, compared with the neutral vocabulary, the attentional blink of males with SUD was weakened. The current research results not only find that males with SUD have an attention bias towards addiction clues from the time characteristics of the attention process, but also it is of great significance to guide the rehabilitation centers to improve the craving and relapse of males with SUD by reducing the appearance of negative addictive information.
... The self-medication hypothesis of addictive disorders posits that PWID expresses self-regulation difficulties, so they use it to mitigate their anxiety and depression (Khantzian, 1985). Further, Stewart and Conrod (2008) view of anxiety and substance use suggests that anxiety causes individuals to develop more drug use behaviors, and drug use further exacerbates anxiety. For example, a study of marijuana users showed that although anxiety levels of the users were somewhat higher before marijuana use, they did not decrease significantly after marijuana use (Buckner et al., 2012). ...
Drug use is a severe problem in China. It had been demonstrated that negative emotions such as anxiety and depression are crucial factors associated with drug addiction and drug relapse. Mindfulness originated from the eastern culture has gotten researchers’ fervent attention for its positive role in emotion improvement and detoxification. The current study investigated the relationship between mindfulness and negative emotions (i.e., anxiety and depression) and the possible mediating roles of social support and resilience in their relationship among Chinese females who inject drugs (FWID). Two hundred and two FWID from mainland China were recruited in this study. Levels of mindfulness, social support resilience, anxiety, and depression were measured by self-report. Results showed that FWID with higher levels of mindfulness might undergo lower anxiety and depression as they had higher levels of resilience, but social support was not a mediator between mindfulness and resilience. Findings showed the mediation role of resilience in the association between mindfulness and anxiety, and the association between mindfulness and depression. Implications in mindfulness intervention and limitations are discussed.
... Notably, the sample sizes of these studies are relatively small (around 20 participants in each study), and the duration of MMT is relatively short or not specified. There is also a lack of investigation on the relationship between attentional bias and demographic, therapeutic, and neuropsychological factors in the patients, for instance, anxiety and impulsivity, which are known to be associated with substance use and addiction (22)(23)(24)(25). ...
... Notably, the sample sizes of studies of opioid-addicted patients under MMT are relatively small (around 20), and the duration of MMT is relatively short or not specified (20,21). Moreover, there is a lack of investigation on the relationship between attentional bias and demographic, therapeutic, and neuropsychological factors in the patients, for instance, anxiety and impulsivity, which are known to be associated with substance use and addiction (22)(23)(24)(25). ...
Objective: Abnormal selective attention to drug cues and negative affect is observed in patients with substance dependence, and it is closely associated with drug addiction and relapse. Methadone maintenance is an effective replacement therapy to treat heroin addiction, which significantly reduces the relapse rate. The present study examines whether the patients with opioid use disorder on chronic methadone maintenance therapy exhibit abnormal attentional bias to drug cues and negative-affective cues. Moreover, its relation to therapeutic and neuropsychological factors is also examined.
Methods: Seventy-nine patients with opioid use disorder under chronic methadone maintenance therapy and 73 age-, sex-, and education-matched healthy controls were recruited and assessed for attentional bias to drug cues and negative affect using a dot-probe detection task. Correlational analysis was used to examine the relationships between the attentional bias and the demographic, therapeutic, and neuropsychological factors.
Results: No significant overall patient-control group difference is observed in drug-related or negative-affective-related attentional bias scores. In the patient group, however, a significant negative correlation is found between the attentional bias scores to negative-affective cues and the duration of methadone treatment (p = 0.027), with the patients receiving longer methadone treatment showing less attentional avoidance to negative-affective cues. A significant positive correlation is found between the negative affect-induced bias and the impulsivity score (p = 0.006), with more impulsive patients showing higher attentional avoidance to negative affective cues than less impulsive patients. Additionally, the patients detect a smaller percentage of probe stimuli following the drug (p = 0.029) or negative-affective pictures (p = 0.009) than the healthy controls.
Conclusion: The results of the present study indicate that the patients under chronic methadone maintenance therapy show normalized attentional bias to drug and negative-affective cues, confirming the involuntary attention of the patients is not abnormally captured by external drug or negative-affective clues. Our findings also highlight that the attentional avoidance of negative-affective cues is modulated by the duration of methadone treatment and the impulsivity level in the patients.
