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Week 6 DQ#1 Peer review: What are the unique challenges in treating someone with an anxiety disorder and a substance use disorder? 

Re: Topic 6 DQ 1

          The normal, healthy reactions everyone experiences with stressful or dangerous situation, medical anxiety reacts with persistent, unfounded fears that affect work, close relationships, social activities, and overall satisfaction of life. Both the physical and psychological symptoms require a multidisciplinary clinical approach. Effort to manage or cope it is not unlikely for clients with anxiety to use alcohol, drugs, or tobacco, or behaviors such as overeating. National Institute of Drug Abuse (NIDA) estimates individuals with anxiety to be two times more likely to use alcohol and drugs. Attempts at self-medicating only reinforce the anxiety symptoms, therefore, the individual will use more to compensate. Only creating more psychiatric and physical symptoms and creating a vicious cycle of chemical dependence (American).

Anxiety and Substance Use Disorder (SUD) challenges:

· Greater clinical severity (Wolitzky-Taylor, 2018) – the possibility the client may have a comorbidity of mood or/and anxiety disorder along with a SUD experience greater severity and persistence of symptoms. Treating one may not help the other and increase chance of a relapse (Milosevic, 2017).

· Poorer treatment outcomes (Wolitzky-Taylor, 2018)– during initial screening and after detox, the client may still present anxiety, but may not have the disorder, such when clients are detoxing from a benzodiazepine. Although the use benzodiazepines to help with anxiety is controversial because of further addiction or the client has strong conflicting emotions and attitudes about medication as a sign of weakness (Brady, 2013).

· Although effective treatments are available, most do not receive treatment. Clinical settings of SUD with anxiety prevalence often go untreated (Wolitzky-Taylor, 2018). The clinical settings of SUD only do not evaluate the prevalence of anxiety as an issue as it is prevalent in the AUD withdrawal, which in turn creates an increase in relapse because the anxiety was not treated.

· Relapse rates and treatment drop-out remain high (Wolitzky-Taylor, 2018) - anxiety disorders relate to a higher alcohol use disorder, increased severity of alcohol withdrawal and higher relapse rate following substance abuse treatment (Smith, 2008).

· Functional impairment, disability, higher rates of suicide, and more frequent visits to the emergency room (Milosevic, 2017)

American Addiction Centers. Treating Addiction with Anxiety Disorders. American Addiction Centers. Retrieved from  https://americanaddictioncenters.org/anxiety-and-addiction

Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance Use Disorder and Anxiety: A Treatment Challenge for Social Workers. Social Work in Public Health, 28:407-423.

Milosevic, I., Chudzik, S. M., Boyd, S., & McCabe, R. E. (2017). Evaluation of an Integrated Group Cognitive-Behavioral Treatment for Comorbid Mood, Anxiety, and Substance Use Disorders: A Pilot Study. Journal of Anxiety Disorder, 46, 85-100.

Smith, J. P., & Book, S. W. (2008). Anxiety and Substance Use Disorders: A Review. The Psychiatric times, 25(10), 19-23.

Wolitzky-Taylor, K., Krull, J., Rawson, R., Roy-Byrne, P., Ries, R., & Craske, M. G. (2018). Randomized Clinical Trial Evaluating the Preliminary Effectiveness of an Integrated Anxiety Disorder Treatment in Substance Use Disorder Specialty Clinics. Journal of Consulting and Clinical Psychology, 86(1), 81-88.

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