In a response to an earlier post, a woman wrote that her son, an opioid addict, developed a new addiction to alprazolam—a medication prescribed by his physician to treat opioid withdrawal while starting buprenorphine. I’ll soon write about the use of buprenorphine for opioid dependence, but for now I will note that the opioid withdrawal that occurs when starting buprenorphine is short-lived, and does not generally warrant treatment with an addictive substance like alprazolam.
I did not, of course, witness her son’s anxiety, and I know nothing about the details of the case. But her remarks reflect a common phenomenon that deserves examination.
I sometimes get frustrated by patients struggling with addiction who also complain of ‘anxiety.’ By my understanding—according to impressions I have developed through my own experiences with addiction — the core problem in those of us with addictions is that we struggle to tolerate the normal pains and stresses of life.
We make the mistake of labeling normal and appropriate feelings of fear, guilt, or shame as ‘anxiety.’ Somewhere along the line we developed the incorrect impression that everyone is happy except us, and that WE have a right to happiness as well. The mistaken impression that ‘everyone is happy’ is one of the cognitive distortions corrected during recovery, in part through reflection and through cultivating insight.
But addicts who cling to a diagnosis of ‘anxiety’ seem unable or unwilling to develop that insight. I admit to having two opposing sets of feelings about addicts in such a position. As a physician, I see anxiety as a condition that warrants a sympathetic approach. But I dislike the way that we addicts become ‘big babies’ who view our own misery as more severe, more important, and more deserving of ‘treatment’ than the feelings of others.
I like to remind myself of a phrase often repeated in 12 step meetings, about the need, in recovery, to ‘face life on life’s terms.’ The subject of this post asked the question “is there nothing for recovering addicts to treat anxiety?”
I have learned that in order to remain free of addictive substances, I must abandon seeing feelings that are the normal ‘part and parcel’ of life to be ‘anxiety.’ There are, of course, such things as anxiety disorders; people who suffer from panic attacks or from debilitating symptoms of obsessive compulsive disorder deserve treatment for those conditions, and should not feel guilty for seeking such treatment. But self-diagnosing an anxiety disorder, or even accepting such a diagnosis, is treading on dangerous ground for those of us with addictions.
Before considering myself to have anxiety I must ask myself, “Am I willing to tolerate the normal ups and downs of human existence?”
Am I saying, then, that addicts have a tougher road to follow— that they are less entitled to treatment of anxiety than ‘normal’ people? Yes, I suppose that is one way to view things—if one chooses to measure the fairness of the world, rather than simply accept the realities of one’s condition. But that is always the case; people with non-psychiatric illness must make sacrifices to accommodate their illnesses, and so must those of us with addictions.
I remember the days before buprenorphine (stay tuned!), when one taste of an opioid could eliminate insight for good, precipitating relapse that literally had no effective treatment. When I had opioid addicts as patients in the operating room, some begged me to avoid giving opioids, instead relying on a combination of regional anesthesia and grit to tolerate breakthrough pain. And of course from a ‘feelings’ perspective, a person new in recovery should expect to have a greater load; the behaviors we engaged in during active using usually resulted in a great amount of anger and distrust, and we should not expect a ‘pass’ on experiencing the consequences of those behaviors. Working through shameful feelings is necessary for developing self-respect and humility—traits that are key to maintaining sobriety.
It is apparent to me that my desire (or need, depending on perspective) to treat uncomfortable feelings fluctuates over time. Some days, particularly when I am experiencing anger, resentments, or hurt feelings, my tolerance for an ‘untreated existence’ is low (understand that WANTING to treat one’s feelings is different from actually TREATING one’s feelings!). On other days I have less desire to ‘treat’ my feelings.
I am convinced that my own ability to tolerate ‘existence’ is higher when I have some awareness that life has an ultimate purpose, and that our existence lies beneath the realm of a Higher Power. (I am amazed by the way that the founders of AA discovered this principle, and included awareness of a Higher Power among the steps that have been used to bring life to so many suffering addicts!) The logical conclusion of this line of reasoning suggests that ‘anxiety,’ for some, may be a consequence of a lack of connection to something deep in life—a Higher Power, Faith, a reason to be alive—something.
To answer, then, the question of whether there is anything for addicts for ‘anxiety,’ I would say yes — but not in the form of a substance. The treatment for anxiety, by my reckoning, is first to take an honest look at whether one’s anxiety is truly worse than the feelings tolerated by our fellow beings. We addicts are bound to feel guilt, shame, and fear, especially in early recovery. Considering those normal feelings to be ‘anxiety’ only feeds into the core misunderstanding about life that led to our addiction in the first place!
And the most effective ‘treatment’ for the uncomfortable feelings of shame, guilt, and fear is to increase our awareness of whatever life is all about–an answer that will be different for each one of us.