Relationship between Anxiety and

Addiction to a Depressant Drug

James F. Scorzelli, Ph.D.* & Saleha Z. Chaudhry, B.A.**

AbstractA systematic random sample of 267 patients who were involved in outpatient detoxification
was surveyed. Their records were evaluated, and the demographics, psychiatric diagnoses, and type(s)
of substance of abuse of each patient were recorded. The results indicated that there was a significant
relationship between an anxiety disorder and whether the patient was addicted to an opioid. A followup was conducted on 79 patients who were addicted to an opioid, and had an anxiety diagnosis. Of
this group, 54 (70%) responded, of which only 22 (40%) said that they were receiving some type of
treatment for their disorder. All of these patients reported that they were sober and that their anxiety
disorder significantly decreased.
Keywordsaddiction, anxiety, co-occurring disorder, depressive drug, relationship

Among persons who are chemically dependent, many

have psychiatric diagnoses (Wilens et. al. 2005; Mitra 2000;
Bums & Teeson 2002; DeHaas, Calamari & Bair 2002;
Stewart & Kushner 2001; Strakowski & DelBello 2000).
Among 500 opioid dependents, Ahmadi and Ahmadi (2005)
found that 105 (21%) of the clients had anxiety disorders
while 274 (54.8%) had depressive disorders. This is referred
to as co-occurring disorders (Goldsmith & Garlaapati 2004).
The presence of a psychiatric disorder can often complicate the treatment and counseling of the client who is drug
dependent (Craig 2004). That is, research suggests that
co-occurring disorders can be treated separately or through
a hybrid approach in which the treatment is mixed and
matched dependent on the individual (Craig 2004; Minkoff
2001). Furthermore, it is unclear why some people develop
mental disorders with addiction. There are a number of
different views that attempt to explain this. Roberts (2000)
and Ayyad and Al-Mashaan (2003) describe the separate

etiologies and course of both disorders, yet feel that common

factors increase the risk for mental disease and substance
abuse. These common factors often pertain to gender, race,
low self-esteem, antisocial personality, and genetic variables.
Based on this, it has been proposed that mental disorders
can increase the risk of drug addiction, or substance abuse
can increase the risk of mental illness (Sullivan et al. 2005;
Green et al. 2002; DiNitto & Webb 2001).
Muesser, Drake and Wallach (1998) felt that the two
disorders are bidirectional and reciprocal. If one believes
that mental disorders increase the risk of substance abuse,
then the person abuses the substance to relieve his or her
symptoms. When under the influence of alcohol or an opioid,
one cannot experience anxiety or the related symptoms.
Depressants slow down heartbeat and breathing and lower
blood pressure, essentially acting as a short-term cure of the
symptoms of anxiety. This belief in self-medication has been
proposed by many researchers (Goeders 2003; Khantzian
1997). If one believes in the self-medication hypothesis, then
it is very important for professionals who deal with addiction to focus on the client's underlying psychiatric disorder.
There are a number of research articles that support the view

Professor, Northeastern University, Boston, MA.

*Graduate Assistant, Northeastern University, Boston, MA.
Please address correspondence and reprint requests to James F.
Scorzelli, Ph.D.. Dept of Counseling and Applied Ed Psych, 203 Lake
Hall, Northeastern University, Boston MA 02115.

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that drug addiction is positively associated with negative

affect, such as depression and anxiety (Ahmadi & Ahmadi
2005; Sbrana et. al. 2005; Ahmadi et al. 2003; Ayyad & AlMashaan 2003; Ramirez 2002; Nutt 2000). Further, there is
substantial support for linking opiate dependency to stress or
anxiety (Goeders 2004, 2003; Ahmadi et al. 2003; Roberts
2000). This linkage indicates that a person with co-occurring disorders often uses an opioid to cope with the tensions
associated with life Stressor or to relieve the symptoms of
anxiety (Pitman & Delahanty 2005).
In terms of treating the patient with co-occurring disorders, research has indicated that there are beneficial affects of
benzodiazepines and methadone in reducing anxiety (Calsyn
et al. 2000; O'Brien, 2005; Wren et al. 2005; Schuurmans
et al. 2005; Pandit, Argyropoulos & Nutt 2001). However,
Drummond (1998) stated that benzodiazepines have some
potential for abuse and may cause dependency, but only a
few cases of addiction arise from legitimate use of the drugs.
Further, he felt that due to the chronic nature of anxiety, the
long-term low dosage of benzodiazepine treatment may be
necessary. Calsyn, Wells, Heming and Saxon (2000) administered the Milln Clinical Multiaxial Inventory (MCMI)
to 122 men and 86 women who entered a methadone
maintenance program within a month of admission and 18
months later. The results indicated an overall decrease on
scales measuring anxiety during the interim between initial
assessment and follow-up.
Mitra (2000) reported that social anxiety was significantly higher among substance abusers and a follow-up
relapsed group with low social approval when compared to
those persons who were successfully rehabilitated. Based on
these findings. Mitra suggested that social cue components
may be helpful in counseling the person who is drug dependent. Goeders (2004) reported that there is a link between
substance abuse and stress, and that stress reduction alone
or in combination with pharmacotherapy may be helpful
in reducing drug cravings or providing abstinence. The
beneficial affects of therapeutic communities in reducing
anxiety among drug abusers was shown in studies by Amram (2002) and Craig (2004). Pardini, Plante, Sherman and
Stump (2000) examined the relationship between religious
faith, spirituality, and the mental health of persons recovering from substance abuse. The researchers found that higher
levels of religious faith and spirituality were associated with
lower levels of anxiety and positive mental health outcomes
of the sample.
With this in mind, the purpose of the present article is to
determine if there is a relationship between anxiety disorders
and substance abuse, and if such a relationship does exist,
the effects of treatment.

were selected. All the patients were involved in outpatient

detoxification from 2001 to 2004. Because the medical
practice has an affiliation with a major university, all the
patients signed a release that indicated that their records
(maintaining personal confidentiality) could be used in
research. Further, the study was approved by the Human
Subjects Committee. Each record was examined and the
demographics, type of drug abused, and diagnoses of the
patients were recorded. The type of drug abused by the
patient came from the results of a urinalysis given to him
or her during the initial and subsequent visits. Further, the
practice did not differentiate between drugs that caused
physical dependence (i.e., opioids and alcohol) and those
that did not (i.e., cocaine) with respect to their treatment
approach. Specifically, all patients, regardless of the drug(s)
of abuse, were provided with medication to counteract the
affects of drug deactivation. Expressly, a person addicted to
a depressant drug (i.e., opioid) was prescribed anti-anxiety
drugs or benzodiazepines, and medication to help him or her
deal with muscle and joint pain, nausea, chills and to prevent
seizures. For hallucinogens, marijuana or stimulants (i.e.,
cocaine), the patient was prescribed benzodazepines and/or
antidepressants. The diagnoses were taken from a diagnostic
evaluation conducted by a clinical psychologist who had
been employed with the practice for eight years, and these
evaluations were in the patients' files. So as to corroborate
the diagnoses, psychiatric/psychological evaluations from
other sources and hospital records were examined. Based
on this review, the diagnoses of 147 (55%) of the patients
were corroborated. The remaining patients only had the
diagnostic evaluation in their files. The diagnoses of the
patients were taken from a diagnostic evaluation in each of
the files. These psychiatric disorders were initially grouped
into the general categories of anxiety and depression. The
specific diagnoses of the anxiety and depressed disorders
were also recorded.
If a relationship was established between drug abuse
and a psychiatric disorder, those patients with co-occurring
disorders would be contacted to dtermine if they sought
treatment for their disorder.
Descriptive statistics were used to summarize the data
and chi square analysis conducted to determine if there was
a relationship between addiction and type of diagnosis, and
gender and the type of diagnosis.
RESULTS
As seen in Table 1, the average age of the patients
was 32.3 years. They ranged in age from 16 to 71 years.
Most were White males who were opiate dependent. In
fact, both the youngest and oldest patients were opiate
dependent. Alcohol was the second most frequent drug of
abuse (16.1%). Only 19 patients (7.1%) were identified as
polydrug abusers (two or more drugs). Further, 41.2% of
the participants had an anxiety-related diagnosis. The types of

METHOD
A systematic random sample of 267 patients of a
group of physicians who specialize in addiction medicine
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Scorzeili & Chaudhry

TABLE 1
Demographic Characteristics of the Patients (N = 267)

Frequency

Percentage

Gender
191

71.6%

76

28.4%

250

93.6%

10

3.7%

2.7%

198

74.1%

Married

48

18.0%

Divorced

16

6.0%

Widowed

1.9%

Male
Female
Race
White
African American
Latino
Marital Status
Single

Age

Mean = 32.3 years

a panic disorder, and 12 were diagnosed with a generalized

anxiety disorder. When asked about treatment, five persons
said that they were in methadone maintenance and received
counseling weekly (drug counseling is a requirement of these
relapse prevention programs). They were all diagnosed with
a panic disorder, and told the investigator that they had not
experienced any attacks since entering methadone maintenance. These patients were all tested with a urinanalysis to
check for potential methadone abuse and all of them were
cleared and allowed take-home prescriptions at six months.
Three of the patients, who also had panic disorders, were seeing psychiatrists, who prescribed benzodiazepines. Although
the patients said that they still had panic attacks, they stated
that the panic episodes had significantly decreased, and
that when they did occur," taking a benzodiazepine quickly
stopped them. Of the remaining 14 patients (12 with a generalized anxiety disorder and two with panic disorders), 10
said that they were still in counseling. The four who were
not in counseling stated that they received counseling for
at least six months before they left. All of these 14 patients
reported that their anxiety had significantly decreased while
in therapy.

anxiety disorders ranged from panic attacks to acute stress

(see Table 2). Of the anxiety disorders, generalized anxiety
(16.1%) and panic disorder (13.9%) were the two most
frequently identified in the case records. It was also found
that 22.8% of the patients had a diagnosis of depression. The
types of depressive disorders were either major depressive
(13.5%) or dysthymic (9.7%). Only 34 patients (12.7%) had
no psychiatric diagnosis. Finally, 94.6% of the women in
the sample had a psychiatric disorder.
The chi square analysis between gender and diagnosis
was significant (x^ = 1.2, p = .001), and indicated that there
was a higher proportion of women than men with a psychiatric diagnosis (see Table 2). When the anxiety disorders
were compared to opiate dependence it was significant at
the .05 level {x^ = 5.19, p - .023). However, the relationships between anxiety and alcoholism (x^ - .870, p = .351),
depression and alcoholism (x^ = .245, p .620), and opiate
dependence and depression (x^ = 2.5, p = .114) were not
significant.
There were 79 (29.6%) patients who were opiate dependent and had an anxiety disorder. These persons were
contacted by letter, and followed up with a phone call. Of
this group, 54 (68%) responded, of which only 22 (40%)
said that they sought out treatment for their anxiety disorder.
The other 32 persons who had anxiety disorders relapsed; 20
were receiving treatment for the second time, while 12 were
receiving outpatient detoxification for the third time. All of
the 22 patients who were opiate free were interviewed by
the principal investigator. Of this group, 10 reported having
Journal of Psychoactive Drugs

DISCUSSION
The results of this study appear to support the belief
that some forms of drug abuse may be related to anxiety
reduction. As indicated, there was a significant relationship
between anxiety disorders and patients who abused opioids.
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TABLE 2
Diagnosis and Substance Abused by Patients (N = 267)
Frequency

Percentage

110

41.2%

Depression

61

22.8%

Adjustment Disorders

50

18.7%

Attention Deficit Disorder

1.5%

Psychosis

1.5%

Explosive

.7%

Bipolar

.7%

34

12.7%

Opiate

192

71.9%

Alcohol

43

16.1%

Cocaine

2.6%

Benzodiazepines

1.1%

Marijuana

.7%

Inhalants

.4%

19

7.1%

Generalized Anxiety

43

16.1%

Panic

37

13.9%

Post Traumatic Stress Disorder

3%

Obsessive Compulsive

1.5%

Acute Stress

.4%

Major Depressive Disorder

36

13.5%

Dsythymic

26

9.7%

Diagnosis
Anxiety

None
Drug Abused

Poly Drug
Specific Anxiety Disorders

Specific Depressive Disorders

Gender and Diagnosis

Anxiety Disorder

67

61%

Female Anxiety Disorder

43

39%

Male

Depression

44

72%

Female

Depression

17

28%

Male

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Scorzelli & Chaudhry

The treatment ranged from methadone maintenance to

counseling. However, of those patients who were in counseling, the methods of anxiety reduction (i,e,, desensitization,
emotive imagery, etc) were not identified. In all cases, the
patients reported that the treatment was effective in decreasing or eliminating their anxiety. This finding seems to
support the beneficial effects of anxiety reduction for those
persons who are opiate dependent (O'Brien 2005; Goeders
2004; Amram 2002),
It should be mentioned that there were possible adverse
effects for the three patients who were prescribed benzodiazepines. Chronic benzodiazepine usage can cause physical
dependency, as well as depression, the dulling of emotions,
and a paradoxical stimulant effect that can provoke aggression and hyperactivity (Drummond 1998), Instead ofthe use
of benzodiazepines for the treatment of anxiety disorders,
the antidepressants Buspar and Paxil, and the gabapentin
Neurotin have been shown to be very effective in reducing
anxiety (Drummond 1998),
In closing, the results of this study support the relationship between an anxiety disorder and opioid dependence.
Therefore, it may be beneficial for counselors to use anxiety
reduction when treating those clients who have co-occurring disorders. Even though the group that sought treatment
for their anxiety disorders was too small to generalize the
results, they all indicated that treatment was helpful. However, this information was obtained from self-reports, which
could have been biased. Also, it would have been helpful to
determine the type of counseling methods that were used
for anxiety reduction.

This was especially identified in the follow-up of the 32

persons who had anxiety disorders and relapsed. This supports the literature that indicates that some people who are
addicted to opioids take the drug to reduce their anxiety or
to help them cope with stress (Ahmadi et al, 2003; Goeders
2003; Roberts 2000), However, the significance was at the
,05 level {p = ,023) and not at the ,01 level. Surprisingly,
there was no relationship between alcohol and anxiety
disorders. Although many researchers believe that one reason people abuse alcohol is to reduce stress, this was not
supported by the study, A reason for this may pertain to the
small number of patients who were alcoholics (16,1%) when
compared to those who were opiate dependent (71,9%), The
sample of alcoholics in the study was too small to effectively
investigate the relationship between alcohol and anxiety.
Other studies have shown that alcohol use is comorbid with
anxiety and depression. Bums and Teeson (2002) found
that respondents with an alcohol use disorder (abuse or dependence) were three times more likely to have an anxiety
disorder. The National Comorbidity Study also has similar
figures (Kessler et al, 1994), In the nationally representative
sample, 55% of those patients with an alcohol dependence
who received treatment in the previous 12 months also had
at least one affective or anxiety disorder during that same
time period (Watkins et al, 2004),
Unlike the anxiety disorders, there was no relationship
between depression and abuse of opiates or alcohol. The
relationship between a psychiatric diagnosis and gender
was the result of the small number of women in the sample
(28,4%), In fact, 94,6% of the women had a psychiatric
diagnosis, while 65,2 % had an anxiety diagnosis (Table 2),
There were only a small number of patients who were
opiate dependent, had an anxiety disorder and sought treatment.

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