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Taking the anxiety out of addiction: the importance of recognising and treating anxiety disorders in addiction clients.
Fraser Shaw, Consultant Psychiatrist, Glasgow Addiction Services
Abstract
Individuals with addiction problems frequently exhibit subjective and objective signs of anxiety, and sometimes present with debilitating anxiety as their primary symptom. It is well known that intake of many commonly abused drugs, including opiates, benzodiazepines and, of course, alcohol, is associated with a reduction in anxiety levels. However, long-term use is almost inevitably associated with an increase in pre-existing anxiety, or the establishment of anxiety problems when none were initially present. It is important to appreciate that the neurobiology of anxiety is very similar, and in many ways identical, to the neurobiology of withdrawal from dependence-inducing drugs. It is therefore unsurprising, but extremely important, that many clients find it difficult or impossible to distinguish between the two, and might at times seek drugs when feeling particularly anxious, or at other times interpret withdrawals as an anxiety attack.
In addition, the spectrum of anxiety disorders encompasses a wide variety of reactions to stress, of which post-traumatic stress disorder (PTSD) is only one example. It is therefore understandable that, for instance, PTSD symptoms frequently become worse during withdrawal states, and indeed the emergence of such symptoms often becomes a major problem during and after detoxification. The biological links between anxiety and addiction will be discussed in detail; in the light of this, possible treatment and management strategies will then be discussed, including how they might be tailored to clients with different personal and drug histories, and at different points in the evolution of their addiction problems. The session will end with a discussion of how a strategy for addressing anxiety problems could be put into practice within our services, what the likely benefits would be, and whether specific anxiety assessment and management should be part of the basic armoury of every addiction worker.
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Biography
Dr Fraser Shaw, MA, MB,BS, BSc, PhD, MRCPsych., is the Consultant Addiction Psychiatrist for East Glasgow, and Honorary Senior Lecturer, University of Glasgow. Having initially trained in medicine, he then undertook a PhD in neurosciences, and had academic jobs at Oxford and Cambridge Universities. He then decided to return to medicine, and trained in psychiatry at the Maudsley Hospital in London, before going to Glasgow as a consultant.
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