How to Relieve Stress and Anxiety without Substances

0:00:13 William Moyers
Hello and welcome to Let's Talk, a podcast series from Hazelden Betty Ford. I'm your host, William C. Moyers. People drink or take drugs for a lot of reasons. Usually to heighten the highs, like on a special holiday or special occasion, a party or on vacation. Or they use substances to mitigate the lows. Like at a time of the loss of a loved one or to ease the stress after a tough day at work. Or at home taking care of the kids. But people also drink or take drugs when there may be no obvious motive, or at least they aren't aware of one. And today we're going to talk about the role that anxiety plays in the use of alcohol and other drugs. My guest and my colleague, Sarah Wicks, a Clinical Psychologist in Mental Health at Hazelden Betty Ford. [turns to Sarah] Eighteen years you've been in this field, yes?

0:01:03 Sarah Wicks
Mmm fifteen, but—

0:01:04 William Moyers
Fifteen!

0:01:04 Sarah Wicks
Yeah, yeah.

0:01:05 William Moyers
So glad that you're with us today, Sarah, thank you. Talk about the role that anxiety plays in the use of substances.

0:01:11 Sarah Wicks
Yeah, well anxiety can be kind of a sometimes very obvious cause of the use. Some folks that come in for help that I'm working with are very aware of how anxious they've been and how they've absolutely yeah, 'I needed to drink to be able to sleep, or to be able to deal with stress at the end of my workday,' and they're just very aware of it. And then others aren't actually as aware of it. Because it's possible to have a pretty outlook and still be anxious. I call it "relentless optimism." [chuckles] But, those are—there's some sense of avoidance through using kind of a positive attitude to actually avoid dealing with things. And then, there can be a lot of anxiety that comes with that. Anxiety can also be like the lid to the jar on a whole bunch of other emotions—

0:02:04 William Moyers
Huh.

0:02:05 Sarah Wicks
—And so when we're trying not to feel our feelings, especially the hard ones, then that can manifest as anxiety. And then, the problem with using is that it's the best and worst solution to the anxiety, right? Like in the moment, the drugs and alcohol, it works—it takes it away, it brings you somewhere else, you just don't care as much about whatever was making you anxious. And so, so it works in the moment. Then you sober up and everything that was stressing you out is still there. And now you also maybe have some guilt about dealing with it in an unhealthy way.

0:02:41 William Moyers
Right. Right.

0:02:42 Sarah Wicks
And so, so then using more of the substance to try to cope with that. Not only the initial stress that you were dealing with but now maybe some of the guilty feelings about maybe you missed an important deadline or a family function because of your use.

0:02:55 William Moyers
Mmm-hmm. Mmm.

0:02:56 Sarah Wicks
And so, now you've got the original anxiety then all these other feelings of guilt and shame and whatnot kind of compounding that. And it turns into a vicious cycle then.

0:03:05 William Moyers
So how does anxiety affect the body?

0:03:09 Sarah Wicks
So, anxiety, you know at its core it comes down to the central nervous system. And there's—we've got a sympathetic nervous system and parasympathetic. So the sympathetic nervous system, think fight or flight or freeze response. And parasympathetic would be our relaxation response. So, the sympathetic nervous system it's there for a very important reason. And, you know, this goes back to I say this comes from also Steve Hayes in Acceptance and Commitment Therapy, he always talks about how our ancestors were the anxious ones. Like they were the ones scanning the savannah for the tigers. They didn't get eaten, so they passed their anxious genes down to us.

0:03:49 William Moyers
Hmm. [smiles, nods]

0:03:50 Sarah Wicks
So we all, you know, many of us have some sort of anxiety. But it's—so today, nowadays, we don't most of us have to watch for tigers out on the savannah. But we still have that active fight or flight or freeze response that can show up. So it shows up in response to a real or a perceived threat.

0:04:13 William Moyers
Ah.

0:04:13 Sarah Wicks
So any kind of perceived threat we can get anxious about.

0:04:18 William Moyers
And is anxiety a diagnosable mental health condition?

0:04:23 Sarah Wicks
It is. So it's like most things, it's on a spectrum. Of people that have just a little of it to people that have a lot. And panic being maybe the most extreme form of it.

0:04:33 William Moyers
Mmm-hmm.

0:04:34 Sarah Wicks
And one of the things that, you know, that I do in my work is talk to someone, get to know them, ask them questions, to see if they have some anxiety does it rise to that level of a clinical disorder?

0:04:47 William Moyers
Aha.

0:04:48 Sarah Wicks
So, things like if you feel like you worry in a way that you know is disproportionate to the stress in your life—

0:04:57 William Moyers
Yeah?

0:04:58 Sarah Wicks
—If you know it's above and beyond what it maybe should be for how stressed you are. And you know it doesn't quite make sense how anxious you are or how nervous you are. But you can't calm yourself down. Even if you know it's irrational—

0:05:12 William Moyers
[nods] Mmm-hmm.

0:05:13 Sarah Wicks
—You can't calm yourself down. And if that happens to you for three months or longer—

0:05:19 William Moyers
Mmm. [nods]

0:05:20 Sarah Wicks
—That could indicate a generalized anxiety disorder. And then there's more specific types of anxiety. Social anxiety or specific phobias, panic disorder, some of those things.

0:05:29 William Moyers
Mmm.

0:05:29 Sarah Wicks
So we—as a Psychologist I'm kind of teasing that out to figure out what we're working with.

0:05:32 William Moyers
Right. And you talked earlier about the fact that people who are anxious, whether they know it or not, they'll use a substance and it'll work perhaps—

0:05:41 Sarah Wicks
Mmm-hmm. [nods]

0:05:41 William Moyers
—In a short period of time. And then it's there again.

0:05:45 Sarah Wicks
Mmm-hmm.

0:05:46 William Moyers
But the point is that when somebody seeks treatment for a substance use disorder, so they're removing the substance because they're getting treated for it and it's an abstinence-based recovery approach, but you've got to deal with the anxiety too.

0:05:59 Sarah Wicks
Right. Right. Which can sometimes be the highest when they stop using. Especially if—so someone who maybe has an addiction without a co-occurring anxiety disorder, they might stop drinking or using and really start feeling better. They call that the "pink cloud," right, like, 'Wow, I've got so much more energy, I'm clear-headed—'

0:06:24 William Moyers
I can conquer the world now! Yeah. [grins]

0:06:25 Sarah Wicks
Yeah, right? And then, but you take somebody with an anxiety disorder, and they get sober, and they're like, 'Whoa, whoa, whoa, I have no coping skills for this now.' And the thing that my body wants most to deal with my anxiety, is the thing I now can't have.

0:06:41 William Moyers
Yeah. Hmm.

0:06:42 Sarah Wicks
So, that's where we talk about the interactions between like an anxiety disorder and post-acute withdrawal symptoms—

0:06:49 William Moyers
Uh-huh. Uh-huh.

0:06:50 Sarah Wicks
—And how that can be worse for some folks compared to others.

0:06:53 William Moyers
Mmm-hmm.

0:06:55 Sarah Wicks
But, every day, this is what I always tell my clients like every day that you're not using, you're training your body that you can do this. You can make it through this—

0:07:04 William Moyers
Mmm-hmm.

0:07:05 Sarah Wicks
—Without a substance. And you're kind of building back your natural resiliency every day that you don't use.

0:07:12 William Moyers
And of course that's a process, it doesn't happen overnight or in a week.

0:07:13 Sarah Wicks
Oh, yeah, yeah.

0:07:15 William Moyers
We talked earlier before we began to record this podcast about the role that therapy and medication play in addressing anxiety. Can you talk more about that now to our audience?

0:07:30 Sarah Wicks
Sure, sure. So some conditions like Clinical Depression or Bipolar Disorder, medications can be extremely effective and even necessary for some folks to take. Anxiety is a bit different in that regard. There are some medications that can help with anxiety. But unlike other mental health issues, the research consistently shows that therapy is equally effective as medications. In the treatment of anxiety.

0:08:07 William Moyers
Mmm-hmm.

0:08:07 Sarah Wicks
Anxiety in the therapy setting, anxiety's like the common cold. [Moyers chuckles] Like, it's everywhere and but unlike the common cold, it's more treatable. [chuckles] Like, you don't have to just wait it out. There's things you can actively do.

0:08:19 William Moyers
Mmm-hmm.

0:08:20 Sarah Wicks
And, you also wanna be careful with anxiety medications. Some of them can be highly addictive.

0:08:26 William Moyers
Yes!

0:08:27 Sarah Wicks
Benzodiazepines, yeah, things like Ativan, Xanax, you gotta watch out for those for sure.

0:08:28 William Moyers
Mmm-hmm.

0:08:31 Sarah Wicks
And then, and so the medications that can be more helpful would be in the class of like SSRIs. I'm not a Psychiatrist, so—

0:08:40 William Moyers
Right.

0:08:40 Sarah Wicks
I can't get too detailed about this 'cause I'm not an expert in the area. But, just having worked closely enough with psychiatry at Hazelden over the years—

0:08:45 William Moyers
Yes.

0:08:47 Sarah Wicks
—That there are some medications that can make a difference for some people, for some people they don't. And but either way, therapy can help and there's no side effects.

0:08:58 William Moyers
Just on that note before we go on, so people who are in recovery from a substance use disorder who are needing treatment, perhaps a medication for their anxiety, this is why it's important that they have a good relationship with their prescribing doc so that the doc knows that they're in recovery—

0:09:16 Sarah Wicks
Mmm-hmm.

0:09:17 William Moyers
Because to your point, some of those substances can be addictive themselves. Yeah.

0:09:21 Sarah Wicks
They can. It's definitely something to watch out for. And I've seen people that get hooked on those kind of meds is some of the most painful post-acute withdrawal that I've ever seen.

0:09:32 William Moyers
Yeah. Long time, too.

0:09:34 Sarah Wicks
Yeah, trying to get off the Benzodiazepines. Yeah.

0:09:39 William Moyers
One of your other important messages is the role that the breath and breathing play in helping to address anxiety. Share that with us.

0:09:50 Sarah Wicks
Okay. Well the reason I like talking about this is because—so, I think one of the reasons I like working with people who are actually—they're coming for help because they have a problem with drugs and alcohol. [Moyers chuckles] And a lot of times they don't even want this fluffy mental health stuff, they're like no, I don't wanna learn breathing skills, I don't wanna learn like whatever, like, I just need to get sober. [Moyers laughs] And so, I have learned—I love working with these folks 'cause I like seeing their change of heart like once they really experience how helpful it can be.

0:10:19 William Moyers
Yes. [smiles]

0:10:23 Sarah Wicks
And so, I've become a bit of a salesperson about like using healthy coping skills, learning them, trying them—

0:10:30 William Moyers
Mmm-hmm.

0:10:30 Sarah Wicks
And so, I like talking about the science behind breathing because I get that cynicism a lot. Like okay, it's just breathing, we all do it every day. But here's the cool thing. So, remember I was talking about the parasympathetic nervous system—

0:10:42 William Moyers
Yes.

0:10:42 Sarah Wicks
—And the sympathetic nervous system.

0:10:43 William Moyers
Mmm-hmm.

0:10:43 Sarah Wicks
There's some very specific ways that you can deactivate your own fight or flight response, deactivate the sympathetic, and activate the parasympathetic.

0:10:53 William Moyers
Hmm.

0:10:53 Sarah Wicks
And so, when we're breathing, when we're hyperventilating when we're nervous, that's actually a result of not fully releasing all the air out of the lungs. [blows out to demonstrate] So, if I'm forgetting to exhale, I'm just breathing in and in and in, and there's no room for that fresh air to get in there.

0:11:11 William Moyers
Yes.

0:11:13 Sarah Wicks
So, the first part to the breathing exercises that I like to emphasize is the exhale. So nice, long exhale. [breathes out] You're fully emptying your lungs. And that allows the fresh air to get into your lungs and the oxygen. We have more oxygen receptors at the bottom of our lungs than anywhere else.

0:11:31 William Moyers
Hmm. Mmm.

0:11:33 Sarah Wicks
So that fresh air, the oxygen has to get down to those receptors into the bloodstream and up to the brain. And that's what's gonna give the parasympathetic relaxation response. Not just breathing. But that oxygen specifically.

0:11:47 William Moyers
Would the power of conscious breathing, would that also equate to the practice of yoga or to other meditative-like activities?

0:12:01 Sarah Wicks
Sure, sure! Yeah. I mean yoga is the breath is a really critical part to that kind of practice. It's one of the reasons I mean I'll work with folks who are athletes and maybe they love, you know, exercise and sports. But they don't wanna practice mindful breathing. I'm like, 'Well, guess what, you already are!' [chuckles] When you're in sports, that's part of the reason those things can be so helpful to us. Is because we're getting deep breaths and releasing the air and getting the fresh air in there and whatnot.

0:12:32 William Moyers
Yes. And just we have about two minutes left, but share with us a little bit about the role that anxiety plays in the family dynamic. So we know we started our podcast talking about anxiety and its influence and impact on somebody with a substance use disorder, but of course we know that a substance use disorder affects much more than just the person who has it, it affects the whole family. Do you see anxiety in family members, do you see depression and other things as a result of a loved one's addiction?

0:13:04 Sarah Wicks
Absolutely. So family members—and I do work with family members specifically—as well as people in their own recovery. I run groups for family members and see them individually. And the anxiety that can show up is often—it kind of rises to the level of like a trauma anxiety.

0:13:28 William Moyers
Yeah. Yeah, yeah.

0:13:29 Sarah Wicks
Because the definition of trauma is you or your loved one being in a dangerous situation.

0:13:38 William Moyers
Mmm-hmm.

0:13:39 Sarah Wicks
So there it is. Somebody who's really heavily drinking, using, maybe they're driving, maybe they're operating machinery, maybe they're you know tripping, falling, you know, getting injuries. They're in dangerous situations. And this can be kind of a chronically traumatic thing. And the result of that kind of traumatic anxiety can be—that can linger quite a bit, even after the person is sober. Maybe the loved one has been sober now for—

0:14:07 William Moyers
Yes.

0:14:07 Sarah Wicks
—Six months or a year, but we're coming up on anniversaries of that 4^th of July that was a nightmare, or we're coming up on the anniversary of the birthday party that went south. And that's gonna bring up anxiety for the often times more so for the family member than the person who's actually in recovery themselves. Because maybe they were blacked out. Maybe they don't even remember.

0:14:28 William Moyers
Right. Right. Mmm-hmm.

0:14:29 Sarah Wicks
But the family member sure does.

0:14:31 William Moyers
Yeah.

0:14:32 Sarah Wicks
And so, trying to give family members a space to work through that is really important as well. Mmm-hmm. [nods]

0:14:36 William Moyers
Important, yes. Last question before we go. What about patients or clients who have an aversion to mindfulness practice? What are they supposed to do?

0:14:46 Sarah Wicks
Oh, good old mindfulness! [grins] Well I love mindfulness and I'm a big fan, I teach it to most of my clients. And I think it's critical to like learn the language of recovery.

0:14:55 William Moyers
Mmm-hmm. Mmm-hmm.

0:14:56 Sarah Wicks
It's building a part of the brain called metacognition. The ability to observe our own thoughts and feelings—

0:15:01 William Moyers
Yes.

0:15:02 Sarah Wicks
—Without just impulsively acting from them. So, a really critical life skill to have. And, there's people who flat-out, you know, it makes them incredibly uncomfortable, really increases anxiety, mindfulness isn't gonna work for panic disorder. You know, for those really higher levels of anxiety. So for folks that don't wanna do that, I recommend things like classic Cognitive Behavioral Therapy.

0:15:27 William Moyers
Yes. CBT.

0:15:28 Sarah Wicks
CBT. Is not a mindfulness-based approach. And it still works, it's still out there.

0:15:32 William Moyers
Yes.

0:15:32 Sarah Wicks
You know, it's been around a while but it works. So that could be—there's also I run some Dialectical Behavioral Therapy groups. DBT.

0:15:41 William Moyers
Mmm-hmm.

0:15:42 Sarah Wicks
And there's a section of DBT that does focus on mindfulness. But there's other sections that give you a variety of other tools as well. Like the breathing, you know, there's various breathing exercises for instance. There's things you can do with ice and cold water, and changing your body temperature. Progressive muscle relaxation. There's some guided relaxation techniques. 'Cause mindfulness in itself is not necessarily a relaxation technique. It's a way to bring yourself to the moment and be open to anything you're experiencing in the moment without trying to relax yourself. So it's a little unique in that regard.

0:16:21 William Moyers
Mmm-hmm.

0:16:21 Sarah Wicks
But then there's other exercises where you are actually practicing relaxation that some folks may like those better.

0:16:28 William Moyers
Well thanks for bringing us all these good options for addressing anxiety and your expertise is making a huge difference. Not just in the lives of the patients and their families that come to Hazelden Betty Ford, but, our audience today on this podcast. Sarah Wicks, thanks for being with us today. [turns to camera] And thanks to all of you for tuning in. Remember, if you or a loved one need help for addiction, don't wait. It is okay to ask for help. Help is available. Treatment works. And recovery is possible. We'll see ya again. [smiles]