Category: <span>Mental Health</span>

Alcohol and Anxiety | Manhattan Alcohol Addiction Treatment
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Anxiety and Alcohol Use

By Ronnit Nazarian, Psy. D

A common theme that I have found while speaking with patients who overdrink has been that they also experience an underlying anxiety disorder. Moreover, they have mentioned having difficulty finding something that helps them disconnect from their stress and anxiety that works as well as having a drink. To most people looking in from the outside, a person who experiences anxiety and a person who experiences drinking problems are often viewed as two separate individuals. Contrary to common belief, however, research shows that approximately 50% of individuals who experience alcohol problems also meet the criteria for one or more anxiety disorders.1 Alcohol use and anxiety are strongly linked and often called co-morbid disorders that interact with each other. One of the major contributors to an increased alcohol intake is a person’s level of anxiety.4

At Fifth Avenue Psychiatry, we recognize that many people who have an increased alcohol use will drink in order to cope with their anxiety (e.g., work stress, social stress, etc.). While alcohol may be used to help cope with anxiety, it can also have long-term consequences in increasing a person’s level of anxiety in the long term. In this blog, we discuss the ways anxiety and alcohol are linked, the consequences of using alcohol as a coping mechanism, alcohol-induced anxiety, and treatment approaches for dual diagnosis of anxiety and alcoholism.

Using Alcohol as a Coping Mechanism (Self-Medication Model)

A mild amount of anxiety is typical for anyone to experience as a reaction to a stressful situation. When someone suffers from an anxiety disorder, their reactions to stress can impact their daily functioning, relationships, sleep cycle, and work production. Those who struggle to cope may turn to the use of alcohol and drugs, engaging in compulsions, and avoiding events to decrease the anxious feelings.

Below are some of the ways people use alcohol to cope with anxiety:

  • Drinking at a party to feel confident, less shy, and to socialize
  • Drinking at the end of the week to destress
  • Drinking to numb negative thoughts and emotions
  • Drinking to feel included and connected to others
  • Drinking to relax
  • Drinking to forget bad memories
  • Drinking to feel happy
  • Drinking to no longer feel in control
  • Drinking to no longer make decisions
  • Drinking to take a break from reality
  • Drinking to fall asleep

What drinking starts as “liquid courage” or a “way to let loose” for a person, it easily becomes a way of self-medicating as it becomes a means of coping. Research shows that most individuals who experience drinking problems and self-medicate with alcohol also experience a generalized anxiety disorder, social phobia, and panic disorder.4  More specifically, it appears that alcohol problems begin after the onset of anxiety disorders. Many individuals who experience social phobia and agoraphobia have reported initially using alcohol as an attempt to control anxiety. Active alcohol use can exacerbate symptoms of anxiety, which plays a significant role in the difficulty of diagnosing anxiety disorders in the face of active alcohol use. The lines blur with distinguishing between symptoms of alcohol withdrawal versus anxiety disorders when symptoms of withdrawal appear like symptoms of anxiety. 3

Over time, as individuals continue to self-medicate with alcohol as a coping strategy, they may require increasingly higher doses of alcohol. Consequently, this can result in an individual developing an independent substance use disorder. Individuals who self-medicate with alcohol are at risk of increased psychiatric co-morbidity, suicidal behavior, levels of stress and dysfunction, and lower health-related quality of life.5

How Alcohol Increases Anxiety Levels (Substance-Induced Anxiety Model)

Using alcohol to cope with anxiety can in turn significantly increase anxiety levels. While alcohol can diminish feelings of anxiety and provide short-term relief, it can lead to increased anxiety. Specifically, alcohol can act as an “Anxiogenic,” which creates feelings of anxiety and panic attacks when withdrawing from alcohol. This feeling can lead someone to continue to drink alcohol to decrease those uncomfortable feelings. This leads to a vicious cycle in which alcohol and anxiety play off each other and makes it no longer clear which disorder (anxiety or alcoholism) is the operating cause.2

Treatment for Co-Occurring Anxiety Disorders and Alcohol Use Disorders

There are many treatment models available to assist individuals with co-occurring disorders. The selection of treatment approach depends on the way in which, and the reasons why a person uses alcohol to cope. For individuals who use alcohol to cope with social anxiety, a combination of Cognitive Behavior Therapy (CBT) and Exposure Therapy can be helpful to challenge thoughts and behaviors surrounding events that cause anxiety. Individuals who use alcohol to cope with stress or intense emotions would benefit from Dialectical Behavior Therapy to learn how to regulate their emotions and tolerate distress. At the root of all treatment models, it would be critical for patients to develop new healthy coping strategies to replace their unhealthy behaviors, such as drinking alcohol. Alongside engaging in therapy, it may be beneficial for the individual to receive pharmacological treatment to decrease the feelings of anxiety that drive a person to drink.

When developing a treatment plan, it is important for the clinician to understand the individual’s presenting problems and determine which of the problems should be the primary focus of treatment. A majority of treatment typically begins with the elimination of alcohol use first.  With alcohol out of the way, one can gain a better understanding of the primary reasons that drive a person to drink.  Sometimes with the reduction of alcohol use, many symptoms such as anxiety and depression are actually reduced. Ultimately though, in many cases, challenging and treating anxiety symptoms that resulted in overdrinking is the ultimate goal.

  1. Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol research: current reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.03
  2. Brady, K., Tolliver, B., & Verduin, M. (2007). Alcohol use and anxiety: diagnostic and management issues. The American journal of psychiatry, 164 2, 217-21; quiz 372 .
  3. Kushner, M. G., Sher, K. J., & Beitman, B. D. (1990). The relation between alcohol problems and the anxiety disorders. The American Journal of Psychiatry, 147(6), 685–695. https://doi.org/10.1176/ajp.147.6.685
  4. Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol research: current reviews, 34(4), 414–431.
  5. Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and anxiety, 35(9), 851–860. https://doi.org/10.1002/da.22771

 

Adult Psychiatry Mental Health • • • • • By PSYCHIATRY NYC 0 Comments

The Effects of the Pandemic Lockdowns: Substance Use, Depression, Anxiety, Attention and Concentration

Written by Britt Gottlich, Psy D

As we begin to see an end in sight for the pandemic, I’ve spent time reflecting on my time as a psychologist for the past year. While the pandemic may be ending and places are starting to open up and as we return to a sense of normalcy, I can’t help but wonder what aspects of the pandemic will stick long-term and how I can use what I have learned over the past year to help prepare.

Attention and Concentration While Working from Home During the Pandemic

The two biggest complaints people have reported have been difficulty with attention/concentration and social isolation. Having to work from home, and quarantine, completely changed our lives in regard to daily coping skills we likely did not know we even had.

As humans, we are social beings. That does not necessarily mean we need to be socializing with friends and family throughout the day to meet that need; it can also be met by riding the subway with others, working in an office place, or interacting with a cashier. In fact, one source states:

According to a meta-analysis co-authored by Julianne Holt-Lunstad, PhD, a professor of psychology and neuroscience at Brigham Young University, lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder. She’s also found that loneliness and social isolation are twice as harmful to physical and mental health as obesity.

Covid-19 took away that normal daily socialization and completely left us to ourselves.

Not only did we become socially isolated, but we lost the basics of self-care that we likely didn’t realize we had incorporated throughout our day until it was gone. For example, a commute to work, as frustrating as it may be at times, gave us the time to mentally prepare for the day and also wind down and let go of the day. The idea that our home is now our office and our office is now our home is one that has greatly affected the mental health of individuals. For individuals who find their job stressful, they may now associate their living space as a stressful place as well. If our homes, which by definition should be a place of happiness and safety, now represent places of stress, what do we do?

Depression, Anxiety, and Substance Abuse on the Rise During the Pandemic

We have seen a large increase in substance abuse, depression, and anxiety throughout this pandemic. In fact, according to the CDC:

Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%).

We have do not have normal social interaction nor do we have the natural separation between work and home. Unfortunately for many, work at home may be one piece of the pandemic that is here to stay. Companies no longer need to pay expensive rent for office spaces or spend money on travel when we have had a year to learn that everything can be done remotely.

How to Create a Healthy Routine During the Pandemic

We need to learn how to incorporate a healthy routine that incorporates all these aspects of self-care. Here are a few tools I often provide to clients and use myself:

  1. Set specific work hours. Just because we don’t have a commute and have more time to dedicate to work does not mean we need to. We still have lives outside of our jobs. Make sure start and end times for your day are marked on your work calendar so others can be respectful of those boundaries.
  2. Take breaks! Working from home does not mean you are not entitled to a lunch break or a few minutes here and there to stretch your legs. You do not need to be glued to a screen—no one can work 9 hours straight!
  3. Create a separate workspace in your home. Don’t work in bed or on the couch as you may start associating those places with stress. Make sure to have a proper desk or setup to work from where you can leave your computer at the end of the day and move to your “living” space.
  4. Exercise. In New York City, especially, most of our commutes include at least some walking. A lot of people have found themselves not moving at all since working remotely. Carve out time each day to move your body. This can include a morning walk, stretching, or more intensive exercise. It doesn’t matter how you move, just try to get in around 20 minutes a day. Also, be mindful of the time of day you exercise. Some find mornings helpful to increase energy and get their day started on the right foot, while others find the evenings helpful to wind down. Do what works best for you!
  5. Socialization. Remember, we are social creatures. Whether it’s getting a coffee in the morning and seeing people on the street, meeting a friend for dinner, or FaceTiming with family, try to connect with one person throughout any given day.
  6. Healthy eating and sleep. We need to treat our bodies with love and respect. If we eat junk food, we likely won’t feel good both physically and mentally. We need to make sure we are treating our bodies well so that our mental capacity and overall mental health is at its best.

Our Manhattan NYC Psychiatrists are Here to Help

At Fifth Avenue Psychiatry, our New York City psychiatrists care about your mental health, and we are here for you. This has been a tough year for us all, but there is finally a light at the end of the tunnel. Let’s learn from this past year and apply some of these lessons to our futures and prioritize our wellbeing.

If you are in need of help, get in touch with our psychiatrists in New York City. We are prepared to provide science-based treatment.

Mental Health • • • By PSYCHIATRY NYC 0 Comments

Coping Mechanisms Against Depression and Anxiety during the COVID -19 Pandemic

Written by Olga Megwinoff, MD

I did not want to write about anything related to the pandemic given that we are already so saturated by news and information related to it. However, I have realized it’s unavoidable. This pandemic and the ensuing quarantine have changed everything about the world as we know it. Most aspects of our personal, familial and social lives have been upended. Therefore, regardless of what I feel, I think that the most useful thing I can do is to write about coping mechanisms for how to endure social distancing and the fear.

I want to focus on what we can do to help each other and ourselves as we are starting week 11 of social distancing in New York. I, as a Manhattan psychiatrist, find myself, my family members, and my patients suffering in one way or another from the direct effects of the fear and social isolation, therefore, I have put together a compilation of simple techniques we can all apply to our lives, especially during this pandemic.

1. Fear and Anxiety

Often our fears are out of proportion to the reality of the situation. Our natural tendency is to over-estimate the risk and underestimate our ability to deal with it. Factors that can contribute to this phenomenon are how much uncertainty there is in a risky situation, how invisible the threat is, how much control people feel they have over the situation, how horrible the possible outcomes are, and how suddenly bad outcomes may occur (Leahy, PhD).

Regardless, the meaning we impose on fearful events contribute to our emotional states. Therefore, changing how we think about these events can reduce anxiety symptoms and improve overall wellbeing. The story we tell ourselves can be a conscious choice where we take a more neutral observer stand point and take into account the context.

You can train your brain not to blend with thoughts, instead to observe them from a distance. If you can do this, then it’s easier to recognize catastrophic or negative thinking. This can be done by monitoring the pros and cons of an event.

For example:

  • “What is the evidence for this thought?”
  • “Is this conclusion based on facts or feelings?”

We can also monitor and challenge negative anxiety-evoking self-statements.

For example:

  • “What are you predicting will happen and what is the likelihood it will actually happen?”
  • “If the worst case scenario were to happen, what would you do to cope with it?”
  • “What are the costs and benefits of worrying about this?”

To counter-balance your thoughts, it’s also imperative to control autonomic arousal through relaxation. Some examples of this are focused breathing, progressive muscle relaxation, exercise, and visualizations.

Your level of fear is inversely correlated to information. Be smart and know the facts. However, do this while limiting the time you expose yourself to the news media cycle and be aware that “the news” is often full of dramatizations instead of factual information.

2. Coping Skills for Stress During COVID-19

The ways in which individuals respond to stressors attenuate the presence of depressed mood and anxiety. This can influence both the duration and severity of their symptoms (Nolen-Hoeksema, 1991).

People have different coping styles, many of these are learned in childhood. Endler and Parker (1990) suggested that there are three basic coping styles: Problem-oriented, emotion-oriented, and avoidance-oriented.

Your coping style may stay consistent across different situations and experiences or the coping strategies you use can be varied. They may change over time as you face a particular stressor. For example, you can be using active coping mechanisms but decide to take a mental break because your anxiety is peaking and decide to use denial for a little while. You may stop looking at the news for a few days and get immersed in an engrossing book. While it is obvious that some of these coping strategies are more healthy than others, they all more or less serve the purpose of lessening anxiety in the moment. Nevertheless, while the less healthy coping mechanisms can still help not feeling anxious in the present moment, by suppression and displacement of the real feelings, these unhealthy coping mechanisms eventually can lead to depression and worsening anxiety.

Problem focused coping refers to overt behavioral attempts to modify or eliminate the sources of stress through one’s own behavior.

Examples include:

  • Active coping: “I tried to find out more about the situation”; “I took some positive action”; “I do what has to be done, but one step at a time”; “ I can’t change the situation but I’m taking action to try and make the situation better.”
  • Planning: “I concentrate my efforts on doing something about it”; “I have been trying to come up with a strategy about what to do.”

Emotional coping includes behavior or cognitive responses whose primary function is to attempt to monitor the emotional consequences of stressors and maintain one’s emotional equilibrium. One example of emotional coping is positive reinterpretation. This consists of monitoring one’s appraisal of the stressfulness of the event. In other words, someone may try to see the positive side of a situation or draw on their past experiences in similar situations.

Other examples of emotional coping:

  • Acceptance: “I have been learning to live with this.”
  • Denial: “This isn’t real.”
  • Turning to religion and/or spiritual beliefs
  • Humor
  • Exercise

Restraint/avoidant coping refers to the degree to which one refrains from acting to resolve a stressful situation.

Examples consist of:

  • “I have been doing something to think less about it”
  • Watching TV
  • Reading
  • Daydreaming
  • Sleeping
  • Substance abuse
  • “When I have a problem, I like to sleep on it”
  • “If I find a problem too difficult, I put it aside until I’m ready to deal with it”
  • “I try to let things work out on their own.”

Additional coping strategies consist of establishing social resources. Social support and willingness and comfort with help-seeking from others (Billings & Moos, 1981; Nadler, 1990) are also likely to influence an individual’s anxiety and depressed mood. One example is discussing your feelings with someone else. Talking to others can be very helpful because it can provide another perspective on the stressor in addition to getting advice about how to solve the problem. While “keeping my feelings to myself” tend to be detrimental in the long run.

3. Social Distancing

Interaction with peers is a powerful and universal human need. Attachment theory (Bowlby, 1980) describes how attachment serves the purpose of reducing anxiety. Attachment is the lasting emotional bond between two people, where one party (in childhood) or both of the parties (in adulthood) tries to maintain proximity to the attachment figure and takes action to ensure that the relationship continues.

Researchers believe that the style and history of an individual’s attachment affect loneliness. Attachment behavior activates when a person feels fear or sadness or contracts a disease. Therefore, during this time of forced social isolation, it is thought that a lack of face-to-face contact and separation from others may lead not only to lack of closeness in relationships, but also to loneliness and stress.

Attachment theory emphasizes that early childhood relationships form attachment styles and influence individual’s views about themselves, others, and the organization of interpersonal relationships. Attachment styles can be defined as patterns of thinking, feeling, and personal behavior in close relationships with a caregiver and other intimate partners. Attachments are made to others and correlates strongly to self-confidence, self-reliance, and ability to deal with the outside world. Accordingly, absence of an attachment figure makes a person feel lonely and/or anxious. Resulting in a lack of emotional stability. Consequently, separation from our parents, good friends, teachers, and mentors can profoundly impact a person’s emotional wellbeing in the many facets mentioned above.

Henceforth, it’s important we actively work on maintaining current relationships, renewing older ones, and cementing bonds. Consider being more loving and more expressive of love to your family, friends, teachers, and mentors. It’s not an exaggeration to state that your emotional well-being depends on it.

Our Manhattan Psychiatrists are Here to Help

At Fifth Avenue Psychiatry, our Manhattan psychiatrists understand how difficult the pandemic has been on us all. Should you find yourself in need of treatment, know that our team is here to help. We invite you to call our New York City office.

Resources:
Billings AG, Moos RH; the role of coping responses and social resources in attenuating the stress of life events.
J Behav Med. 1981 Jun; 4(2):139-57.

Daniel Brown, PhD, Living Meditation 3/30/2020; Using The Best of Western Psychology and Eastern Meditative Traditions as a Response to the Corona Virus Pandemic.

Charlie Silverstein MD. On My Mind: Coronavirus, fear, and anxiety. blog March 18, 2020.

Brief COPE

Active and Passive Coping Strategies: Comparing Psychological Distress, Cortisol, and Proinflammatory Cytokine Levels in Breast Cancer Survivors
Joana Perez-Tejada
Larraitz Garmendia
Ainitze Labaka
Oscar Vegas
Eneritz Gómez-Lazaro
Amaia Arregi

CJON 2019, 23(6), 583-590 DOI: 10.1188/19.CJON.583-590

Bartholomew K, Perlman D (1994). Attachment process in adulthood. London: Kingsley Publication.

Bowlby J (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Erozkan, A., The attachment styles bases of loneliness and depression.International Journal of Psychology and Counselling Vol. 3(9), pp. 186-193, December 2011

 

Addiction and Treatment Adult Psychiatry Alcoholism and Recovery Mental Health • • • • By PSYCHIATRY NYC 0 Comments

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D.

I often meet with people who say they are unsure of whether they have experienced trauma or not. So, what is trauma? Most people define trauma based on how trauma is portrayed in the media. But, in reality, it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another.

The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.” The way I like to understand trauma is based on an individual’s interpretation of the event. As children, we live under the assumption that “good things happen to good people and bad things happen to bad people.” When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, “If good things happen to good people, and this happened to me, then I must be bad.” Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.

We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event.

What is Cognitive Processing Therapy?

This is where Cognitive Processing Therapy (CPT), a 12-session behavioral psychotherapy, can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas and, using evidence and facts, combat those thoughts with rational ones.

How is Cognitive Processing Therapy Used to Treat PTSD?

CPT has been a very effective treatment modality which is often used in treating veterans with Post Traumatic Stress Disorder (PTSD). In fact, in 2017, a study which analyzed the effectiveness of CPT on veterans found that veterans who completed the 12-session treatment had a significant difference in their symptoms and a decline in Post-Traumatic Stress Disorder Checklist scores than veterans who did not complete or comply with treatment.

Other Treatments Used to Treat PTSD

Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, however, I have seen the most improvement and success with CPT.

While there are treatments such as CPT that are very effective in treating trauma, one of the most important pieces in this type of therapy is rapport. In all therapy, it is important to have a positive relationship with your therapist where you feel comfortable and not judged. Especially when disclosing a trauma and going deep into the event, feelings, and cognitions related to it, it is important that you feel trusting of the person providing that treatment.

The Common Connection Between PTSD and Addiction

From my experience working at a VA and here at Fifth Avenue Psychiatry, I see that there is a high comorbidity for substance abuse and PTSD, especially when PTSD goes undiagnosed or untreated. VA statistics note that more than 2 out of 10 Veterans with PTSD also have a substance use disorder, and one out of three veterans seeking treatment for substance use disorders also meet criteria for PTSD. The American Addictions Center reported that 55-60% of individuals who suffer from PTSD have comorbid addiction or alcoholism. They also note that “people who suffer PTSD are between two and four times more likely to also battle addiction than their peers who do not also struggle with PTSD.”

Again, traumas are not something that can be erased, but they can be something you can learn to live with. You can begin to see the world, people, and yourself in healthier ways again. You may never fully believe that “good things happen to good people,” but eventually you may believe that “bad things sometimes happen to good people.”

In need of PTSD treatment in Manhattan? Contact our Manhattan PTSD psychiatrists for an individualized, science-based treatment plan.

Sources:

Why More Attorneys Are Searching for an Addiction Therapist Near Me
Addiction and Treatment Mental Health • • By samuel glazer 0 Comments

The Lawyer: The Partyer and the Alcoholic

It’s a tired popular media trope: the attorney, burdened by the stresses of work, pours a glass of bourbon at the end of a long day. Maybe he is waiting for a verdict to come in after an impassioned speech in front of a jury, maybe she is prepping for a long day at the Supreme Court ahead. Alcohol as a coping mechanism in pop culture is as old as television itself. Read more

The Wolf of Wall Street
Addiction and Treatment Mental Health • • By PSYCHIATRY NYC 0 Comments

Why Financial Execs Can’t Manage Stress, Leading to Addiction Treatment

The world of financial executives has long been the subject of fascination. The Wolf of Wall Street, a movie starring Leonardo DiCaprio based on a memoir by Jordan Belfort of the same name, tells a compelling story of a financial executive’s meteoric rise and equally spectacular fall. Read more

Dual Diagnosis and the Benefits of Treating Co-Occurring Disorders Simultaneously
Mental Health By PSYCHIATRY NYC 0 Comments

Co-Occurring Substance Use and Mental Health Disorders

A person struggling with a substance use disorder (SUD) may experience significant barriers to recovery that may range from social support to lack of quality treatment options. One common barrier is a lack of dual diagnosis treatment when necessary. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that a third of substance use admissions in 2017 involved a co-occurring mental health disorder. When a person suffers from two behavioral health conditions simultaneously, failure to effectively address them both with evidence-based treatment could affect the recovery process. Here’s how dual diagnosis treatment can help.
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