anxiety + substance use · 2 • anxiety + substance use table 1. symptoms of anxiety anxiety can...

substance use

anxiety +

Contents:Who is this booklet for and What does it do? 1

What is anxiety? 1

What is an anxiety disorder? 3

hoW common are anxiety disorders? 4

What causes anxiety? 4

anxiety and substance use 5

When should i seek help? 6

hoW are anxiety disorders treated? 6

tips for staying Well 7

techniques for staying Well 9

Where to get help 15

About this booklet:this booklet is part of a series on mental health and substance use funded by the australian government department of health and ageing.

substance use in this booklet refers to the use of alcohol, tobacco and other drugs.

Other booklets in this series include:

• TraumaandSubstanceUse• MoodandSubstanceUse• PsychosisandSubstanceUse• PersonalityandSubstanceUse

Available at www.ndarc.med.unsw.edu.au

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Who is this booklet for And WhAt does it do?• Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorotherdrugs

whoareexperiencinganxiety.• Itaimsto:

—Helpexplainwhysomepeoplefeelthewaytheydo.—Givesuggestionsaboutthingspeoplecandotohelpmanagesymptomsofanxiety

andsubstanceuse.

WhAt is Anxiety?• Anxietyisthefeelingapersongetswhentheyare

stressed,worriedorafraidofsomething.• Anxietycanaffectthewayapersonfeelsphysicallyand

emotionally,thewaytheythinkandthewaytheybehave(seeTable1).

• Anxietyisanormalpartoflifethateveryonefeelsfromtimetotime.Forexample,itisnormaltofeelanxious,stressedorworriedbeforeatestorajobinterview.Itisalsonormaltofeelanxiouswhensomethingdangerousmightbeabouttohappen.Acertainamountofanxietyishelpfulinthesesituationsbecauseithelpsapersonpreparetoperformattheirbestortoavoiddangeroussituations.

• Anxietycanbecomeaproblemifitissooverwhelmingthatitstartstogetinthewayofdailylife,thatis,whenitinterfereswithworkorstudy,orwhenithasanegativeimpactonrelationshipswithworkmates,familyorfriends.

• Ifanxietygetsinthewayofaperson’sdailylifeandtheyarefindingithardtocope,theymighthaveananxietydisorder.

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table 1. Symptoms of anxiety

Anxietycanaffectthewayyoufeelemotionallyandphysically,thewayyouthink,andthewayyoubehave.Thistableshowssomecommonsymptomsofanxiety.Have you experienced any of these symptoms when you’ve been anxious or worried? Tick (4) the box next to the symptoms that you have experienced.

Physical reactions

Sweating Shaking Shortnessofbreath Racingheartbeat,painortightnessinthechest Nausea,vomiting Dizziness Drymouth Muscletension Restlessness Goingredintheface Difficultyfallingorstayingasleep Feelingonedge Beingeasilystartled(e.g.,byloudnoisesorsuddenmovements)

emotional reactions

Worried Stressed Fearful Irritable Feelingimpendingdoom Needingconstantreassurance

thoughts

Findingithardtoconcentrateorrememberthings Confusion Thinkingthesamethingsoverandover Negativethoughtslike‘Iamgoingcrazy’,or‘Iamgoingtoembarrassmyself’

behaviours

Avoidingandescapingfromthingsthatmakeyouanxious Beingonthelookoutfordanger Repeatedchecking(e.g.,makingsuredoorsarelockedortheovenisoff) Usingalcohol,tobaccoorotherdrugstocope Withdrawingfromothers

WhAt is An Anxiety disorder?• Thereareanumberofdifferenttypesofanxietydisorders,andmanypeoplemayhave

symptomsofmorethanone(seeTable2).

table 2. Types of anxiety disorders

Generalised Anxiety disorder (GAd)

ApersonwithGADworriesaboutanumberofthings,likehealth,money,familyorworkproblems.Theyworryaboutthesethingsmorethanothersandtheyfinditveryhardtostopworrying.

social Anxiety disorder (social Phobia)

Apersonwithsocialphobiahasstrongfeelingsofanxietyaboutbeingjudgedordisapprovedofbyothers.Thisleadstothepersonavoidingsocialplacesandevents,andbeingafraidofdoingorsayingsomethingthatcouldbeembarrassing.

Post-traumatic stress disorder (Ptsd)

PTSDcanoccurafterapersonseesorexperiencesafrighteningortraumaticevent.ApersonwithPTSDre-experiencesthetraumaticeventthroughunwantedmemoriesornightmares,andtheytendtoavoidpeople,places,andotherthingsthatmightremindthemoftheevent.SymptomsofPTSDalsoincludehavingtroublesleeping,memoryproblems,feelingon-edge,orbeingeasilystartled.Forfurtherinformationontheconsequencesoftrauma,pleaseseethebookletTrauma and Substance Use,alsoavailableinthisseries.

Panic disorder

Apanicattackisanextremeanxiousreaction,whereapersonexperiencesaracingheartbeat,shaking,shortnessofbreath,chesttightness,chillsorhotflashes,anddizziness.Duringapanicattack,apersonmightfeelanoverwhelmingsenseoffear,lossofcontrol,orthebelieftheyarehavingaheartattackorgoingcrazy.Thesefeelingsmayseemliketheycomeoutofnowhere.Apersonwithpanicdisorderexperiencespanicattacksineverydaysituations,andwilloftenstayawayfromsituationswheretheyareafraidtheywillhaveanotherpanicattack.Thiscanleadtoapersonhavingpanicdisorderwithagoraphobia.

Agoraphobia

Peoplewithagoraphobiafearsituationsorplacesfromwhichescapemightbedifficult(orembarrassing)orinwhichhelpmightnotbeavailableintheeventofhavingapanicattackorpanic-likesymptoms.Theseplacesmightincludesupermarkets,crowds,confinedspaces,publictransport,liftsandsoon.Thefearofhavingapanicattackinsuchasituationcanbesogreatthatapersonmightavoidthemcompletelyandevenavoidleavingtheirhousealtogether.

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Specific Phobias

Apersonwithspecificphobiaexperiencesextremeanxietywhentheyareexposed,orthinktheywillbeexposed,toafearedobjectorsituation.Commonspecificphobiasincludefearofflying,spidersandotheranimals,heights,smallspacesandgerms.

obsessive Compulsive disorder (oCd)

ApersonwithOCDexperiencesconstant,endlessandunwantedthoughts,whicharecalledobsessions.Theseobsessionscreatecontinuedfeelingsofanxietyandpanic.ApersonwithOCDtriestocontrolthesethoughtsandreducetheirfeelingsofanxietyandpanicbycarryingoutcomplicatedandrepetitivetasks,calledcompulsions.Thesemightbewashingtheirhandsoverandovertocontrolthoughtsthattheyareunclean,orcheckinglightswitchesorotherappliances,orcountingtasks.Compulsionsareoftenverytimeconsumingandtheimpactonaperson’slifecanbeverysignificant.

hoW Common Are Anxiety disorders?• Anxietydisordersarecommon—aboutoneinnineAustraliansexperienceananxiety

disordereachyear,and20%haveexperiencedananxietydisorderatsomepointduringtheirlife.Femalesaremorelikelythanmalestoexperienceananxietydisorder.

• Anxietydisordersareevenmorecommonamongpeoplewhohavealcoholorotherdrugproblems.Aboutoneineverythreepeoplewithalcoholorotherdrugproblemsalsohaveananxietydisorder.

• ThemostcommonanxietydisordersseenamongpeoplewithalcoholorotherdrugproblemsarePTSD,GADandsocialphobia.

• Ifyouhaveproblemswithanxiety,youarenotalone.

WhAt CAuses Anxiety? • Thereisnosinglecauseofanxiety.However,severalfactorsmaycontributetothe

developmentofanxiousthoughtsandbehaviourssuchas:—Afamilyhistoryofanxiety—Learnedwaysofresponding(e.g.,fromparents,friendsorteachers)—Chemicalimbalancesinthebrain—Lifeexperiences(e.g.,familybreak-up,abuse,bullying,interpersonalconflict,

orothertraumaticevents)—Alcohol,tobaccoorotherdruguse

table 2. Types of anxiety disorders continued

Anxiety And substAnCe use• Sometimespeopleusealcohol,tobaccoorother

drugstocopewiththeiranxiety.Thisisoftencalled‘self-medication’.

• Whilealcohol,tobaccoorotherdrugusemayprovideshort-termrelieffromanxiety,inthelong-term,itcanactuallymaketheanxietyworseasalcohol,tobaccoorotherdrugusecancauseanxiety.Peoplealsooftenfeelanxiouswhentheyarecravingalcohol,tobaccoorotherdrugs,orwhentheyarecomingdownorwithdrawingfromalcohol,tobaccoorotherdrugs.

• Thiscanleadtoacyclewheretheanxietyandalcohol,tobaccoorotherdrugusefeedoffeachother(seeFigure1).Somepeoplefindthattheydevelopalcohol,tobaccoorotherdrugproblemsbecausetheyfeelthattheyneedtodrinkorusegreateramountsmorefrequentlytocopewiththeiranxiety.

What happens to your anxiety when you reduce or stop drinking, smoking or using? do you notice any changes?

What happens to your alcohol, tobacco and other drug use when you feel anxious?

Alcohol, tobacco or other drug use

Anxiety

Craving

Figure 1:Cycleofanxiety,cravings,andalcohol,tobaccoorotherdruguse

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When should i seek helP?• Ifyoubelieveyouranxietyisaproblemorifyouansweryestoanyofthefollowing

questions,youshouldseekprofessionalassistance(seepages15–16): Areyoursymptomsverydistressing? Dotheyinterferewithyourhome,work,study,relationshipsorsociallife? Doyouusealcohol,tobaccoorotherdrugstocope? Haveyouthoughtaboutharmingyourselforothers?

hoW Are Anxiety disorders treAted?• Effectivetreatmentsareavailable.Bothpsychologicaltherapyandmedicationcanhelp

peopleaffectedbyanxietydisorders.• Oftenbylearninghowtobettermanagetheiranxiety,apersoncanlearnhowtobetter

managetheirsubstanceuse.

Psychological therapy• Cognitivebehaviourtherapy(CBT)iscommonlyusedinthetreatmentofanxiety,and

hasthebestevidenceofimprovingthisdisorder.CBTisalsoeffectiveformanagingsubstanceuse,sotreatmentcanoftenbecombinedtotargetbothaperson’sanxietyandsubstanceuseproblems.Thistypeoftherapyisaimedatchangingunhelpfulpatternsofthinking,behavioursandbeliefs,aswellashelpingthepersonconfrontfearedsituationsthatcontributetotheiranxiety.

• Ifyou’reinterestedinseeingapsychologist,yourGPcanhelpyoubypreparingamentalhealthplan,andreferringyoutoanappropriatepsychologist.

medication• Medication,particularlysomeoftheanti-depressantdrugs,mayalsobehelpful

alongsidepsychologicaltherapy.• Medicationscanbehelpfulinmanagingyouranxiety;however,somepeopleexperience

unpleasantanddistressingsideeffects.Inmostinstancesthereisachoiceofmedicationavailable,butitmaytaketimetoestablishwhichmedicationisbestsuitedtoyourneeds.Tellyourdoctoraboutanysideeffectsthataredistressingyou.

interactions with alcohol, tobacco or other drugs

• Itisveryimportantthatyoufollowyourdoctor’sinstructionswhentakinganymedicationthathasbeenprescribedtoyou.

• Beforebeingprescribedmedicationitisimportanttotellyourdoctoraboutyouralcohol,tobaccoorotherdrugusesothattheymaygiveyouthebestpossiblecare.

6  •  Anxiety + substAnCe use

• Alcohol,tobaccoandotherdrugscaninteractwithsomeprescriptionmedications,andthisinteractionmayaltertheeffectivenessofthemedication.Mixingprescribedmedicationswithalcoholorotherdrugscanalsohavedangerousconsequencesincludingoverdoseandpossiblydeath.

• Ifyouusealcohol,tobaccoorotherdrugsandareonmedication,letyourdoctorknowifyouareplanningtostopusingalcohol,tobaccoorotherdrugs.Whenyoustopdrinking,smokingorusing,thebloodconcentrationsofothermedicationscanalsobeaffected.Thedoctormayneedtoadjustthedoseofyourmedication.

tiPs for stAyinG WellThereareanumberofthingsyoucandotolookafteryourself:• Recognise early warning signs. Warningsignsaresignalsthatyoumaybemorelikely

toexperienceanxietyagain.Youmayrecognisethatyouarechanginginhowyouthink,actorfeel.Somecommonwarningsignsincludeworry,fearordread,havingdifficultyconcentrating,feelingirritable,fatigued,sweating,nausea,tremorsorarapidheartbeat.Youcanalsolearntoidentifyyourwarningsignsbythinkingaboutthesignsandsymptomsyouexperiencedwhenyoubecameunwellinthepast.Ifyouexperiencethesewarningsigns,seekprofessionalhelptoreducetheriskofexperiencingfurtheranxiety.

• Take care of yourself.Makesureyoueathealthilyandgetregularexercise.Exercisehelpstoreduceanxietybyprovidinganoutletforthestressthathasbuiltupinyourbody.

• Plan to do something you enjoy each day. Thisdoesn’thavetobesomethingbigorexpensive,aslongasitisenjoyableandprovidessomethingtolookforwardtothatwilltakeyourmindoffyourworries.

What are some things that you like to do that are pleasant or enjoyable?

• Make time for rest and relaxation.Gettingenoughsleepandmakingtimeforrestandrelaxationareimportantformanagingstressandanxiety.Youcanusetechniquessuchascontrolled breathing, progressive muscle relaxation,ormindfulness(thesetechniquesaredescribedonpages9–12),oranyotheractivityyoufindrelaxing(e.g.,reading,listeningtomusic,goingforawalk).Thesetechniquescanalsohelpyoumanageyourcravingsorurgestousealcohol,tobaccoorotherdrugs.

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• Reduce your use of caffeinated drinks(e.g.,soft-drinks,energydrinks,coffee,tea).Caffeineisastimulantandkeepsyoufeelingalertandon-edge.Itproducesthesamephysicalresponsethatistriggeredwhenweareanxious.

• Avoid or limit your use of alcohol, tobacco or other drugs.Alcohol,tobaccoandotherdrugscanintensifyyouranxiety.Itisrecommendedthatnomorethantwostandarddrinksshouldbeconsumedeachday(forfurtherinformationrefertotheAustralianDrinkingGuidelines).Avoidhighdosesofsubstances,andriskydrugtakingbehaviour,suchasinjectingdruguse.Stimulantdrugssuchasecstasy,amphetaminesandcocainespeedupthenervoussystemandcanmakeyouranxietyworse.Takeregularbreaksfromdrinkingorusing,andavoidusingmultipledifferenttypesofdrugs.Ifyouhavebeendrinking,smokingorusingregularlyitcanbedifficulttocutdown.Theactivitieslistedonpages9–14ofthisbookletmayhelpyoucopewithyourcravingsandurgestouse.

• Take medication as prescribed.Avoidmixingprescribedmedicationwithalcohol,tobaccoorotherdrugs,asthiscouldhavedangerousconsequences,suchasmakingprescribedmedicationineffectiveorincreasingtheeffectsofalcoholorotherdrugs.

• Seek support.Everybodyneedssupport.Talktofamilymembersorfriendsthatyoutrustaboutyourfeelings,orwritethemdowninadiary.Theserviceslistedattheendofthisbookletmayalsobeuseful.

• Plan to do something each day that brings a sense of achievement.Ofteneverydaytaskslikewashing,cleaning,payingbillsorreturningphonecalls,tendtopileupwhenapersonisgoingthroughahardtime.Thiscanbecomeoverwhelmingasthepilegetsbiggerandbigger.Byjustchoosingoneoftheseactivitiestodoeachday,youcanpreventthingspilingup,whichcanhelpyoufeelabitmoreincontrolofyourlife.Theflow-oneffectcanbearealsenseofachievement(orrelief)thatthisactivityhasbeencompleted.

• Monitor your emotions.Trykeepingtrackofyouremotionsandanxietysymptomsinadiary.Writedownhowyouhavefeltatdifferenttimesoftheday.Whenwereyouranxietysymptomshighest,whenyoufelttheworst?Whenwereyouranxietysymptomslowest,whenyoufeltbest?Whatwereyoudoingandwhatwereyouthinkingatthosetimes?Whendidyouhavecravingstousealcohol,tobaccoorothersubstances?Howmuchsleepdidyouhaveeachnight?Keepingadiaryofyouranxietyandemotionscanhelpyoulearnthepatternsbetweenthewayyoufeel,thethingsyoudoandthewayyouthink.

What strategies do you find help you to manage your anxiety reactions and your alcohol, tobacco or other drug use?

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teChniques for stAyinG Well Theactivitiesandtechniquesonthefollowingpagescanbeusedtohelpmanageanxietysymptomsaswellascravingstousealcohol,tobaccoandotherdrugs.Youcanalsopractisethemeverydayaspartofageneralplantokeepwell.Whilemanypeoplefindthetechniquesonthefollowingpagesuseful,theydon’tworkforeveryone.Donotusethemifyoufindthemdistressingorunpleasant—itisimportanttofindwhatworksbestforyou.

Controlled breathing exerciseHaveyounoticedsometimesthatyou’rebreathingtoofast?Stresscanaffectyourheartrateandbreathingpatterns.

Arelaxedbreathingrateisusually10to12breathsperminute.

Practisethisexercisethreetofourtimesadaywhenyou’refeelingstressedoranxioussothatyoucanusethisasashort-termcopingstrategy.

1 Timethenumberofbreathsyoutakeinoneminute.Breathingin,thenoutiscountedasonebreath.

2 Breathein,holdyourbreathandcounttofive.Thenbreatheoutandsaytheword‘relax’toyourselfinacalm,soothingmanner.

3 Startbreathinginthroughyournoseandoutslowlythroughyourmouth,inasix-secondcycle.Breatheinforthreesecondsandoutforthreeseconds.Thiswillproduceabreathingrateof10breathsperminute.Inthebeginning,itcanbehelpfultotimeyourbreathingusingthesecondhandofawatchorclock.

4 Counttoyourself.

5 Continuebreathinginasix-secondcycleforatleastfiveminutesoruntilthesymptomsofoverbreathinghavesettled.

6 Afterpractisingthisexercise,timethenumberofbreathsyoutakeinoneminute.Practisethecontrolledbreathingexerciseeachdaybeforebreakfast,lunch,dinnerandbedtime.Usethetechniquewheneveryoufeelanxious.Gradually,you’llbefamiliarenoughwiththeexercisetostoptimingyourself.

Source: beyondblueFactSheet6–ReducingStress2010

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mindfulnessMindfulnessisatechniquethathelpsyoufocusonyourinternalorexternalenvironment,withoutbeingdistractedorconcernedbywhatsurroundsyou.Mindfulnesscanbeappliedtoanytaskthatyoudo,suchasdoingthewashingup,orbrushingyourteethforexample.Thisparticularactivityistoshowyouhowtousemindfulnessskillstopayparticularattentiontoaroutineactivity(walking).Thistechniquemightseemdifficulttostartwith,butifyoupractise,itwillbecomeeasier.

1 First,findaplacewhereyoucanwalkupanddownwithoutworryingaboutwhomightseeyou.Itdoesn’tmatterwhereyouare,aslongasyoucantakeabout10steps.

2 Standinarelaxedposturewithyourfeetpointingstraightaheadandyourarmshanginglooselybyyoursides.Lookstraightahead.

3 Youwillpractisewalkinglikeitisthefirsttimeyouhaveeverwalked.Startwalkingandwhileyouarewalking,practisepayingattentiontoallthephysicalandothersensationsthatoccur—sensationsthatyouprobablywouldnotnormallybeawareof.Startbybringingyourfocustothebottomsofyourfeet,noticingwhatitfeelslikewhereyourfeetcontacttheground.Feeltheweightofyourbodytransmittedthroughyourlegsandfeettotheground.Youmayliketoflexyourkneesslightlyacoupleoftimestofeelthedifferentsensationsinyourfeetandlegs.

4 Next,transferyourweightontotherightfoot,noticingthechangeinphysicalsensationsandyourlegsandfeetasyourleftleg‘empties’ofweightandpressureandyourrightlegtakesoverassupportforyourbody.

5 Withtheleftleg‘empty’,allowyourleftheeltoriseslowlyfromthefloor,noticingthechangeinsensationsinyourcalfmusclesasthishappens.Allowtheentireleftfoottoliftgentlyofftheflooruntilonlyyourtoesarestillincontactwiththeground.Slowlyliftyourleftfootcompletelyoffthefloorandmoveyourleftlegforward,noticingthephysicalsensationsinyourfeet,legsandbodychangeasyourlegmovesthroughtheair.

6 Placeyourleftheelonthegroundinfrontofyouandallowtherestofyourleftfoottomakecontactwiththefloor.Asthishappens,noticethechangesinphysicalsensationsthatoccurasyoutransfertheweightofyourbodyontoyourleftfootfromyourrightfoot.Allowyourrightfootto‘empty’ofweight.

7 Repeatthisprocesswiththerightfoot.Firstliftyourrightheelofftheground,thentherestofyourfoot,andmoveitslowlyforward,noticingthechangesinphysicalsensationsthatoccurthroughoutthismotion.

8 Keeprepeatingthisprocessasyouslowlymovefromoneendofyourwalktotheother,beingawareoftheparticularsensationsinthebottomsofyourfeetandheelsastheymakecontactwiththefloor,andthemusclesinyourlegsastheyswingforward.

9 Continuethisprocessupanddownthelengthofyourwalkforabout10minutes,beingawareasbestyoucan.

10 Yourmindwillwanderawayfromthisactivityduringyour10minutesofpractice.Thisisnormal—it’swhatmindsdo.Whenyounoticethishashappened,gentlyguidethefocusofyourattentionbacktothesensationsinyourfeetandlegs,payingparticularattentiontothecontactyourfeethavewiththefloor.Thiswillhelpyoustayinthepresentmoment,concentratingonwhatishappeningnow,ratherthanworryingaboutthepastorthefuture.

11 Tobeginwith,walkmoreslowlythanusual,togiveyouabetteropportunitytopractisethisexercise.Onceyoufeelcomfortablewiththeexercise,youmayliketoexperimentwithdifferentspeedsofwalking.Ifyouarefeelingagitated,youmayliketostartoffwalkingfast,withawarenessthatthisiswhatyouaredoing,andthenslowdownnaturallyasyoubegintosettle.

12 Trytoworkthisactivityintoyourdailyroutine—practisewhenyouarewalkingtothebus,ortotheshops,oraroundthehouse.

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Progressive muscle relaxationProgressivemusclerelaxationinvolvestensingandrelaxingdifferentmusclegroupsoneaftertheother.Ithelpstoreducephysicalandmentaltension.Afullsessionofrelaxationtakesabout15to20minutes.

1 Sitinacomfortablechairinaquietroom.

2 Putyourfeetflatonthefloorandrestyourhandsinyourlap.

3 Closeyoureyes.

4 Dothecontrolledbreathingexerciseforthreeminutes.

5 Afterthreeminutesofcontrolledbreathing,startthemusclerelaxationexercisebelow.

6 Tenseeachofyourmusclegroupsfor10seconds,thenrelaxfor10seconds,inthefollowingorder:» Hands:clenchyourhandsintofists,thenrelax» Lower arms:bendyourhandsupatthewrists,thenrelax» Upper arms:bendyourarmsupattheelbow,thenrelax» Shoulders: liftyourshouldersup,thenrelax» Neck:stretchyourneckgentlytotheleft,thenforward,thentotheright,

thenbackwardsinaslowrollingmotion,thenrelax» Forehead and scalp: raiseyoureyebrows,thenrelax» Eyes:closeyoureyestightly,thenrelax» Jaw: clenchyourteeth,thenrelax» Chest:breatheindeeply,thenbreatheoutandrelax» Stomach:pullyourtummyin,thenrelax» Upper back:pullyourshouldersforward,thenrelax» Lower back:whilesitting,rollyourbackintoasmootharc,thenrelax» Buttocks:tightenyourbuttocks,thenrelax» Thighs:pushyourfeetfirmlyintothefloor,thenrelax» Calves:liftyourtoesofftheground,thenrelaxand» Feet:gentlycurlyourtoesdown,thenrelax

7 Continuecontrolledbreathingforfivemoreminutes,enjoyingthefeelingofrelaxation.

Source: beyondblueFactSheet6–ReducingStress2010

Coping with CravingsTheeasiestwaytocopewithcravingsorurgestousealcohol,tobaccoorotherdrugsistotry to avoidtheminthefirstplace.Thiscanbedonebyreducingyourexposuretocravingtriggers(e.g.,gettingridofdrugsandfits/pipesinthehouse,notgoingtopartiesorbars,reducingcontactwithfriendswhouse,andsoon).Sometimescravingscan’tbeavoided,andyouneedtofindwaystocopewiththem.

Cravingsaretime-limited,thatis,theyusuallylastonlyafewminutesandatmostafewhours.Ratherthanincreasingsteadilyuntiltheybecomeunbearable,theyusuallypeakafterafewminutesandthendiedown,likeawave.Everywave/cravingstartssmall,andbuildsuptoitshighestpoint,beforebreakingandflowingaway.

Cravingswilloccurlessoftenandfeellessstrongasyoulearnhowtocopewiththem.Eachtimeapersondoessomethingotherthanuseinresponsetoacraving,thecravingwilllosesomeofitspower.Thepeakofthecravingwavewillbecomesmaller,andthewaveswillbefurtherapart.

Below are some things for you to try out, to cope with the symptoms of cravings. Put a tick (4) in the box next to those things you think you could do.

Eat regularly,evenwhenyoudon’tfeellikeit.

Drink plenty of water—especiallywhenyougetacraving.

Insteadofdrinking,smokingorusing,drink water or chew gum.

Use‘Delaying’and‘Distraction’whenyourcravingissetoff.Whenyouexperienceacraving,putoffthedecisiontodrinkorusefor15minutes.Goanddosomethingelselikegoforawalk,read,listentomusic,ordothedishesetc.Thiswillhelpyoutobreakthehabitofimmediatelyreachingforalcohol,tobaccoorotherdrugswhenacravinghits.Youwillfindthatonceyouareinterestedinsomethingelse,thecravingwillgoaway.What are some things you could do to distract yourself?

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Usetherelaxationanddeep breathingtechniquesdescribedearliertocopewithacravingonceitissetoff.Ifacravingdevelopsinresponsetostressfulsituations,relaxationtechniquesanddeepbreathingexercisesarereallyuseful.

Ride out the craving by ‘urge surfing’.Formapictureinyourmindofawaveatthebeach.Thisisacravingwave,andrememberthatthecravingwavewillbuilduptoitshighestpoint,andthenfallawayasitrollsintoshore.Picturethecravingwavebuildingup,gettingreadytobreak,seeitbreak,seethefoamform,andseethewavefadeawayasitrollsintoshore.Now,pictureyourselfridingthewave,surfingthecravingwaveintoshore.Youdon’tfalloff,youdon’tgetdumpedandchurnedaround,justpictureyourselfcalmlysurfingthecravingwaveintoshore.

Talk to someone,perhapsafriendorfamilymember,aboutcravingwhenitoccurs.

Use positive self-talk.Tellyourselfthatcravingsonlylastabout10minutes.Tellyourself‘thisfeelingwillpass’.Youwillfindthattheurgesandcravingsthemselveswillbeeasiertodealwith.Saytoyourself,‘yes,thisfeelsprettybad,butIknowitwillbeoversoon’.

Challenge and change your thoughts.Whenexperiencingacraving,manypeoplehaveatendencytorememberonlythepositiveeffectsofusingdrugsandoftenforgetthenegativeconsequencesofusing.Remindyourselfofthebenefitsofnotusingandthenegativeconsequencesofusing.Thisway,youcanremindyourselfthatyoureallydon’tfeelbetterifyouhave‘justonedrink’andthatyoustandtolosealotbydrinking,smokingorusing.are there other things you do that help you cope with cravings?

Coping with Cravings continued

Where to Get helPThebestplacetostartisto see a doctor.Theycanprovideyouwithfurtherinformationandareferraltoanappropriatehealthprofessional.Theorganisationsbelowmayalsobeuseful.

Talkingwithtrustedfamily members or friendscanalsobeveryhelpful.Yoursupportnetworkcanassistyouinmakingdecisions,helpyouaccessservices,andgiveyouvitalsupportthroughrecovery.

national

FamilyDrugSupport: 1300 368 186Lifeline: 13 11 14Quitline: 13 78 48SANEHelpline: 1800 187 263ACt:

Alcohol&DrugInformationService: (02) 6207 9977CanberraAllianceforHarmMinimisationandAdvocacy: (02) 6279 1670nsW:

Alcohol&DrugInformationService: (02) 9361 8000or1800 442 599NSWUsersandAIDSAssociation: (02) 8354 7300or1800 644 413nt:

Alcohol&DrugInformationService: (08) 8922 8399or1800 131 350NorthernTerritoryAIDS&HepatitisCouncil: (08) 8953 3172qld:

Alcohol&DrugInformationService: (07) 3837 5989or1800 177 833QLDInjectorsHealthNetwork: (07) 3620 8111or1800 172 076QueenslandIntravenousAIDSAssociation: (07) 3620 8111sA:

Alcohol&DrugInformationService: 1300 131 340SouthAustralianVoiceinIVEducation: (08) 8334 1699tAs:

Alcohol&DrugInformationService: (03) 6230 7901or1800 811 994TasmanianCouncilonAIDS,Hepatitis&RelatedDiseases: (03) 6234 1242

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16  •  Anxiety + substAnCe use

ViC:

Alcohol&DrugInformationService: (03) 9416 1818 or1800 888 236HarmReductionVictoria: (03) 9329 1500VictorianDrugUsersGroup: (03) 9329 1500WA:

Alcohol&DrugInformationService: (08) 9442 5000or1800 198 024WesternAustraliaSubstanceUsersAssociation: (08) 9321 2877

Therearealsosomehelpful websiteswhichgiveinformationandguidance.Herearesome:

AnxietyOnline: www.anxietyonline.org.auAustralianCentreforPosttraumaticMentalHealth: www.acpmh.unimelb.edu.auAustralianDrinkingGuidelines: www.alcohol.gov.auAustralianDrugInformationNetwork: www.adin.com.auBeyondblue: www.beyondblue.org.auBlackDogInstitute: www.blackdoginstitute.org.auClinicalResearchUnitforAnxietyandDepression: www.crufad.unsw.edu.auDruginformationandadvice: www.saveamate.org.auDruginformationandresearch: www.druginfo.adf.org.auDruginformation,services,informationandsharedstories: www.somazone.com.auDualDiagnosis:AustraliaandNewZealand: www.dualdiagnosis.org.auFamilyDrugSupport: www.fds.org.auHeadspace: www.headspace.org.auHIV,sexualheathanddruginformationforlesbian,gay,bisexualandtransgendercommunities: www.acon.com.auMentalIllnessFellowship: www.mifa.org.auQuitnow: www.quitnow.info.auReachOut!: www.reachout.com.auSANE: www.sane.org

©NationalDrugandAlcoholResearchCentre2011

ThisbookletwasproducedbytheNationalDrugandAlcoholResearchCentre.ItwaswrittenbyKatherineMills,ChristinaMarel,AmandaBaker,MareeTeesson,GlenysDore,FrancesKay-Lambkin,LeonieMannsandTonyTrimingham.Thankyoutoeveryonewhowasinvolvedindevelopingthisbooklet.

DesignedandtypesetbyPetaNugent

ISBN978-0-7334-3047-3

ThisbookletispartofaseriesonmentalhealthandsubstanceusefundedbytheAustralianGovernmentDepartmentofHealthandAgeing.

Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorotherdrugswhoareexperiencinganxiety.

Itaimsto:• Helpexplainwhysomepeoplefeelthewaytheydo.• Givesuggestionsaboutthingspeoplecandotohelpmanagesymptoms

ofanxietyandsubstanceuse.

Otherbookletsinthisseriesandfurtherinformationonmentalhealthandsubstanceuseareavailableatwww.ndarc.med.unsw.edu.au