The idea that suffering from depression, anxiety, stress, et cetera makes it harder to stop using drugs and alcohol has been quite popular over the past 15 years. However, it is wrong. I have studied and analyzed this issue extensively. Here’s a small excerpt from the notes I prepared on this subject for the 13th edition of The Saint Jude Program:
As was mentioned earlier, the very existence of so-called “dry drunks” is enough proof that “underlying issues” don’t actually cause substance use. People change their substance use habits regardless of such problems. Here’s another significant result to codify that point. A landmark epidemiological study, NESARC, that surveyed 43,000 people to learn about the course of substance use problems in the general population found: first, that most people get over their substance use problems eventually (over 90%) – but more importantly, they found that people do get over these problems, equally, whether or not they have various mood disorders and/or anxiety disorders.
The study measured whether people had the following Mood and Anxiety disorders:
Mood disorders included DSM-IV primary major depressive disorder (MDD), dysthymia and bipolar disorders. Anxiety disorders included DSM-IV primary panic disorder (with and without agoraphobia), social anxiety disorder, specific phobias and generalized anxiety disorder.
These are by far the most common diagnoses our guests have been given in the past. In an analysis of nicotine, cannabis, alcohol, and cocaine users (in which a vast majority were diagnosed with mood and anxiety disorders), the researchers found that:
No association was observed between mood and anxiety disorders and dependence remission for any of the substances assessed.
So, not only was it found that conditions like depression, bipolar, and anxiety (stress), do not cause people to “stay addicted” – a correlation wasn’t even found either. So as much as these conditions may be experienced by people with substance use problems, they simply do not correlate with either their ability or probability of changing their substance use habits.
Other findings in NESARC for comorbid disorders were: Personality disorders were found to be associated with lower probability of remission from alcohol and cannabis use disorders. However, in the case of alcohol, probability of remission was decreased by only 13% – just barely reaching clinical significance. Conduct disorders were only associated with remission from cannabis disorders – and actually increased probability of remission! However, with both of these results, we must remind our readers they represent only probability of remission – not ability. That is, they don’t establish that these disorders have any causative powers over whether one chooses to use substances or not.
Lopez-Quintero, C., Hasin, D. S., de los Cobos, J. P., Pines, A., Wang, S., Grant, B. F., & Blanco, C. (2011). Probability and predictors of remission from lifetime nicotine, alcohol, cannabis, or cocaine dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction (Abingdon, England), 106(3), 657–669. LINK
Another interesting set of results: Nancy K Mello was a researcher involved in several meticulously designed behavioral laboratory studies carried out on so-called “Gamma Alcoholics” (or “skid-row/bowery drunks”) who were kept in a hospital setting and allowed to drink with various contingencies. She observed many alcoholics spontaneously initiate abstinence in the course of her studies. In analyzing one of her studies she remarked:
In each instance, cessation of drinking was impulsive and abrupt. Moreover, cessation of drinking followed an obvious stress situation in four of the seven instances in which subjects spontaneously terminated a drinking episode. It was somewhat surprising to find that cessation of drinking was correlated with the occurrence of a stress situation. In contrast, there were seldom clearly definable events which accompanied resumption of drinking. On each occasion, subjects appeared less anxious and less depressed when they resumed drinking than when they terminated a drinking episode. These data complement clinical reports that an alcoholic may start drinking with little subjective feeling of tension, stress, or depression after deliberately planning a drinking spree…
Contradictory to the idea that alcoholics drink to medicate stress, she witnessed several instances of alcoholics stopping drinking after stressful events.
She also pondered alcohol’s role in improving mood, by discussing some evidence from her own studies and others’. One study she discussed found that alcoholics “showed the least change in mood” while under the influence of alcohol, when compared to non-alcoholic drinkers and depressed non-alcoholic drinkers. Two more studies she discussed found that alcoholics tended to become “progressively more tense and anxious while drinking.”
Mello, N. K. (1972). Behavioral Studies of Alcoholism. In B. Kissin & H. Begleiter (Eds.), The Biology of Alcoholism (pp. 219–291). Springer US. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4684-0895-9_9
Of course we all know that people can get into all sorts of moods when drinking – but the point here is that much of the research in controlled laboratory settings doesn’t seem to show that stress causes excessive drinking – or that drinking necessarily relieves stress as a rule. And the epidemiological data show that stress aka “anxiety” doesn’t impede people from changing their substance use habits.
Copyright 2013, Baldwin Research Institute, Inc., 9 Market Street, Amsterdam, NY 12010
My full notes contain further analysis of why these conditions are not an impediment to moderating or quitting substance use, but these are the most relevant points for a quick review.
Of course none of this is meant to imply that if you have the problems listed above you shouldn’t seek help. If you feel you need it, you absolutely should seek help for these psychologoical/emotional problems. What you shouldn’t do though, is believe that your substance use is caused by these problems, or that quitting substance use is dependent upon resolving these problems, or that relapse can be caused by these problems. Such beliefs will only make it harder for you to address your substance use issues.