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Managing Anxiety and Insomnia in Addiction Recovery

Anxiety and insomnia are common problems for people in treatment for substance use disorders. In many cases, these issues were present prior to substance abuse, were masked during the addiction, and have now resurfaced in sobriety. Knowing how managing anxiety and insomnia in addiction recovery will happen can put clients at ease. At The Ranch PA, we believe in transparency and education. Because we want every individual to find their way through recovery and make sobriety lasting, we have clear protocols for managing anxiety and insomnia in addiction recovery.

Why Anxiety Emerges During Addiction Treatment

Substances like alcohol, opioids, or benzodiazepines have an anxiety-relief component to them. These drugs are basically nervous system depressants and naturally calming. Professionals prescribe some people benzodiazepines to help with anxiety before they began abusing them. Other people may have been self-medicating their anxiety with alcohol. And in the case of opioid abuse, people may not have even realized that they were less anxious when they were using them until they stopped. Regardless of their drug of choice, many people complain early in treatment that they can’t sleep and are struggling with anxiety. This is because when we take away the chemical, their coping mechanism, they often get rebound anxiety and insomnia.

Treating Anxiety in Medical Detox

During drug detox, people may experience increased anxiety because the body gets restless without these substances or they’re experiencing that baseline anxiety again that they never dealt with in the first place. When clients come into treatment, we detox them from their drug of abuse with different protocols. For example, if someone is addicted to alcohol we may use a long-acting benzodiazepine or phenobarbital to help them through withdrawal. If they’re abusing Xanax (a short-acting benzodiazepine), we may prescribe phenobarbital or a long-acting medication like clonazepam to taper – getting them through the detoxification process safely. For those withdrawing from opioids, we sometimes use a buprenorphine taper and some comfort medications short term. These methods can help ease some of the anxiety that comes up and other withdrawal symptoms. Detox protocols are individualized based on the client’s withdrawal symptoms, physical make-up, drug(s) of abuse and length of time they’ve abused drugs. Once clients move through detox, we have additional ways of addressing anxiety and insomnia.

Addressing Anxiety and Insomnia in Addiction Treatment

It’s important to educate clients that the substances they were abusing were naturally suppressing their anxiety, and now it’s returning. They need to develop healthy coping skills to address the underlying issues that have been fueling their anxiety all along. Sometimes they may need help from medications to do this. However, medication needs to be used in tandem with therapies such as cognitive behavioral therapy (CBT), music/art therapy or psychodrama. If anxiety is significant or particularly impairing, we may prescribe a selective serotonin reuptake inhibitor (SSRI) like Lexapro, Zoloft or Paxil in addition to therapies. We may also prescribe gabapentin, a drug initially used as an anti-seizure medication but that has recently been found to have qualities that can help ease anxiety and mood disorders. We use this with caution. Prescribing medications for anxiety can be tricky because many clients still want the immediate relief they got when active in their addiction, but they really need to work on coping skills. Sometimes they want a pill, and they want it now. My job is to not always give them that pill – not to feed into their compulsion – but help them understand there are other ways. It takes two minutes to okay a prescription but much longer to help them understand we know what they feel is real. It’s hard for a client to understand that no medication may be the best option at the moment. It makes us often unpopular at the time, but seeing the long-term outcome is worth it for all.

Managing Anxiety and Insomnia in Addiction Recovery

We will work with clients to manage their anxiety and insomnia without medications. Some of the ways we do this include:

  • Cognitive behavioral therapy: This approach helps clients identify unhealthy thought processes, beliefs, and behaviors. Clients work to change these with the help of assignments and by putting skills learned into real-life practice. CBT provides a sense of control. Studies have shown it to be effective in treating anxiety disorders.
  • Neurofeedback: This is a noninvasive biofeedback technique. It uses visual and auditory stimuli to train the brain to function more effectively and efficiently. It decreases obsessive thoughts, which can help with anxiety and insomnia.
  • Mindfulness: Paying attention to the body and breath has a calming effect. Also, it helps people become less reactive and overstimulated. Mindfulness meditation has been shown to help with generalized anxiety disorder.
  • Fitness: Exercise is a natural stress reliever and can help ease anxiety symptoms.
  • Education: It’s important that we educate clients that anxiety and insomnia can be a normal part of recovery. We help clients understand anxiety may have been an ongoing problem for them well before addiction. It will take some time to correct now that they’re not using drugs or alcohol. Clients often come into treatment on safe medications for anxiety or depression and want immediate changes. Helping them understand why these medications didn’t work or stopped working while they were actively using drugs is important. These medications need time to work while they’re sober. Time and sobriety are often the best choice.
  • Good sleep hygiene:  We encourage clients to practice good sleep hygiene to combat insomnia. This includes not using electronics close to bedtime, keeping a consistent sleep schedule, having a regular bedtime routine, having a supportive and calming sleep environment, exercising and avoiding caffeine.

Getting Treatment at The Ranch PA

Our medical staff and therapists work closely with clients. We determine if clients need to be prescribed medication. Sometimes, clients just need to understand anxiety and insomnia are a natural part of the recovery process. Typically, we tell clients to give it four to six weeks using their new coping skills to help alleviate symptoms. That being said, if we find that after a few weeks a client is experiencing pretty significant distress due to anxiety, we will try to ease their symptoms with some of the previously mentioned SSRIs. We weigh that carefully with their progress though. Medications can change lives, but the body does have an innate ability to heal itself if given the opportunity. So, we consider many factors when deciding, and we listen most of all to the client. At The Ranch PA, we keep the client’s best interests in mind. Lasting recovery means having the kind of treatments and therapies available to best serve unique needs. This is why we offer a variety of therapeutic programs, such as:

These traditional and alternative therapies give clients the tools they need to get and maintain sobriety. Contact us today at 717.969.9126 to begin your recovery.

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