The presence of an anxiety disorder can significantly increase the risk of relapse to AOD use [1159, 1160]. Techniques for managing clients with symptoms of anxiety are outlined in Table 48. Clients may also be encouraged to try relaxation techniques to manage the distressing and distracting symptoms of anxiety [103, 1161, 1162].
Some useful relaxation methods include:
- Progressive muscle relaxation.
- Controlled or abdominal breathing.
- Calming response.
- Visualisation and imagery.
- Grounding.
Each method works best if practiced daily for 10–20 minutes; however, not every technique may be appropriate for every client. These techniques are described in detail in Appendix CC. Some of the cognitive behavioural techniques described in Appendix BB (i.e., cognitive restructuring, structured problem solving, and goal setting) may also be useful in managing symptoms of anxiety [1163–1166], but again, no one strategy is effective for everyone. If the client experiences unpleasant effects from any strategy, they should discontinue its use.
As with depressive symptoms, many anxiety symptoms will subside after a period of abstinence and stabilisation [777, 866–868]. It may be useful to explain to clients that it is quite normal to feel anxious when entering treatment but that these feelings usually improve over a period of weeks. During and after this time, constant monitoring of symptoms will allow the AOD worker to determine if the client requires further treatment. If the client has a history of anxiety in circumstances when they are not intoxicated or withdrawing, they may have an independent anxiety disorder. For these clients, it is unlikely that their anxiety symptoms will resolve completely with abstinence – indeed their symptoms may even increase. In such cases, clients should be assessed for an anxiety disorder and the treatment options should be considered.
Table 48: Dos and don’ts of managing a client with symptoms of anxiety
| Do: |
|
Approach the client in a calm, confident, and receptive way.
|
|
Move and speak at an unhurried speed.
|
|
Be patient in order to allow the client to feel comfortable to disclose information.
|
|
Minimise the number of staff present and attending to the client.
|
|
Minimise surrounding noise to reduce stimulation.
|
|
Reassure the client frequently (e.g., ‘This won’t take much longer’).
|
|
Explain the purpose and structure of interventions.
|
|
Remain with the client to calm them down.
|
| Don't: |
|
Crowd or pressure the client.
|
|
Get frustrated or impatient.
|
|
Panic. The more relaxed you are, the more relaxed the client is likely to feel.
|
|
Act shocked by what the client may reveal.
|
Adapted from NSW Department of Health [431], SAMHSA [102], and Clancy and Terry [448].