Psychologist Anna Heal

Hello Harold. Thank you for sharing your question. It takes courage to reflect on such long-standing patterns and consider change. You are asking a very insightful question about whether your addictions and social anxiety can be addressed together in therapy. The short answer is yes, absolutely. In fact, it is often highly recommended to tackle them concurrently, as they frequently fuel one another in a cyclical pattern.

For someone who has managed these habits for over three decades, the therapeutic approach must be respectful of that history while fostering new growth. A foundational step is developing a strong therapeutic alliance with a psychologist who specializes in addiction and anxiety. This relationship provides the safety needed to explore the deeper psychological trauma you mentioned. A common and effective framework is cognitive behavioral therapy (CBT), which can help you identify and restructure the thoughts and beliefs that drive both the urge to use substances and the fear in social situations. For instance, you might learn that a belief like I am inadequate in social settings triggers both anxiety and a craving to smoke or drink to cope.

Another powerful approach is acceptance and commitment therapy (ACT). Instead of fighting the uncomfortable feelings of anxiety or craving, ACT teaches skills to accept them as passing experiences while committing to actions aligned with your values, such as health or connection. This can reduce the struggle and the power these feelings have over you. Given the duration of your habits, mindfulness-based relapse prevention is also valuable. It increases awareness of triggers, bodily sensations, and emotional states without automatic reaction, creating a pause between impulse and action.

Exploring the unresolved issues with family and work stress you referenced would likely involve psychodynamic or trauma-informed elements within therapy. Understanding how past experiences shaped your coping mechanisms can bring profound insight and reduce self-blame, which is a crucial part of healing. Furthermore, since social anxiety is a key barrier, therapy would gradually incorporate exposure techniques. This means slowly and systematically facing feared social situations in a controlled way, building confidence without relying on substances. This work is done carefully to avoid overwhelming you.

It is also important to consider your overall lifestyle and support system. Therapy can help you build healthier coping strategies for stress, such as exercise or hobbies, and strengthen social support, perhaps initially in low-pressure settings. While change is challenging at any age, your lifetime of experience can be a great asset in therapy, providing wisdom and perspective. The goal is not necessarily perfection but building a life where these habits and anxieties no longer control your choices. I encourage you to take the step of consulting with a licensed psychologist to begin this integrated work. You have already started the process by asking this question.