Addictive disorders/substance use disorders (SUDS) affect almost everyone in the United States, either directly or indirectly. The cost of substance abuse to the social and economic structure in the United States is huge. Anxiety is one of the most frequently mentioned symptoms which lead to relapse during the early weeks of recovery due to neurohormonal changes in the limbic system as well as cortisol production which occur during this time. Present research in the treatment of anxiety in substance abuse and long term recovery is focused on genetics and pharmaceuticals, however most pharmaceuticals produce sedation. Additional therapies in early recovery, which decrease the symptoms of anxiety while enhancing cognitive ability to learn and apply coping skills, are needed. Purpose: The purpose of this dissertation was to identify the natural degradation of anxiety symptoms occurring during the first few weeks following detox from alcohol or opiates. To identify non pharmacological methods in use to decrease anxiety symptoms during this period, and then examine whether treatment with Cranial Electrotherapy Stimulation (CES) would enhance the degradation of anxiety symptoms. Methods and Results: The initial prospective study of 53 men in residential treatment, measured anxiety on entry, 30 and 60 days. The results found that increased anxiety measured prior to a participant leaving against medical advice was more significant than increased anxiety measured on admission. The follow-on pilot study in the same residential program was a double-blind experimental study using CES with active and placebo CES units loaned from the manufacturer. The intervention was conducted during the first 3 weeks of opiate/alcohol abstinence; a period identified when anxiety peaks, and dropout rate is high. There were 29 men in the experimental group and 31 in the placebo group. Salivary cortisol and state anxiety were measured on the first and final day of CES treatment. Anxiety was also measured at study enrollment and at 30 days when study enrollment was terminated. The results were statistically inconclusive as both the placebo and CES (experimental) groups trended downward; however the trend was greater in the CES group. Discussion/Implications: Anxiety was identified as a significant factor in leaving treatment early. Cranial Electrotherapy Stimulation appears to decrease anxiety in non-substance abusing populations. However, these finding were not supported in this substance abusing population during the first month of recovery. Although CES appeared to be the most promising alternative therapy, more research is needed in the use of this and other emerging therapies for the treatment of anxiety symptoms during this early recovery period.


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Graduation Date





Neff, Donna


Doctor of Philosophy (Ph.D.)


College of Nursing



Degree Program










Release Date


Length of Campus-only Access

3 years

Access Status

Doctoral Dissertation (Open Access)

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Nursing Commons