Anxiety and Substance Abuse

Anxiety is a natural response to stress; your body enters this state in order to turn on the “flight or fight” response to urge protection when danger is sensed. Anxiety and substance abuse is a common dual-diagnosis, and can become severe if left untreated. Even though anxiety is a natural part of life, if it becomes prolonged, all-consuming, and interferes with everyday life, it is considered to be a mental health disorder. When anxiety co-occurs with substance abuse, both conditions can be exacerbated. While anxiety may lead to excessive use of substances, substance abuse is known to cause anxiety. Both conditions should be treated simultaneously for a successful recovery. 

What is Anxiety Disorder?

It’s normal to go through periods of time where you feel stressed, nervous, or worried. Anxiety is a natural reaction to human emotion and life’s many challenges. Natural anxiety will come when necessary and cease when it’s no longer needed. When you have an anxiety disorder, these feelings are experienced for long periods of time with no reason for them.

Being in a constant state of fear or panic can be debilitating, and often keeps individuals from doing the things they love. It can keep you from interacting with friends and family, excelling at your career, and in extreme cases cause physical disabilities and severe fatigue. The symptoms of anxiety differ from person to person, but some common characteristics include:

  • Chronic feelings of worry, fear, and distress
  • Extreme fatigue
  • Irritability 
  • Nausea 
  • Feelings that you are dying or extremely ill 
  • Feeling like you need to avoid triggers
  • Increased heartbeat
  • Slowed breathing
  • Trouble concentrating or staying present
  • Gastrointestinal problems
  • Uncontrollable mood swings
  • Isolation
  • Depression

Since anxiety is different for everyone, the severity of symptoms will differ from person to person. However, if you have been evaluated by a physician and there is no medical or physical reason for these symptoms (meaning you are in good health) you are likely suffering from an anxiety disorder. 

How does Anxiety Affect Substance Abuse?

Anxiety commonly co-occurs with substance abuse. Since the effects of anxiety can cause severe emotional and physical difficulties, many people find that substances temporarily relieve some of the negative effects. Although they occur independently and should be treated as such, having both can create a vicious cycle and hinder the ability to overcome one another.

In the case of a general anxiety disorder (GAD), using drugs and alcohol can lower the severity of the everyday side effects. Many people cope with substances to ease their physical symptoms like body tension and calm their overactive emotions. They become dependent on substances and lose their ability to naturally calm themselves down. 

In cases of social anxiety, its common to use alcohol to feel more comfortable participating in social events, but this creates a deeper fear of socializing while sober. Alcohol abuse is a common repercussion of this coping mechanism. 

Panic disorder is another form of anxiety that co-occurs with substance abuse. The fear of experiencing a panic attack can cause individuals to abuse drugs and alcohol in order to prevent them. Regardless of the type of anxiety, someone suffers from, substance abuse is only a band-aid and will not only worsen anxiety over time but create comorbidity that needs attention and proper treatment to overcome. 

Which Comes First, Anxiety or Substance Abuse?

Anxiety and Substance abuse are two of the most prevalent mental health disorders and often co-occur with one another. In cases of a dual diagnosis, it can be difficult to pinpoint which condition came first and led to the development of the other.  The National Epidemiologic Survey on Alcohol and Related Conditions found that those with an Anxiety disorder are 15% more likely to develop a co-occuring substance abuse disorder. 

When anxiety is co-occurring with substance abuse, oftentimes it is a way of self-managing the symptoms. The attempt to control my physical and emotional symptoms is an example of anxiety-causing substance abuse disorder.

On the other hand, alcohol and substance abuse change the way the body produces hormones, cognitive function, and nervous system regulation. These unnatural changes can make the body believe it’s in danger and ignite the “flight or fight” response. Since those with an addiction are constantly putting dangerous chemicals in the body, this anxiety/ stress response will be chronic, constant, and fit the criteria of an anxiety disorder. 

Typically when these co-occurring conditions develop in this form treatment of substance abuse will lower the occurrence of anxiety. In most cases of dual diagnosis, whichever condition came first is the focus of treatment, but both need attention and a rehabilitation program. 

Why Do Anxiety and Substance Abuse Co-Occur?

There are many reasons why these specific conditions occur, and why each influence one another. The development of a dual diagnosis can stem from a variety of different factors, including:

  • Coping Mechanisms: The strong relationship between addiction and anxiety is commonly due to individuals attempting to control their negative symptoms on their own instead of receiving proper treatment. 
  • Genetics- There is strong evidence that substance abuse and anxiety are both genetically predisposed, meaning that if it already runs in your family, you are more susceptible to developing one or both of these mental health conditions. Since they co-occur so frequently, even if only one is in your family, you may develop the other later in life. 
  • Side Effects of Addiction/Withdrawal: the symptoms of withdrawal and heavy substance abuse can closely resemble those of anxiety disorder. If experienced long enough, the body can adapt and believe this state to be a normal one and lead to the development of chronic general anxiety. 

Diagnosing Anxiety and Substance Abuse  

The first step in recovery is understanding what conditions you are experiencing, how and why they co-occur and receiving an official diagnosis from a medical professional. It’s important to see an experienced physician to conduct a full evaluation of your symptoms to properly identify the conditions and come to the conclusion of a dual diagnosis. When both of these conditions co-occur, treating only one will not make for successful rehabilitation. 

There are several ways doctors and therapists can identify these coexisting conditions and create a treatment plan from the perspective of not one condition, but both simultaneously. 

The processes of diagnosing will likely include the following:

  • Physical Examination
  • Lab Tests
  • Psychological Examination

During these evaluations, the patient will work one on one with experienced professionals to understand the severity and specific characteristics of his or her substance addiction and co-occurring anxiety. They will also attempt to uncover which condition came first and led to the other, so the patterns of development can be better understood. 

There are different types of anxiety and different types of substance addiction that can all fall under the category of this dual diagnosis, so it’s important, to be honest with your treatment team about your drug use, thoughts, and experiences that led you to seek help. 

Treatment for Anxiety and Substance Abuse

Treatment for a dual diagnosis of anxiety and substance abuse disorder will include a combination of treatments aimed at addressing both the mental and physical side effects of these co-occurring conditions. Treatment will look different for each individual case, but common options for treatment typically include: 

  • Detox
  • Depression/Anxiety medications
  • Talk Therapy (CBT, ACT therapy)
  • Nutritional Therapy
  • Meditation & Yoga
  • Behavioral Modification Therapy
  • Relapse Prevention 

Anti-anxiety medications are not always used, especially if there is a concern for addiction after substance abuse, however, they have proven successful in a large percentage of patients. If medical staff finds that anxiety was the condition that led to the development of addiction, oftentimes anti-anxiety medication is used. Antidepressants including SSRIs and Tricyclics are designed to help the brain’s chemistry function at its normal levels. Some patients have only prescribed them for a short period of time while others will find more success staying on them long term. 

Counseling sessions with a psychiatrist or therapist will help address both your mental illness and substance addiction, and aid in discovering the root causes of their development. Unresolved childhood trauma, insecurities, genetics, and effects from past experiences can be a major factor in the development of both conditions. Talking with a professional will enable you to learn how to accept and let go of whatever experiences are triggering your anxiety and addiction.  

Holistic approaches should also be considered for a dual diagnosis of Anxiety and substance abuse to teach individuals how to cope with everyday stressors and triggers. Yoga and meditation offer tools of relaxation and mindfulness, and acupuncture or massage therapy can lessen the tension that has manifested as a result of chronic stress. 

Treatment at Discovery Institute 

Here at the Discovery Institute, we provide comprehensive services designed to address all aspects of the disease of addiction and mental health, from initial assessment and detox to therapies and support groups, and thorough aftercare. Clients are offered multiple evidence-based approaches, each having been shown clinically to fight addiction and co-occurring anxiety from a variety of angles. Upon discharge, clients will have the tools and confidence they need to maintain sobriety and regain control of their lives. Contact us anytime to start your journey! 

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.