Anxiety and Addiction

Anxiety disorders range from social anxiety to post-traumatic stress disorder. These disorders share common symptoms of fear, but each type presents unique symptoms and causes. People with anxiety disorders have a high likelihood of suffering from substance abuse. Treatment for co-occurring disorders can help patients recover.

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People feel anxious before moments of uncertainty. Some people feel more anxious than others before taking a test, before a competition or before a public speaking engagement. For most people, the feelings are temporary.

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For people with anxiety disorders, the feelings don’t go away. Instead, the anxiety gets worse over time and affects daily activities. Anxiety can begin for no clear reason, paralyzing the individual. It doesn’t necessarily go away when a threat is removed.

Millions of Americans suffer from anxiety disorders, and millions also suffer from substance use disorders. The illnesses can develop independently from one another, or one can cause the other.

Although people with anxiety disorders don’t always develop substance use disorders, or vice versa, research shows strong associations between the two. An estimated 18 percent of all people with substance use disorders have an anxiety disorder.

It can be difficult for health care providers to diagnose anxiety disorders in people with a substance use disorder because it is difficult to tell the difference between symptoms of intoxication and withdrawal and symptoms of anxiety.

There are several types of anxiety disorders, including generalized anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. People with different types of disorders experience anxiety for various reasons and in diverse ways. However, they all feel fear or worry in the absence of a clear and present danger.

People with mental or physical illnesses also commonly suffer from anxiety disorders, making diagnosis and treatment even more difficult. Sometimes, other problems may need to be treated before someone can receive treatment for anxiety.

Substance abuse adds one more complicated variable to the treatment equation. People with anxiety disorder who also suffer from a substance use disorder should seek treatment from rehabilitation centers with a specialization in treating co-occurring disorders.

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Types and Symptoms of Anxiety Disorder

Anxiety disorders can be broken down into different categories and conditions, with each disorder characterized by different symptoms. Anxiety disorders have common symptoms such as unexplainable or irrational fear and worry lasting at least six months.

Types of anxiety disorders include:

Generalized anxiety disorder:
GAD is characterized by long-lasting symptoms, constant worrying and extreme tension without obvious reason.
Obsessive-compulsive disorder:
OCD is characterized by recurring thoughts or repetitive behaviors. People with OCD often perform monotonous rituals, such as hand washing, counting and cleaning, in order to provide temporary relief from their obsessions or compulsions.
Panic disorder:
Panic disorder is characterized by recurring episodes of intense fear along with physical symptoms such as heavy breathing, dizziness and increased heartbeat.
Post-traumatic stress disorder:
PTSD develops after exposure to a traumatic event, usually involving the threat of extreme physical harm. Exposure to events involving violence, natural disaster, accidents or war often causes PTSD.
Social anxiety disorder:
Also called social phobia, SAD is characterized by extreme anxiety and self-consciousness in seemingly normal social circumstances.

Certain anxiety disorders have more obvious causes than others.

Causes of Anxiety Disorder

Research indicates biological, psychological and environmental factors contribute to a person’s likelihood of developing an anxiety disorder. Most people with anxiety disorders react to stress differently than the general population for genetic reasons.

Studies indicate the part of the brain that processes fear in people with anxiety problems has an unusually high sensitivity to stress and unfamiliar situations. Chemicals in the brain called neurotransmitters also play a large role in anxiety disorders. Serotonin and cortisol in particular seem to be connected to feelings of depression and anxiety.

Family history and genetics are important risk factors for anxiety. About 50 percent of people with panic disorder and 40 percent of people with generalized anxiety disorder have family histories of the disorders.

Other mental illnesses can contribute to anxiety disorder:

  • People with depression often feel symptoms of anxiety. A combination of depression and anxiety increases the risk of substance abuse and suicide.
  • People with bipolar disorder often feel symptoms of panic disorder, and anxiety can make bipolar disorder worse.
  • Eating disorders and anxiety disorders have a high association with one another. Obsessive-compulsive disorder may contribute to an eating disorder.
  • Anxiety disorder is a major risk factor for substance use disorders. Anxiety can contribute to alcoholism and drug abuse. People with PTSD are also at a high risk for chronic pain, increasing the risk of abusing opioids, such as hydrocodone.

Substance abuse can lead to anxiety disorders. Research shows anxiety and substance use disorders occur together at higher-than-normal rates.

Other risk factors for anxiety disorders include gender and age. Women suffer anxiety at a rate double that of men. Symptoms of OCD, phobias and separation anxiety develop during youth, and panic disorder and social phobia symptoms appear in teenage years.

Treating Substance Use Disorders and Anxiety

Some health care facilities focus on treating people with co-occurring disorders. Although health professionals may not treat anxiety disorder and a substance use disorder at the same time, it’s important to treat both conditions using the same treatment plan.

Anxiety disorder can increase the severity of alcohol addiction and drug use disorder and increase relapse rates. Substance use disorders also reduce the recovery rates of people suffering from anxiety disorders and increase the risk of suicide in patients with panic disorder. Providers that address co-occurring disorders keep all of those factors in mind when developing a treatment plan.

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Two treatment options are available for anxiety disorders: medication and therapy. Patients should always discuss previous treatments and their history of medications with a doctor before beginning a medication. Every drug is accompanied by a side effect, and health providers ensure the benefits outweigh the risks.

Medications do not cure anxiety disorder, but they can lessen symptoms.

Medications for anxiety disorder include:

Older antidepressants, such as tricyclics, can help with anxiety but may come with serious side effects.
Selective serotonin reuptake inhibitors:
SSRIs affect chemicals in the brain that may alleviate symptoms of anxiety.
Monoamine oxidase inhibitors:
MAOIs can be effective, but they interact with many other substances.
Anti-anxiety drugs:
Benzodiazepines, such as Xanax, act quickly but can cause drowsiness and can be addictive if misused.
Beta blockers:
Drugs such as Inderal (propranolol) are used to treat heart problems but have been successful in treating social anxiety.

Medications are often more effective when combined with therapy. Cognitive behavioral therapy can help people adjust the way they react to situations that may cause anxiety or change the way they perceive fears and handle them.

When a patient is ready, they may be exposed to fears to desensitize them or allow them to practice handling those situations. Exposure therapy is done only when the patient is comfortable and ready.

CBT is also effective when included as part of group therapy. Stress management techniques, aerobic exercise and reduced exposure to substances such as caffeine may combat anxiety.

Getting Help

People with co-occurring anxiety and substance use disorders need professional medical treatment to recover. Health care facilities that specialize in treating co-occurring disorders successfully help people recover and reduce symptoms of anxiety.

Whether through medication, therapy or both, health professionals have proven methods for mitigating symptoms and helping patients recover.

Long-term treatment may be necessary depending on the severity and length of the conditions. Health professionals will help patients determine the best course of treatment for them.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer,
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.

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