Anxiety and Substance Abuse

Anxiety is a natural response to stress that can help people be alert to dangers in their surroundings.1 In other words, where fear is the emotional response to an imminent threat, anxiety is the anticipation of a future threat. However, when fear or stress-induced anxiety persists longer than normal2 and it becomes disruptive to your life, you may have developed an anxiety disorder. Anxiety disorders affect about 19.1% of the U.S. population in the past year and an estimated 31.1% of U.S. adults experience any anxiety disorder at some point in their lives, making it one of the most common mental illnesses in the country.3

Read on to learn more about anxiety, how anxiety and substance abuse affect each other, and what to expect from treatment for co-occurring anxiety and substance use disorder.

What Is Anxiety?

woman experiencing symptoms of anxiety disorderMost people experience some anxiety from time to time, which is natural and expected.4 If you’ve ever had to speak in public, make a big decision, gotten pulled over by the police, or had to take an important test, you have most likely experienced a short period of anxiety.

But for people with anxiety disorders, this anxiety may not go away quickly, or it may become more severe over time, interfering at school, work, and in relationships with other people.4

Social Anxiety Disorder Symptoms

People with social anxiety disorder have marked fear or anxiety in social or performance situations where they might be negatively evaluated or scrutinized by others, leading them to feel embarrassed and to avoid social situations.2, 3 SAD affects approximately 7% of Americans in any given year.4

The following symptoms of SAD typically appear when a person has to perform or be in front of others in a way that is out of proportion than most:5

  • Nausea or stomach sickness.
  • Increased self-consciousness and fear of judgment.
  • Sweat, tremble, blush, rapid heart rate.
  • Avoiding places where people gather.

To be diagnosed with SAD, one must experience these symptoms without them being attributed to illicit drugs or another medication or medical condition. Symptoms must also be persistent and last for six months or more.2

Generalized Anxiety Disorder Symptoms

Generalized anxiety disorder (GAD) is a type of long-lasting and excessive anxiety that gets in the way of your daily life and can include physical and mental symptoms occurring more days than not for at least 6 months. In any given year, GAD affects 2.9% of American adults. The anxiety can be focused on normal concerns like work or family, or simple things like daily responsibilities.1, 2, 4

Symptoms of GAD can include: 2

  • Fatigue.
  • Feeling nervous, restless, or anxious.
  • Irritability.
  • Lack of concentration or focus.
  • Muscle tension.
  • Problems with falling asleep, staying asleep, or disturbed sleep.

Panic Disorder and Panic Attack Symptoms

Panic disorder is a type of anxiety that involves repeated panic attacks paired with ongoing fears of more panic attacks, and/or changes in your behavior in efforts to avoid future panic attacks, like avoiding situations that may trigger them.1, 2, 4

Since many of the symptoms are physical and can be extremely severe, people experiencing a panic attack may think they are experiencing a heart attack, especially the first time it happens.1 Panic attacks often begin to occur in the early 20s but can start at any age.1 Symptoms of panic attacks generally last for only a few minutes and may include:2

  • Sweating.
  • Chest pain.
  • Chills or hot flashes.
  • Dizziness, light-headedness, or feeling faint.
  • Feeling detached.
  • Nausea.
  • Numbness or tingling.
  • Shaking or trembling.
  • Stomach pain.
  • Feeling like you can’t breathe, are being smothered, or choking.
  • Feeling like something terrible will happen.
  • Heart palpitations, racing heart, or increased heart rate.
  • Being afraid of losing control, “going crazy,” or dying.

Co-Occurring Disorders: Anxiety and Substance Abuse

Anxiety and substance use disorders are closely linked, as one diagnosis increases the risk for the other.6 For people with GAD, substance use disorders are the most frequently co-occurring psychiatric diagnoses. GAD is also strongly linked to AUD and approximately 20% of people with SAD also suffer from a drug or AUD.5 p415 In fact, people who have alcohol use disorder (AUD) are more likely to develop panic disorder (4.2%) than those who do not have AUD (1%).6

In one study, about 17.7% of people with a substance use disorder in the last year met the diagnostic criteria for an anxiety disorder, while 15% of people with an anxiety disorder in the last year met the criteria for at least one co-occurring substance use disorder.6

Studies estimate that people with anxiety disorders are most likely to use: 6

  • Alcohol (up to 34.5% of people).
  • Marijuana (15.1%).
  • Cocaine (5.4%).
  • Amphetamines (4.8%).
  • Hallucinogens (3.7%).
  • Sedatives (2.6%).

It can be difficult to tell if the anxiety disorder or substance use disorder came first. Both disorders are functionally intertwined in both their development and maintenance.7 Biological and environmental risk factors can predispose people to develop anxiety and substance use disorders or both. 8

Genetics play a role in the development of substance use and anxiety disorders, as does exposure to stress or trauma, which can increase the likelihood of anxiety sensitivity, especially during childhood. Both disorders affect similar areas of the brain, including how the chemicals in the brain function.2, 8

Anxiety disorders can also lead more directly to substance use disorders.7 People with anxiety may use substances to relieve their symptoms (i.e., self-medicate), although this can actually make symptoms worse both in the short term as well as in the long run.8

Substance use can also induce anxiety disorders. This can be a result of the substance changing parts of the brain as well as a result of experiencing the substance’s intended effects or side effects. For a person who may be predisposed or sensitive to developing anxiety, substance dependency or addiction can make it more likely that they will develop that condition.8

Treating Anxiety and Substance Abuse

group therapy to help treat patients with anxiety and substance abuseSince anxiety and substance use disorders are closely intertwined, they are most effectively treated simultaneously. Otherwise, anxiety could lead to a substance use relapse, or vice versa.6 Integrated treatment is vital to recovery from both disorders.6


For many, the first step is to attend a detox facility for withdrawal management. It’s important to note that detox only allows your body to safely clear itself of substances under medical supervision; it doesn’t address the underlying factors that contribute to addiction. It should be followed by additional treatment to help you get a good start on the road to recovery.9

Staff at the detox center should work to help link you to the next phase of treatment.9

Inpatient Treatment

A doctor is on staff to provide medication for your anxiety disorder, should you need it, in inpatient treatment at a hospital or residential treatment center. Nurses are available to administer medication and monitor you, and trained psychologists, social workers, mental health counselors, or other mental health professionals will provide intensive group and individual counseling. Attendance at these as well as self-help/peer support meetings may be strongly suggested or even required, as they will address ways to better cope with stressors, manage anxiety and prevent relapse.9

Outpatient Treatment

Instead of living at the treatment facility, you will live at home so you can continue your daily school and/or work routine. You may be required to attend group sessions several times a week, and at least one individual session with a therapist or counselor. Outpatient treatment may work well for someone who has already completed an inpatient program or who has a strong network of support from friends or family. Self-help/peer support meetings are strongly suggested, as they’re a good way to strengthen your support network.9


This is especially important for people who are diagnosed with co-occurring disorders. Treatment is important, but it is vital to continue receiving ongoing care for both disorders by seeing a private psychiatrist and therapist regularly. Finding a therapist who specializes in dual diagnosis and in managing co-occurring anxiety and substance use disorders could be a great way to stay on track with your recovery. In addition, attending self-help/peer support meetings can keep you moving forward in your recovery. Some of these meetings are even geared specifically for those with co-occurring substance use and mental health disorders.

Treatment for Dual Diagnosis

Many facilities, including Oxford Treatment Center, offer highly effective, evidence-based dual diagnosis treatments for clients with co-occurring disorders. In many settings, practitioners may provide workbooks and interactive group sessions using a variety of individualized treatment techniques, including:

  • Motivational Interviewing. This technique focuses on stages of change, identifying specific goals, and actively working to reach individualized goals.
  • Cognitive Behavioral Therapy. This approach focuses on how thoughts can influence emotions and actions, and altering how we think to create positive change. Similar techniques like Rational Emotive Behavioral Therapy and Solution-Focused Therapy are also incorporated.
  • 12-Step Programs. Learning about what the 12 steps are, and how to live them, is important for anyone in recovery. You can attend meetings, learn about sponsorship, and get answers to questions you may have regarding 12-step fellowships.

A Life in Recovery

Successful treatment could help you regain control over your life. Anxiety and substance use disorders are difficult to struggle with, and it may feel like they have taken over your life.

When dealing with these issues, you may feel lost or hopeless. Successful treatment can empower you to do what you haven’t been able to do in the past, whether that entails going to school, work, socializing with others, or even simply going someplace you’ve been scared to visit.

Anxiety can hold you back, as can a substance use disorder, but you don’t have to let these disorders rule your life. Recovery is possible, as long as you are willing to ask for help and put in the effort.



  1. American Psychiatric Association. (2017). What are anxiety disorders?
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
  3. National Institute of Mental Health. (2017). Any anxiety disorder.
  4. National Institute of Mental Health. (2018). Anxiety disorders.
  5. National Institute of Mental Health. Social anxiety disorder: more than just shyness.
  6. Brady, K.T., Haynes, L.F., Hartwell, K.J., & Killeen, T.K. (2013). Substance use disorders and anxiety: A treatment challenge for social workers. Social Work in Public Health, 28 (3-4), 407-423.
  7. Smith, J.P. & Book, S.W. (2010). Anxiety and substance use disorders: a review. Psychiatric Times 25(10), 19-23.
  8. National Institute on Drug Abuse. (2018). Common comorbidities with substance use disorders.
  9. National Institute on Drug Abuse. (2012).Principles of drug addiction treatment: A research-based guide (3rd edition).
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