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Anxiety And Addiction: Co-Occurring Disorders

Medically reviewed by

Dr. Gerardo Sison, Pharm.D

Anxiety disorders are common among people who struggle with drug and alcohol addiction. At Addiction Campuses, we offer dual-diagnosis treatment capable of treating anxiety and addiction at the same time to help patients recover from their addiction and reduce anxiety.

Anxiety

Anxiety and substance use disorders affect millions of people in the United States and are commonly experienced together. There are several possible explanations for this, including their shared risk factors.

Many of the same factors that can cause or put someone at risk for developing an anxiety disorder are also found in people who struggle with drug and alcohol abuse. The most common anxiety disorders that co-occur with addiction include:

  • generalized anxiety disorder (GAD)
  • panic disorder
  • social anxiety disorder

Post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) also commonly co-occur with substance abuse, although they are no longer classified as anxiety disorders.

Researchers estimate that about half of those who struggle with substance abuse experience a mood or anxiety disorder at some point in their lives. People with anxiety disorders are also two times more likely to struggle with substance abuse than the general population.

Overcoming drug and alcohol addiction requires healing all aspects of a person’s well-being, including mental health. The most effective type of treatment for people with co-occurring anxiety and addiction is a dual-diagnosis treatment program.

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Which Comes First: Anxiety Or Substance Abuse?

Anxiety is a common risk factor for substance abuse, which means that having anxiety can make a person more likely to develop a drug or alcohol problem. However, people can also develop anxiety either as a result of their substance abuse or afterward as an independent problem.

One of the difficulties of diagnosing anxiety disorders in people with a history of substance abuse is the fact that alcohol and many drugs cause anxiety as a side effect. Similarly, anxiety can also develop as a symptom of drug and alcohol withdrawal.

Diagnosing anxiety as an independent disorder means that it has been deemed a problem that is separate from a person’s substance abuse. If a person has a history of anxiety that precedes their substance abuse, this can make it easier for a doctor to give dual-diagnoses.

In most cases of co-occurring anxiety and addiction, struggles with anxiety precede a person’s substance abuse, with the exception of post-traumatic stress disorder. However, this is not true for everyone.

The answer to which comes first is not clear-cut and can vary for different people based on their unique history of mental health and substance abuse issues.

Shared Risk Factors For Anxiety And Addiction

One explanation behind the common co-occurrence of anxiety and addiction is their shared risk factors. That is, there are certain factors that can make a person more likely to develop certain illnesses or disorders.

Both anxiety and substance abuse can be caused by a combination of biological, environmental, genetic, and other lifestyle factors, including recurrent stress. Trauma and abuse can also cause anxiety, and make someone more likely to abuse drugs or alcohol.

People with anxiety may also turn to drugs or alcohol in order to alleviate their anxiety symptoms. For someone with social anxiety disorder, for instance, drugs or alcohol may seem helpful as a way to feel relaxed in social settings.

Heavy alcohol and drug use can also numb anxiety, and temporarily distract a person from other problems they may be experiencing in their life.

How Substance Abuse Can Cause Anxiety

Research has shown that rates of substance abuse are higher in people with anxiety than in the general population, and vice versa. In some cases, this is a direct result of the drug or substance itself.

Anxiety is a common side effect of many drugs, and can also occur as a ‘hangover’ effect or symptom of withdrawal. The effects of chronic substance abuse on the brain can also lead to anxiety over time due to the interactions they have with certain chemicals in the brain.

Drugs and alcohol can also exacerbate symptoms of anxiety, making anxiety even more difficult to manage. This can create a frustrating cycle of using drugs or alcohol to relieve anxiety, and then using more when the anxiety still hasn’t gone away or has become worse.

Common substances of abuse that can cause anxiety include:

  • alcohol
  • benzodiazepines, when abused (e.g. Xanax, Klonopin, Valium)
  • cocaine
  • opioids
  • amphetamines (e.g. Adderall)

The anxiety that occurs as the direct result of drugs or alcohol is known as a substance-induced disorder. Substance-induced anxiety disorders are less common than experiencing each as their own separate problem.

In people without a previous history of anxiety, anxiety symptoms typically decrease anywhere from a few days to a few weeks after stopping their substance use.

Anxiety During Withdrawal

Drug and alcohol withdrawal occurs when a person who has become dependent on a substance reduces their use or attempts to quit. In people with severe dependence, symptoms of withdrawal can begin occurring within hours of their last dose.

The types of withdrawal symptoms a person experiences and their severity can vary depending on the substance. Anxiety, however, is a common symptom experienced during withdrawal from multiple addictive substances, including alcohol, opioids, and benzodiazepines.

The anxiety that is caused by withdrawal is temporary and can last anywhere from a few days to a few months. Factors that can affect this timeline include:

  • length of time a person was abusing substances
  • the amount
  • frequency of use
  • medical and mental health history
  • previous history of substance withdrawal

Certain medications can be used to ease anxiety during this process to help the brain and body readjust without the drug or substance in your system. This, combined with behavioral therapy is the most effective way to improve anxiety symptoms and overcome addiction.

Anxiety Signs And Symptoms

Everyone experiences some level of stress in their lives, but not everyone has an anxiety disorder. Anxiety disorders are diagnosed when a person has met certain diagnostic criteria.

The primary symptom of anxiety disorders is excessive worry, occurring most days for at least six months. In addition to this, five other criteria must also be met to receive an anxiety disorder diagnosis.

These additional diagnostic requirements include:

1. Has difficulty controlling the feelings of excessive worry and anxiety

2. Experience at least three of the following six symptoms most days for at least six months:

  • becoming easily fatigued
  • restlessness, or feeling on-edge
  • difficulty concentrating
  • muscle tension
  • sleep disturbances (difficulty falling or staying asleep)
  • irritability

3. The anxiety is not solely experienced as a result of other symptoms (e.g. not just feeling anxious about having social anxiety)

4. The anxiety symptoms have a clear, negative impact on the person’s ability to function in their personal, social, and/or professional lives

5. The anxiety is not a result of drug or alcohol use, or another mental health or medical condition

For people without a previous history of anxiety, it can be difficult to tell whether or not a person’s anxiety is related to substance abuse or its own independent problem. The only way to determine whether or not the anxiety is related to substance abuse is to stop using the substance.

Treatment For Co-Occurring Anxiety And Substance Abuse

At Addiction Campuses, we believe that our patients benefit the most from treatment that is able to treat co-occurring disorders at the same time, rather than separately. This is known as a dual-diagnosis treatment.

Our dual-diagnosis treatment programs are offered on an inpatient level for people who struggle with substance abuse and at least one other mental health disorder. This type of treatment takes an integrated approach, meaning our programs combine the use of multiple treatment services in order to treat all aspects of a person’s issues.

This includes:

  • medical detox services
  • cognitive behavioral therapy (CBT)
  • group therapy
  • expressive therapies
  • relapse prevention

Having an anxiety disorder can make overcoming an addiction more difficult than just getting help for substance abuse alone. With the right treatment, however, recovery is possible. By entering one of our treatment programs, we can help you or a loved one overcome addiction and find healthier ways to reduce anxiety.

Contact us today to learn more about our dual-diagnosis programs and find a treatment program that meets your needs.

Substance Abuse and Mental Health Services Administration (SAMHSA) - https://store.samhsa.gov/system/files/sma13-3992.pdf

Anxiety and Depression Association of America - https://adaa.org/understanding-anxiety/related-illnesses/substance-abuse

Medically reviewed by

Dr. Gerardo Sison, Pharm.D
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