Addiction and Anxiety

Co-occurring disorders are common, and one of the combinations seen most often is anxiety disorder with substance use disorders. Anxiety, especially when untreated, can lead to substance abuse and addiction. Being screened for both conditions, and for other mental health conditions, is crucial for ensuring patients get accurate and complete diagnoses and that they get the best treatment. Effective treatment for anxiety and addiction includes a plan for addressing both conditions at the same time.

What Is Addiction and Anxiety?


The comorbidity of addiction and anxiety disorders is well documented. These two chronic conditions often occur together and have risk factors in common. Anxiety disorders are characterized by worry and fear that is out of proportion to a person’s experiences and situations. They cause excessive worry that is difficult or impossible to control and lead to varying levels of dysfunction across multiple areas of a person’s life.

Addiction is a dependence on drugs or alcohol, and it commonly co-occurs with anxiety. The most likely explanation for the co-occurrence is that someone with anxiety may turn to alcohol or a drug as a way to cope with the negative feelings. This is an unhealthy coping mechanism and can lead to addiction.

Because addiction and anxiety are so intertwined, it is crucial anyone who struggles with both conditions gets treated for both at the same time. When only one is addressed, it will likely lead to relapses in anxiety, substance use, or both.

Facts and Statistics


The only other types of mental illness that occur more commonly with substance use are mood disorders, like depression and bipolar disorder. Anxiety disorders co-occurring with substance abuse and addiction are very common.

  • Approximately 20 percent of people with an anxiety or mood disorder also struggle with a substance use disorder.
  • Twenty percent of people with substance use disorders also have anxiety or a mood disorder.
  • Alcohol abuse is common with social anxiety disorder.
  • Anxiety is more strongly correlated with dependence, or addiction, than with substance abuse or mild substance use disorder.
  • Having panic disorder, a type of anxiety disorder, is a risk factor for relapse in people with substance use disorders.
  • Untreated anxiety in children is a strong risk factor for later substance abuse.Substance abuse triggered by anxiety is more common than anxiety triggered by substance use.

Symptoms and Diagnosis of Addiction and Anxiety


There are several types of anxiety disorder, but they are all generally characterized by similar symptoms. Most people experience some of these symptoms at some time in their lives, but in order to be diagnosed with an anxiety disorder they must persist for a long period of time and on most days. The symptoms must also be severe enough to cause a lot of distress and impairment in daily activities. Symptoms of anxiety disorders include:

  • Feeling restless and on edge
  • Being unable to concentrate
  • Getting fatigued easily
  • Irritability
  • Muscle tension
  • Difficulty falling asleep or staying asleep
  • Rapid heart rate, shortness of breath, and sweating
  • Panic attacks
  • A lot of worry over social situations
  • Specific fears

These symptoms can lead a person to self-medicate, especially when a diagnosis hasn’t been made and the individual is not receiving professional treatment. Self-medication with alcohol or illicit drugs seems like a way to alleviate symptoms, but it only leads to a cycle of greater anxiety and more substance use. Ultimately, many people will develop a substance use disorder or even addiction. Signs of a substance use disorder or dependence include:

  • Out-of-control use of the substance, for instance planning to use less but failing
  • Continuing to use a substance in spite of the fact that it is causing problems, such as in relationships, or legal problems
  • Impairment in normal activities and responsibilities, such as school or work, because of substance use
  • Developing tolerance and needing to use more of a drug or alcohol to get the same effect
  • Experiencing withdrawal symptoms when not using

Diagnosing co-occurring mental illness and substance use can be challenging, because the two issues often are linked in complex ways. It is important for anyone diagnosed for one condition to be screened for the other. Only careful screening will lead to full and accurate diagnoses and professional treatment.

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High-Functioning Anxiety and Addiction


Diagnosing these comorbid conditions becomes even more difficult when a person is high-functioning. This means that, although they may meet the criteria for anxiety disorders and substance use disorders, they are able to cope well enough that they function almost normally. Functioning well at school, work, in the home, or in relationships can hide the real issues, but this high level of functioning will not last forever. Without addressing the underlying issues, functioning will eventually deteriorate. Trying to hide anxiety and substance use is not helpful or healthy. These issues must be diagnosed and treated for a person to get better.

Causes and Risk Factors


A common reason that anxiety and addiction co-occur is that anxiety symptoms often lead to self-medication with drugs or alcohol. Another explanation for the phenomenon is that the two conditions have similar risk factors, including:

  • Experiencing trauma, especially during childhood
  • Stressful life situations and chronic stress
  • A family history of anxiety disorders or substance abuse
  • Having other mental illnesses

Misusing substances is also a risk factor for anxiety disorder, and vice versa. There are other risk factors for anxiety and for substance abuse that are different, but these common factors overlap and can help explain why it is so likely that a person will struggle with both anxiety disorders and substance use disorders at the same time.

Withdrawal and Detox

Once a person has been diagnosed with anxiety and addiction, it is important to begin treatment as soon as possible. With addiction the first step of treatment is detox. This refers to the time it takes to go from stopping use of a substance to the substance no longer being in the body. During this period, which may be days or a week, a person will experience withdrawal symptoms. In most cases withdrawal is not dangerous, but it can be severe and lead to relapse, so undergoing detox with supervision is important. Different substances may cause specific withdrawal symptoms, but typical experiences include:

  • Headaches
  • Insomnia or excessive sleepiness
  • Nausea, vomiting, and abdominal upset
  • Changes in mood, including worsening anxiety, anger, and irritability
  • Sweating, tremors, and shaking
  • Confusion and disorientation
  • Loss of appetite

Other Co-Occurring Disorders


Co-occurring disorders generally refers to a mental illness with substance abuse, such as anxiety with addiction, but it can also refer to other types of illnesses. For instance, someone with anxiety may have more than one type of co-occurring anxiety disorder, including generalized anxiety disorder, panic disorder, social anxiety, and others.

There may also be other co-occurring disorders that a person with anxiety and substance use experience. These may include a chronic or terminal physical illness that causes pain and other distressing symptoms, behavioral conditions like attention deficit hyperactivity disorder, sleep disorders, or eating disorders. Substance use disorders may also include multiple substances, like alcohol, prescription drugs, or any type of illicit drug.

Treatment and Prognosis


Treating both anxiety disorders and addiction at the same time is crucial. The most effective treatments for both mental illness and addictive disorders are those plans that address all of a patient’s needs. These two conditions do not exist separately, but influence and affect each other, so they both need to be treated at the same time. If substance use is ignored it is very difficult to resolve anxiety, and if the anxiety is ignored a patient will be more likely to relapse after addiction treatment.

Treatment plans are individualized, but there are some commonalities. The best plans include therapy and, if appropriate for the patient, medications. Certain types of substance use disorders, such as those involving opioids, can be treated well with medication-assisted treatment along with therapy. For anxiety disorders, SSRI antidepressant medications are often a helpful supplement to therapy.

Therapy for both conditions may include cognitive behavioral therapy, which helps patients learn to be more aware of their negative thought and behavior patterns and to change them. Therapy can be individual or group, with family involvement, or may involve specialty types such as trauma-focused therapy, addiction counseling, or relational therapy.

While therapy and medications are the main elements of treatment for anxiety and addiction, patients also benefit from additional treatment strategies. These may include participation in support group participation, alternative and creative therapies, self-care, nutrition, and exercise. Also important for anyone struggling with addiction is relapse prevention. The best treatment plans include strategies to help avoid relapse, such as mindfulness, avoiding triggers, healthy coping strategies, and relaxation techniques.

Having anxiety and issues with addiction at the same time is not uncommon, but it is challenging. Anxiety is a terrible feeling, and it is natural to seek out a way to soothe that feeling. Drugs and alcohol may feel like temporary relief, but in the end they cause more harm than good, even causing addiction in many patients. Getting diagnosed for all mental health issues and getting treatment for anxiety and addiction together is crucial for getting well again.