Anxiety and Substance Abuse

An anxiety disorder may lead to abusing alcohol or other substances to self-medicate to relieve anxiety symptoms. Usually, people with substance use disorder (SUD) and anxiety disorders experience them separately. Having both can be a continual cycle where the symptoms of one disorder can worsen the symptoms of the other.

What’s Anxiety?

Anxiety is a natural response to stress by your body. It’s a feeling of fear about what’s about to happen. A job interview, the first day at work or school, or giving a speech cause most people to feel nervous and afraid. However, if your feelings of anxiety are:

  • extreme,
  • last longer than 6 months, and
  • interfering with your life,

you may have an anxiety disorder.

7 Major Anxiety Disorders

There are seven main types of anxiety disorders:

1. Generalized Anxiety Disorder (GAD)

The main features of GAD are chronic anxiety and excessive tension and worrying, even when there is little or no apparent cause.

2. Obsessive-Compulsive Disorder (OCD)

OCD is characterized by repeated unwanted thoughts (obsessions) and repetitive behaviors (compulsions). The behaviors such as hand-washing, checking, counting, or cleaning are often performed repetitively in the hope of stopping the unwanted thoughts or making them go away.

3. Panic Disorder

This disorder features unexpected and repeated spells of intense fear with physical symptoms that might include:

  • Chest pains
  • Heart palpitations
  • Shortness of breath
  • Dizziness
  • Abdominal pain

4. Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after being exposed to a terrifying event or ordeal where serious physical harm happened or was threatened to you or someone else.

5. Social Phobia/Social Anxiety Disorder (SAD)

This disorder is characterized by overwhelming anxiety and extreme self-consciousness in typical everyday social situations. It might be limited to one particular type of situation, like fear of speaking in formal or informal situations. It could also be eating and drinking in front of others. In the most severe form, it may be so prevalent that the individual has symptoms almost every time they are around other people.

6. Separation Anxiety Disorder

This disorder features an unreasonable fear of being away from home or loved ones.

7. Illness Anxiety Disorder

This is anxiety about your health, also known as hypochondria.

What Are Symptoms of Anxiety?

difficulty sleepingDepending on the person experiencing it, anxiety can feel different to different people. Sensations can range from butterflies in your stomach to a racing heart. You might even feel out of control like there’s a disconnect between your body and mind.

Other people might experience anxiety through nightmares and panic attacks. You might have painful thoughts and memories that you can’t control or a general feeling of fear and worry. Also, you might fear a particular place or event. Symptoms of general anxiety include:

  • increased heart rate
  • rapid breathing
  • restlessness
  • difficulties with concentrating
  • difficulty falling asleep

Bear in mind that your anxiety symptoms might be completely different from someone else. That’s why it’s important to know all the ways anxiety can show itself.

What is an Anxiety Attack?

An anxiety attack is a feeling of overpowering uneasiness, fear, worry, or distress. An anxiety attack builds slowly for many people, and it may get worse as a stressful event gets closer. Attacks can vary widely, and symptoms may be different among individuals. The reason is that the many symptoms of anxiety don’t happen to everyone and they may change over time.

Common symptoms of an anxiety attack include:

  • Feeling faint or dizzy
  • Shortness of breath
  • Dry mouth
  • Sweating
  • Chills or hot flashes
  • A feeling of dread and worry
  • Restlessness
  • Distress
  • Fear
  • Numbness or tingling

Anxiety and Panic

A panic attack and an anxiety attack have some of the same common symptoms, but they’re not the same. Panic attacks appear suddenly and involve intense and overwhelming fear. There are usually physical symptoms such as a racing heartbeat, shortness of breath, or nausea.

However, anxiety is usually related to the anticipation of a stressful situation, experience, or event. It may develop gradually. But panic attacks aren’t always initiated by stressors. They usually come out of nowhere. During a panic attack, the fight-or-flight response takes over. Physical symptoms are more intense than anxiety.

Interestingly, you can experience anxiety and a panic attack at the same time. For example, you might feel anxiety while worrying about a possibly stressful event, such as an important presentation at work. When the actual event arrives, anxiety may result in a panic attack.

How Do Addiction and Anxiety Develop?

Man having anxiety

As previously mentioned, these disorders feed off each other, which makes diagnosis and treatment even more challenging and complicated. This comorbidity (two disorders at the same time) creates a mutual maintenance pattern in which each disorder affects the treatment and outcome of the other. The most common complications of some comorbid conditions are:

  • Social Anxiety Disorder: The comorbidity of substance use disorder (especially alcohol abuse) is common among people who have SAD. People with this particular anxiety disorder claim that alcohol helps ease their anxiety, although it often makes it worse. Alcohol abuse typically follows the onset of this disorder.
  • Post-Traumatic Stress Disorder: It is common for PTSD to occur with substance abuse. Individuals struggling with this disorder regularly use drugs or alcohol to try to relieve the anxiety. Unfortunately, substance abuse may worsen symptoms of PTSD. Mental health professionals usually treat PTSD and SUD together because the symptoms of PTSD (intrusive thoughts and disturbances in sleep) can easily cause substance abuse relapse.
  • Panic Disorder: Alcohol and drugs frequently cause panic attacks. So having a panic disorder is a risk factor for relapse among people with panic disorder. Alcohol abuse frequently begins before or at the same time as panic disorder symptoms.

Risk Factors for Co-Occurring Disorders

Very often, there is a genetic risk factor for both SUD and certain mental health disorders. Yet, genes alone usually don’t explain all the causes for co-occurring disorders. Other factors include:

  • Family
  • Environment
  • Stress
  • Poverty
  • Loss
  • Traumatic life events

The Denial Issue

Common to both substance abuse and mental health disorders is denial. It’s difficult to admit you have a dependence on drugs or alcohol. It’s also difficult to admit how much of an effect they have on your life. As a result, you may be trying to ignore them while hoping they would just go away.

Some people are ashamed or afraid of being viewed as weak or a failure if they admit they have a problem. However, coexisting conditions can happen to anyone, and admitting you have a problem and seeking help is the first step to overcoming your issues and reaching the goal of recovery.

Understanding Dual Diagnosis

When you have a substance use disorder and a mental health disorder occurring at the same time (comorbid conditions),  it is called a dual diagnosis. In this case, you have a co-occurring SUD and anxiety. Dual diagnoses can be hard to recognize because it takes time to figure out what may be a mental health disorder and what might be an alcohol or drug abuse condition.

In addition, the signs and symptoms also vary depending on the mental health issue and the substance being abused. Whether it’s alcohol, recreational drugs, or prescription medication, there are still some warning signs that you may have a dual diagnosis. Consider these questions:

  • Do you deal with unpleasant memories or feelings by using drugs or alcohol? Does substance use help you control your pain or the intensity of your moods? Do substances help you face situations that scare you or help you stay focused on tasks?
  • Is there a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or do you drink when you’re being bothered by unpleasant memories or feeling anxious?
  • Has a family member struggled with either a mental disorder or alcohol or drug abuse?
  • Do you feel depressed, anxious, or somehow out of balance even when you’re sober?
  • Have you ever had treatment for either your mental health or addiction problem? Did you relapse back into substance use because of the mental health disorder or vice versa?

Dual Diagnosis Treatment Options

Anxiety TreatmentThe best treatment for the comorbid disorders of anxiety and addiction is a united approach in which both the mental disorder and SUD are treated at the same time. At this point, it doesn’t matter which disorder came first. Long-term recovery depends on getting treatment for both disorders by the same provider or treatment team.

Choosing Your Team

Even though there are several approaches that treatment programs might use, these are the basics of effective treatment that you should look for:

  • Treatment should concentrate on treating both the SUD and the mental health disorder.
  • You should have a part in the decision-making process and be involved in setting goals and developing plans for change.
  • Your treatment should include some basic education about your disorders and the issues related to them.
  • You should be taught healthy coping skills and strategies to minimize substance abuse, improve your relationships, and aid you in dealing with the stress, challenges, and upsets in your life.

Treatment Approaches

Addiction and mental illness are difficult to overcome on their own. But when they appear together it is even more challenging. There is evidence from studies that SUDs and anxiety commonly co-occur. The interplay between the two disorders is complex and changeable. Some of the specific anxiety disorders tied to substance abuse include:

  • GAD
  • Panic disorder
  • PTSD
  • OCD (less frequently)

There have been many investigations into new treatments for co-occurring anxiety and substance use disorders. Due to the mutual maintenance pattern of the disorders, most studies have tried to find treatments that speak to both disorders. Research is continuing to develop and includes pharmacotherapy (medications) and psychotherapy (counseling, talk therapy) as the main approaches for these dual diagnoses.


There has been a variety of medications that have been found to be potentially effective. The antidepressant Paxil shows signs of being effective for the treatment of social anxiety disorder with alcohol use disorder (AUD). Similarly for Topamax (a migraine and epilepsy medication)  and buspirone (BuSpar), a short-term anxiety medication.


Psychotherapies are an essential part of the treatment for SUD and anxiety disorders because it helps you learn to cope without the use of substances.

  • Cognitive Behavioral Therapy (CBT): CBT has already proved to be effective for both disorders independently. It is now showing to be a successful approach for developing specialized treatments for people with both disorders.
  • Motivational Interviewing (MI): This therapy involves a therapist helping an individual determine whether substance use is consistent with their goals and values.

Inpatient Rehab

This is an option if you want or need to receive 24-hour medical and mental health care. In a residential program, you will receive therapy, support, medication, and other health services.

When you choose a treatment plan, it’s important to remember that the best treatment is to consolidate care for both conditions Each one should be considered primary and receive treatment at the same time.

Unified Care at Chapel Hill Detox

The days of “I can’t treat your anxiety until you stop drinking” are over. Although there is no standard dual diagnosis treatment, our medical professionals at Chapel Hill can use best practices to create an individualized treatment program just for you. Dual diagnosis is a common issue that many people face. And even though it is a challenging issue, you can get better with support and the proper treatment. Let us be your team. Your days on this cycle of abuse and fear can be over if you make the first move and contact us now.