Anxiety is a common mental health disorder, one that can often be found alongside a substance use disorder (SUD). The relationship between anxiety and addiction is a complex and often codependent one.
For some, anxiety serves as the catalyst for using drugs and alcohol, as use and abuse of these substances can dull feelings of dread or worry. Long-term substance use can also trigger or intensify the symptoms of anxiety, creating a vicious cycle that is difficult to break. Understanding the connection between anxiety and substance abuse is crucial, as co-occurring anxiety and SUDs require specialized, integrated treatment to address both conditions at the same time.
What is Anxiety?
Anxiety is the feeling of fear, dread, and uneasiness. It can cause a person to sweat, become restless, and undergo an accelerated heartbeat. Anxiety is a normal reaction to stress and can even help a person cope in the face of challenge, difficulty, or before making an important decision.
However, for people with anxiety disorders, feelings of fear, dread, and uneasiness are constant and overwhelming. An anxiety disorder is a condition in which a person lives with anxiety that does not go away and grows more intense with time. The symptoms of an anxiety disorder can interfere with daily activities such as job performance, schoolwork, sleep, and personal relationships.
There are several distinct types of anxiety disorders. These include:1,2,3
- Generalized anxiety disorder (GAD). People with GAD worry about ordinary issues such as health, money, work, and family. However, their worries can be excessive and constant, lasting all day, every day for six months or more.
- Panic disorder. People with panic disorder experience panic attacks—sudden, repeated periods of intense fear and uneasiness when there is no immediate danger. Panic disorder symptoms can come on quickly, without warning, and have been known to last several minutes or more.
- Phobias. People with phobias have an intense fear of something that poses little to no actual danger. The fear may be of spiders, flying, or crowded places.
- Social anxiety disorder, or social phobia, causes extreme fear, nervousness, and avoidance of social interactions due to a deep concern about being judged, embarrassed, or negatively evaluated by others.
- Agoraphobia is an anxiety disorder where a person fears and avoids places or situations that can trigger panic, make them feel trapped, powerless, or humiliated.
- Selective mutism occurs when people consistently do not speak in specific settings, such as school or work, despite being able to speak comfortably in more familiar environments, such as at home with family or with friends. This can negatively affect a person’s ability to function socially, academically, and professionally.
- Separation anxiety disorder typically appears in childhood and involves intense, developmentally inappropriate distress about being apart from a parent or primary caregiver.
Fortunately, anxiety disorders are treatable. The causes of anxiety disorders do not necessarily stem from the use of drugs or alcohol. but an anxiety disorder paired with problematic substance abuse often alters potential treatment plans. The concurrent treatment of a mental health disorder such as anxiety with a SUD is known as dual diagnosis treatment.
Symptoms of Anxiety Disorders
The symptoms of many common anxiety disorders can come on quickly and feel debilitating. Exact symptoms of anxiety disorders vary depending on the type, but some common symptoms include:2,3
- Feeling nervous, restless, or tense
- Having a sense of impending danger, panic, or doom
- Increased heart rate
- Rapid breathing or hyperventilation
- Sweating
- Trembling
- Weakness or fatigue
- Trouble concentrating or thinking about anything other than the present worry
- Sleeplessness
- Gastrointestinal problems or discomfort
- Avoidance of situations that have triggered anxiety in the past
What Causes Anxiety?
Like many mental health conditions, the exact cause of an anxiety disorder is not fully understood. Experts believe anxiety is caused by several overlapping factors. Brain chemistry plays a part, as imbalances in neurotransmitters like serotonin, dopamine, norepinephrine, and GABA can all affect how one experiences anxiety. The brain’s structure and activity are also factors. For instance, the amygdala, which helps regulate fear, tends to be more active in people living with anxiety disorders. Genetics can also come into play. Meanwhile, environmental influences like chronic stress at work or a past traumatic experience can disrupt the brain’s chemical balance, increasing the risk of developing an anxiety disorder.3
Is There a Connection Between Anxiety and Substance Abuse?
A great deal of research in recent years suggests that anxiety disorders and SUDs co-occur at greater rates than might be expected by mere chance.4 What’s more, the interactions between anxiety and SUDs and anxiety are multifaceted, making them hard to diagnose and treat effectively.
Anxiety symptoms can often emerge in people who have used or abused drugs and alcohol over an extended period, or who are experiencing drug or alcohol withdrawal. Meanwhile, anxiety disorders are a common risk factor for the development of an SUD. These symptoms often modify the presentation of an SUD as well as exactly how the SUD runs its course. Similarly, SUDs can alter the presentation and course of an anxiety disorder.5
When a person is living with both an anxiety disorder and an SUD, they receive what is known in medical circles as a “dual diagnosis.” Dual diagnoses are common, as many people turn to alcohol or drugs as a means of self-medication or escape from their anxiety disorder symptoms.
How Does Substance Use Affect Anxiety Disorders & Treatment?
Not only can anxiety disorders be a risk factor for the development of an SUD, they can also change the way that SUDs present and are treated. In turn, SUDs can change the way that anxiety disorders present and are treated. The main reason for this is the overlap in symptoms, making dual diagnosis and subsequent treatment a challenge.6 Overlapping symptoms of anxiety disorders and SUDs include:7,8
- Trouble sleeping
- Irritability or angry outbursts
- Mood swings
- Periods of restlessness or agitation
- Appearing fearful, anxious or on-edge
- Sweating
- Nausea or diarrhea
Medical practitioners have found that the best way to differentiate substance-induced symptoms of SUD from symptoms of an existing anxiety disorder is medical observation over time. Substance-related symptoms tend to improve with time, provided the patient remains drug-free and sober, while anxiety disorder symptoms do not.6
Can I Get Treated for Anxiety & Addiction at The Same Time?
When someone has co-occurring SUD and anxiety, it is recommended they receive treatment for both disorders simultaneously. Fortunately, many treatment programs specialize in the treatment of co-occurring conditions. These dual diagnosis anxiety and SUD treatments are tailored to the specific needs of the patient, taking into account their age, the misused substance or substances, and the severity of the anxiety disorder, among other factors.9
How Is Anxiety & Addiction Treated?
Dual-diagnosis treatment of an SUD and anxiety disorder can take place in a variety of settings, though treatment must start with detox. Detox is the process of ridding toxic substances from the body while managing the withdrawal symptoms that occur.
Following detox, the patient will undergo one or more treatments designed to help them maintain their sobriety and treat their anxiety. These treatments include residential treatment, partial hospitalization (PHP) treatment, intensive outpatient (IOP), outpatient (OP), and aftercare. The exact treatment plan depends on the patient and their needs.
In treatment, patients typically receive therapy, counseling, and group support to help them develop coping mechanisms and avoid relapse by defining and working through their individual triggers. Empowered Recovery Center in Atlanta also employs holistic techniques like mindfulness and breathwork that are known to help patients living with anxiety and other mental health disorders.
Dual diagnosis treatment may also include the issuance of prescription medications to manage the patient’s withdrawal symptoms. This is known as medication-assisted treatment, or MAT for short.
Medications Used to Treat Anxiety Disorders
There is no cure-all for an anxiety disorder. However, several medications, known as anxiolytics, can ease symptoms. Some anxiolytics provide relief but can be habit-forming. Others may take longer to work but are safer for long-term use. Medical providers may also prescribe antihistamines, beta-blockers, or even antiseizure medications, depending on the individual case. Common anti-anxiety medications include:
- Benzodiazepines (alprazolam, clonazepam, chlordiazepoxide, diazepam, lorazepam)
- SSRIs (citalopram, escitalopram, fluoxetine)
- SNRIs (duloxetine, venlafaxine)
- Tricyclics (imipramine)
- Atypical antidepressants (mirtazapine)
- Antihistamines (hydroxyzine)
- Beta-blockers (propranolol)
- Antiseizure drugs (gabapentin, pregabalin)
Treating Co-Occurring Anxiety Disorders in Atlanta
If you or a loved one is struggling with addiction or a mental health disorder like anxiety, Empowered Recovery Center in Atlanta can help. Our dual-diagnosis treatment can support you or your loved one in recovery. We offer a number of rehab programs and addiction therapy options to suit your needs, including partial hospitalization programs (PHP), intensive outpatient programs (IOP) and outpatient rehab. All of our programs include one full year of recovery coaching at no extra cost to provide continued support once you’ve completed your program.
We accept several insurance plans and are more than willing to work with out-of-network plans to make sure you receive the help you need. Our admissions team can verify your insurance benefits so that you’ve got everything you need when it comes to paying for rehab or using insurance to pay for rehab. If you’d like to learn more about our comprehensive dual-diagnosis treatment, call us today or fill out our online contact form.
Recovery is possible. It starts by reaching out to Empowered Recovery Center.
References
- MedLine Plus (2023). Anxiety. National Library of Medicine. Retrieved May 12, 2025, from https://medlineplus.gov/anxiety.html#:~:text=Anxiety%20is%20a%20feeling%20of,a%20normal%20reaction%20to%20stress
- Mayo Clinic (2018). Anxiety Disorders. Mayo Foundation for Medical Education and Research. Retrieved May 12, 2025, from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
- Cleveland Clinic (2024). Anxiety Disorders. Cleveland Clinic’s Health Library. Retrieved May 12, 2025, from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
- U.S. National Library of Medicine (2010). Anxiety and Substance Use Disorders: A Review. National Institutes of Health. Retrieved May 13, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC2904966/
- U.S. National Library of Medicine (2010). Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations. National Institutes of Health. Retrieved May 13, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC2921723/
- U.S. National Library of Medicine (2013). Substance Use Disorders and Anxiety: A Treatment Challenge for Social Workers. National Institutes of Health. Retrieved May 13, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC3775646/
- Substance Abuse and Mental Health Services Administration (2023). Mental Health and Substance Use Co-Occurring Disorders. Substance Abuse and Mental Health Services Administration. Retrieved May 14, 2025, from https://www.samhsa.gov/mental-health/what-is-mental-health/conditions/co-occurring-disorders
- Substance Abuse and Mental Health Services Administration (2023). Anxiety Disorder. Substance Abuse and Mental Health Services Administration. Retrieved May 14, 2025, from https://www.samhsa.gov/mental-health/what-is-mental-health/conditions/anxiety
- The National Institute of Mental Health (2024). Substance Use and Co-Occurring Mental Disorders. National Institutes of Health. Retrieved May 14, 2025, from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
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