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Substance Use and Co-Occurring Anxiety Disorders

young man struggling with co-occurring anxiety disorders Anxiety and Substance Use Disorders commonly co-occur. People may turn to substances for short-term relief of their anxiety. However, in the long term, substances exacerbate anxiety. This creates a cycle of continued use and increased anxiety.

Anxiety Symptoms and Statistics

According to Johns Hopkins Medicine, around 18% of people aged 18-54 have an Anxiety Disorder. People with an Anxiety Disorder are five times more likely to be hospitalized for mental health disorders. While there are several types of Anxiety Disorders, many of the types share common symptoms. These are: -Increased heart rate -Rapid breathing -Trembling or shaking -Restlessness or tension -A sense of impending danger or panic -Weakness or fatigue -Trouble concentrating or focusing on anything but the current worry -Insomnia -Gastrointestinal issues -Avoidance of anxiety triggers

Types of Anxiety Disorders

Generalized Anxiety Disorder (GAD)

GAD is the most prevalent anxiety disorder. According to DSM-5 criteria, it is diagnosed when a person experiences excessive worry more days than not for at least six months. Worry is considered excessive when it is either not tied to a specific threat, or considered disproportionate to the risk. Generalized Anxiety Disorder is not about a specific subject, and the anxiety can shift from topic to topic. It doesn’t necessitate having panic attacks.

Panic Disorder

About 3% of the United States population has a panic disorder. An isolated panic attack is different from Panic Disorder, which is diagnosed when a person has: -Frequent, unexpected panic attacks -Ongoing worry about having another attack -Changes in behavior, such as avoiding situations that might trigger a panic attack -Fear of the consequences of an attack, such as having a heart attack, losing control, or appearing “crazy”

Obsessive-Compulsive Disorder (OCD)

OCD is a disorder in which a person has recurring, uncontrollable thoughts (obsessions) and behaviors (compulsions). The compulsions are a response to the obsessions and are repeated over and over. According to the National Alliance for Mental Illness (NAMI), 1.2% of US adults experience OCD. Symptoms often present in childhood, adolescence or young adulthood.

Post-Traumatic Stress Disorder (PTSD)

According to the American Psychiatric Association, approximately 1 in 11 people will be diagnosed with PTSD in their lifetime. PTSD is a mental health disorder that can occur in people who have experienced or witnessed a traumatic event. People with PTSD have distressing thoughts, feelings or flashbacks about the event long after it has ended. They might avoid situations or events that remind them of the traumatic experience.


According to the Mayo Clinic, phobias are an “overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance.” People with specific phobias may realize that their fears are irrational, but feel unable to control them.

Co-Occurrence of Substance Use and Anxiety Disorders

Either an Anxiety or a Substance Use Disorder may precipitate the other. A person with an Anxiety Disorder may turn to substances to numb symptoms. The substances will increase their anxiety, altering the course of their Anxiety Disorder. On the other hand, symptoms of anxiety may present after chronic substance use. Whichever disorder presents first, it is clear that the two disorders intensify one another. According to the Harvard Review of Psychiatry, “The co-occurrence of these disorders is associated with greater symptom severity, higher levels of disability, and poorer course of illness relative to either disorder alone.” 17% of people with a SUD responding to a National Epidemiological Survey on Alcohol and Related Conditions also met criteria for an Anxiety Disorder.

Alcohol and Anxiety

People with an Anxiety Disorder are about three times more likely to have an Alcohol Use Disorder. Alcohol is commonly used to “relax” or to temporarily relieve anxiety. However, a study by The National Institute on Alcohol Abuse and Alcoholism and University of North Carolina School of Medicine found that people with Alcohol Use Disorder are more likely to experience PTSD. Chronic alcohol consumption rewires the brain, making it harder for people to recover from traumatic experiences.


Benzoadiazepines are commonly prescribed for short-term relief of anxiety, such as during a panic attack. However, the 2013 National Survey on Drug Use and Health found that 1.7 million Americans aged 12 or older were abusing these drugs at the time of the survey. As Benzos are meant to be taken over a short period of time, chronic use can affect anxiety levels. It can also cause severe withdrawal when use is stopped. Benzos decrease stress levels in the brain and increase dopamine. If the brain comes to expect this, it may stop creating these chemicals on its own. This can lead to increased anxiety, elevated heart rate, and panic symptoms.


A study from the University of Michigan Medicine found that anxiety is linked to opioid use. People with mood or Anxiety Disorders are twice as likely to use opioids, and three times more likely to abuse them. As with alcohol, medications are absorbed more slowly as we age. Another similarity between alcohol and drug abuse in older adults is that both may mirror symptoms of aging. Warning signs such as confusion, memory loss, and balance issues may be misread.


Intense symptoms of anxiety and panic are the most commonly reported side-effects of using stimulants. Withdrawing from stimulants also increases anxiety. Cocaine, for example, speeds up the activity of some of the brain’s neurotransmitters, causing racing thoughts and increased anxiety. Cocaine withdrawal also leads to increased anxiety. As with alcohol, medications are absorbed more slowly as we age. Another similarity between alcohol and drug abuse in older adults is that both may mirror symptoms of aging. Warning signs such as confusion, memory loss, and balance issues may be misread.

How Does Substance Use Disorder Affect Anxiety Disorders?

No matter what the substance, there is often a similar cycle. People use to relieve symptoms, leading to increased anxiety and subsequent need to use more. As long as a person is still using substances, the cycle will continue or worsen.


With any combination of substance use and mental health disorders, it’s important to treat both. According to the journal Social Work Public Health, “Interrupting the destructive cycle of using alcohol and drugs to combat intolerable subjective states is an important task of early recovery.” Many people with anxiety learn avoidance, which ends up increasing the anxiety. In order to treat both disorders, they need to learn healthy coping skills and ways to self-regulate their anxiety. According to this same journal, Cognitive Behavioral Therapy is one of the most effective ways to start to break this cycle.

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