Anxiety disorders are some of the most common co-occurring disorders among people suffering from addiction. The Anxiety and Depression Association of America (ADAA) reports that people with anxiety disorders are 2-3 times more likely to have a substance use disorder. About 20 percent of people with a substance use disorder also have a mood or anxiety disorder. Having both an anxiety disorder and a substance use disorder can complicate the recovery process, with the symptoms of one disorder worsening symptoms of the other. As a result, it’s essential that treatment programs can accommodate cases of dual diagnoses and treat both issues simultaneously.
Anxiety Disorders and Substance Abuse
There are many different kinds of anxiety disorders, and any can contribute to substance abuse; however, some disorders are more likely to co-occur with substance abuse than others. Social anxiety disorder, post-traumatic stress disorder (PTSD), and panic disorder are a few of the anxiety conditions with a strong correlation to substance use disorders.
Social anxiety disorder involves anxiety triggered by social situations. People who suffer from this disorder experience significant anxiety and self-consciousness when in situations where others may judge them. Symptoms may occur only in specific situations, such as when performing in front of a crowd, or they may happen every day, such as when interacting with strangers or using the telephone. Alcohol abuse is the most common substance use problem among people with social anxiety, according to ADAA. Alcohol abuse and dependence may be the result of self-medicating social anxiety, as individuals often drink in social settings in order to feel more at ease.
Post-traumatic stress disorder, commonly referred to as PTSD, is an anxiety disorder that results from trauma. People with this disorder experience flashbacks, during which they feel as if they are re-experiencing the traumatic event, as well as nightmares, severe anxiety, and uncontrollable thoughts about the trauma. PTSD can result from a single traumatic event, like a car accident, or trauma that is sustained over a period of time, such as being in a warzone for several months. According to the Department of Veterans Affairs, at least 2 out of 10 veterans with PTSD also have a substance use disorder. Both alcohol and drug abuse are common among those with PTSD.
Panic disorder, a disorder in which an individual experiences sudden panic attacks with no apparent cause, is another disorder that commonly co-occurs with substance abuse. A panic attack is a period of sudden and intense anxiety when there is no real danger present. The person may feel as if they are having a heart attack or dying, or feel a strong sense of dread and uncontrollable anxiety. Most people experience one or two panic attacks at some point in their lives, but people with panic disorder experience frequent panic attacks. This can lead to agoraphobia, a fear of leaving one’s home. Many people with panic disorder attempt to self-medicate their anxiety by abusing drugs or alcohol; however, most people with panic disorder do not develop a substance use disorder. In a study published by Addictive Behaviors, about 10 percent of people with panic disorder reported using alcohol to self-medicate, and 6 percent had used illicit drugs to treat their symptoms.
There are many other kinds of anxiety disorders, including generalized anxiety disorder and specific phobias. Any anxiety disorder can co-occur with substance abuse. The link between these two types of disorders can be multifaceted, and it is rarely a simple cause-and-effect relationship.
What Causes Anxiety and Substance Abuse?
An attempt to self-medicate anxiety disorders is a common contributing factor to the development of substance use problems, but other factors can also be at play. Rather than one disorder causing the other, these two problems can often stem from the same underlying cause.
According to NIDA, some genetic factors may lead to a predisposition to both substance abuse and anxiety. Some of these genes make an adolescent more prone to substance abuse and conduct disorder, which can lead to drug problems and anxiety later in life. Additionally, drug dependence and anxiety both involve similar areas of the brain, particularly the production and regulation of the chemical dopamine. This may allow anxiety to influence drug use, and drug use to influence anxiety.
In some cases, the link between anxiety and substance use may stem from adolescence. The brain goes through significant changes throughout an individual’s adolescent years, and many different factors can influence brain development during this time. Using drugs as a teen significantly increases the risk of developing a substance use disorder later in life. Using drugs while the brain is still developing can affect the development of the prefrontal cortex, the part of the brain responsible for decision-making and impulse control. These same changes to the brain may also contribute to the later development of anxiety disorders. Anxiety disorders developed in adolescence may also increase the risk of self-medicating these symptoms with drugs or alcohol.
Treating Co-occurring Anxiety and Substance Abuse
The presence of an anxiety disorder can complicate recovery from substance abuse by triggering stress that can lead to relapse. It can be difficult to stay sober while also trying to manage symptoms of an anxiety disorder. It can also be difficult to successfully manage overwhelming anxiety while trying to recover from substance dependence or abuse. Therefore, it is important that both disorders be treated concurrently.
Pharmacotherapy – treatment with medication – is one of the most effective treatments for both anxiety disorders and substance use disorders. According to a study from Psychiatric Times, a few medications have shown efficacy in treating both substance abuse and anxiety. Selective serotonin reuptake inhibitors (SSRIs), which commonly treat both mood disorders and anxiety disorders, may also lower rates of substance abuse for some people. Some medications both lower anxiety and reduce drug or alcohol cravings. Others only lower anxiety, which can help some people avoid substance abuse by removing a common trigger for drug or alcohol use.
The most effective treatment methods for both anxiety and substance abuse are a combination of pharmacotherapy and psychotherapy, or talk therapy. Therapy for those with anxiety disorders needs to be tailored to individual needs in order to be effective. The study from Psychiatric Times referenced above found that women with social anxiety disorder did not do as well in traditional 12-Step substance abuse recovery groups as those without social anxiety. Individual therapy may be more effective for these individuals. Therapy to treat anxiety also needs to carefully avoid triggering a relapse of substance use. Exposure therapy, which is commonly used to treat anxiety and involves exposing the individual to the feared situation, may not be appropriate for this population, because the stress of exposure to an anxiety trigger could lead the individual to self-medicate with drugs or alcohol.
Both anxiety disorders and substance use disorders are widespread throughout the population. Those facing both of these challenges have unique treatment needs, as these disorders can each contribute to the other. Through a combination of pharmacotherapy and counseling, both of these disorders can be overcome, and lasting recovery can be reached.