Anxiety Disorders & Drug or Alcohol Addiction

If you struggle with an anxiety disorder and a substance use disorder (SUD), you are not alone. The presence of a mental health issue and an SUD at the same time is considered a co-occurring disorder, and more than 1 in 4 adults with a mental illness also experience a substance use problem.1

Here is a closer look at anxiety and substance use disorders, risk factors for both, and how you can help someone who is struggling with anxiety and addiction.

What Are Anxiety Disorders?

Anxiety disorders are a type of mental health disorder that involve excessive fear, anxiety, and related behavioral disturbances.2 Everybody at one point or another is faced with moments of anxiety or anxiousness, and for many people, anxiety, or worry is a normal part of everyday life, but it doesn’t lead to significant impairment in functioning.3

A key difference in discerning normal anxiety from an anxiety disorder is that anxiety disorders impact a person’s ability to function in many areas of everyday life, including school, work, and at home.3

There are several types of anxiety disorders.3 Common anxiety disorders that often co-occur with an SUD include:4

  • Generalized anxiety disorder (GAD).
  • Social anxiety disorder.
  • Panic disorder.

Symptoms of anxiety disorders vary from person to person, range in their severity, and are dependent on several factors, including the type of anxiety disorder you have. For example, someone with social anxiety disorder may have difficulty making eye contact with others, while someone with generalized anxiety disorder may have difficulty focusing because their thoughts are plagued.3

Symptoms of Anxiety Disorders

The body can manifest anxiety in various ways and the specific symptoms a patient exhibits are what determine the type of anxiety disorder the patient has. Medical professionals use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM) as a tool to help diagnose a specific anxiety disorder as well as specific substance use disorders and other mental health maladies.

The criteria below are not exhaustive and are included to help differentiate between some of the different types of anxiety disorders mentioned above.

The criteria used to diagnose generalized anxiety disorder (GAD) include:2

  • Excessive worry and anxiety that occurs more days that not for 6 months or more.
  • Worry that is difficult to control.
  • Three or more of the following symptoms are associated with the anxiety: restlessness, easy to fatigue, concentration difficulties, irritability, tense muscles, or disturbances with sleep.

Diagnostic criteria for social anxiety disorder (SAD) include:2

  • Fear or anxiety about one or more social situations that lends a person to scrutiny by others.
  • Fears about acting in a way that will cause embarrassment or cause others to reject them or be offended by them.
  • Fear or anxiety that is almost always provoked by the social situations.
  • Fear or anxiety that is intense when one avoids or endures social situations.
  • Fear or anxiety that is not proportional to the actual threat posed by the social situation.
  • Fear or anxiety or avoidance that lasts for 6 months or more.

Panic disorder diagnostic criteria include:2

  • Unexpected recurrent panic attacks (a surge of intense fear or discomfort that occurs abruptly).
  • One or more of the attacks has been followed by a persistent worry about having another panic attack or the consequences of a panic attack and/or behavior has changed significantly in an effort to avoid having panic attacks.

In addition to the symptoms above that distinguish these specific types of anxiety, there are additional diagnostic criteria that are common to all three:2

  • The fear or anxiety results in clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The disturbance cannot be attributed to another medical condition or the physiological effects of a substance.
  • The disturbance is not caused by another mental disorder.

Co-Occurring Anxiety Disorders and Drug or Alcohol Addiction

Anxiety disorders and addiction frequently co-occur, and when they do, they are associated with:5

  • An increase in symptom severity.
  • Greater functional impairment.
  • A more problematic course of illness than for either disorder alone.

In cases of social anxiety disorder that co-occurs with substance use disorder, a person may use substances to self-medicate in an attempt to ease their social fears.2

Some individuals with panic disorder attempt to treat their anxiety disorder with alcohol or medications and develop a substance use disorder.2

Having both an anxiety disorder and a substance use disorder complicates treatment of the SUD and makes it more difficult for patients to sustain abstinence.2

Signs of Substance Use Disorders

When being diagnosed with a co-occurring disorder, a licensed medical or mental health professional will evaluate you for each disorder independently.6

Addiction is characterized by the compulsive use of drugs or alcohol that often continues despite the harmful consequences of these substances. An addiction to drugs or alcohol is more formally diagnosed as a substance use disorder (SUD) or alcohol use disorder (AUD). To be diagnosed with SUD or AUD, an individual must meet at least 2 diagnostic criteria within the same 12-month period, as outlined by the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5).2

Signs of substance use disorders include:2

Risk Factors for Co-Occurring Anxiety Disorders and Addiction

It is important to note that the relationship between anxiety disorders and addiction is complex and multifaceted. The two disorders commonly co-occur and having an anxiety disorder increases the odds of having a SUD just as having a SUD increases the odds of having an anxiety disorder.4

That doesn’t mean one causes the other, although anxiety disorders and substance use disorders each modifies the presentation and treatment outcome for the other.6,4 Certain risk factors can increase your chances of developing co-occurring mental health disorders like anxiety and SUDs. Risk factors for the development of anxiety disorders and SUDs include:7

  • Genetics. Your genes can make you more vulnerable to developing a substance use and mental health disorder.
  • Epigenetics. Another risk factor is the changes that can occur that do not alter the gene sequence but affect the regulation of gene activity as well as gene expression.
  • Environmental factors. The influence of multiple environmental factors can increase the risk of both an SUD and a mental health disorder.
  • Brain region involvement. There are implications that certain areas of the brain and multiple neurotransmitter systems are involved in both substance use disorders and other mental disorders.
  • Stress. A common risk factor for both SUD and mental health disorder, stress can cause neurobiological changes.
  • Traumatic experiences. People may try to reduce anxiety and avoid dealing with the consequences of trauma by using substances.

In addition to the common risk factors above, other pathways that can contribute to co-occurring anxiety and substance use disorders include:7

  • Substance use disorders can contribute to mental health disorders. Substance use can change the structure and functioning of the brain in the same areas that certain mental disorders disrupt. These changes can lead to the development of a mental health disorder.
  • Mental health disorders can contribute to substance use disorders. Having an underlying mental illness can increase your risk for substance use disorders due to self-medicating as a means of coping as well as changes in that brain that may make a person more susceptible to problematic substance use.

Anxiety Disorders & Alcohol Use Disorder

Anxiety disorders and alcohol addiction oftentimes co-occur with one another. There is a strong association between alcohol use disorder and anxiety disorder as evidenced by up to 50% of people receiving treatment for problematic alcohol use also meeting the criteria for at least one type of anxiety disorder.8

Researchers believe that alcohol is often used to help tolerate symptoms of anxiety and that psychological and neurological processes that occur in the brain increase negative affect as well as the risk for alcohol misuse among those with anxiety.8

Anxiety Disorders & Drug Use

Using illicit drugs or misusing prescription medications can impact the development of mental health disorders and the symptoms of such disorders.1

The use of substances can cause changes in the brain in the same areas that are disrupted by anxiety and other mental disorders. When drug use starts before the first symptoms of anxiety are exhibited, it may the that the changes in brain structure kindle what was already a predisposition to develop anxiety.7

As with alcohol, many people who experience a mental health disorder, such as anxiety, use drugs as a way to self-medicate, and substances can make the symptoms worse over time.6

It is important to note that not all people who experience a substance use disorder will develop a mental health disorder, and vice versa.

How to Help Someone With Co-Occurring Anxiety and Substance Use Disorders

If you are a loved one of someone who is struggling with anxiety and SUD, you are not alone. Understanding how to help a loved one with addiction can feel overwhelming at first, but several strategies can help you support a loved one struggling with co-occurring disorders. These strategies include:9

  • Making yourself available to your loved one to discuss your family history of addiction or mental health disorders.
  • Being compassionate and expressing your concerns openly and without judgment.
  • Reminding your loved one that help is available and that mental and substance use disorders are treatable.
  • Seeking support and professional treatment for your loved one.

Treating Anxiety Disorders and Addiction

The standard of care for co-occurring disorders are to treat both the mental health disorder and the addiction concurrently with integrated treatment methods.4,10 Anxiety disorders are typically treated with medication, psychotherapy, or a combination of the two.3

Treatment for substance use disorders may also include these elements, depending on the substance that was used. Various behavioral therapies may be employed on their own or along with medications for co-occurring anxiety disorders and substance use disorders, including but not limited to:

  • Cognitive-behavioral therapy (CBT): Patients learn how to recognize and modify harmful beliefs and behaviors.
  • Dialectical behavior therapy (DBT): A type of treatment that helps to reduce self-harm behaviors including drug use.
  • Integrated group therapy: This therapy addresses both disorders simultaneously and helps patients understand the relationship between the two.
  • Contingency management or motivational incentives: Patients are rewarded for positive, healthy behaviors.

AdCare recognizes the importance of treating co-occurring disorders, and that’s why we offer specialized treatment programs that address both SUDs and mental health disorders. We are in-network with many major insurance providers. You can quickly check if you can use health insurance to pay for rehab by completing a confidential .

If you are looking for addiction treatment facilities in Massachusetts and Rhode Island, AdCare has multiple treatment facilities available. We offer a variety of services and levels of addiction treatment, such as:

Depending on your needs, your length of stay can vary from a short stay in rehab to long-term residential rehab.

If you or someone you love is struggling with anxiety and addiction, help is available. Reach out to a compassionate admissions navigator at to start the rehab admissions process and begin your recovery journey.

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AdCare has multiple locations throughout Massachusetts and Rhode Island, making it easily accessible to most parts of New England. We offer an integrated system of care and have been helping individuals and families struggling with addiction for 45 years. Take the next step toward recovery: learn more about our addiction treatment programs in MA and RI or learn about how rehab is affordable for everyone.