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Anxiety & Substance Use Disorder: What You Need to Know

Behavioral Health General Mental Health Treatment

Mental health disorders co-occurring with substance use disorders are exceedingly common in the United States. 

The U.S. Department of Health and Human Services reports that one in four Americans living with a serious substance use disorder like anxiety is also dealing with a co-occurring substance use disorder (SUD).[1]

About 9.2% of the U.S. population deal with an anxiety or mood disorder, and about 9.6% of the population have substance use disorders.[2] Having one disorder increases the likelihood of developing the other.[10] 

Hence, someone who deals with anxiety is more likely to turn to substances at some point to manage their anxiety. Similarly, a person with a substance use disorder may experience anxiety related to their substance misuse.

The good news is that help is available to effectively manage both disorders.

The Connection Between Anxiety Disorder & Substance Use Disorder 

The symptoms of anxiety disorder can be overwhelming. Whether in the form of obsessive-compulsive disorder (OCD), panic disorder, phobias, or general anxiety, the symptoms can make it difficult for the individual to function or feel comfortable. 

As a result, many seek out drugs and alcohol to help them escape those feelings of discomfort or otherwise diminish the overwhelm associated with anxiety symptoms.[3]

When substance use becomes the preferred, or only, coping mechanism for dealing with anxiety, a substance use disorder can quickly develop as the person becomes physically and psychologically dependent on their substance of choice. 

Types of Anxiety That May Co-Occur With SUD

Several different types of anxiety disorders may co-occur with SUD, including these:[4]

  • Specific phobias
  • Social phobias
  • Generalized anxiety disorder
  • Panic disorder
  • Obsessive-compulsive disorder


The rate of occurrence of a substance use disorder in someone diagnosed with OCD is far higher than the rate of occurrence of a substance use disorder in people diagnosed with any other anxiety disorder. This is especially true for men.[5]

The reason may be compulsivity. At its core, substance use is characterized by the inability to manage the compulsive use of substances, and OCD is characterized by compulsive behaviors to manage feelings of anxiety. 

When combined, it can make it especially difficult to recover from either disorder as one feeds the other. Continued substance use can increase feelings of anxiety that can in turn increase rates of compulsive behavior. 

Risk Factors for Anxiety & SUD

Several issues can indicate an increased risk of developing an anxiety disorder co-occurring with a substance use disorder. However, it is important to note that the existence of one or more of these issues does not guarantee the development of the dual diagnosis, nor does a lack of these indicate that there is not a dual diagnosis of anxiety and SUD at play. 

  • Genetics: When someone has one or more close family members (like a parent or sibling) who have struggled with either anxiety disorder or a substance use disorder, they are at a higher risk of developing co-occurring anxiety and SUD. 
  • Unsuccessful treatment for anxiety: When attempts to treat anxiety do little or nothing to help the individual manage symptoms, they may be more likely to turn to substances to assist them and ultimately develop an SUD as a result. 
  • Suicidal ideation: Suicidal ideation has been found to be correlated with the existence of anxiety disorder, depression disorder, and/or substance use disorder.[6]

Assessment Process for Anxiety & SUD

The assessment process to identify a dual diagnosis of anxiety disorder and substance use disorder is relatively simple. It will usually include the following:

  • A full medical and mental health history
  • Patients reporting difficulties at work or in relationships
  • Diagnostic tests, usually in the form of questionnaires 

Looking at past treatment outcomes, the length and type of symptoms, and the results of diagnostic tests, as well as considering the patients’ goals for their treatment experience and beyond, can help providers to create a personalized treatment program. 

Signs of Comorbid Anxiety & SUD

Signs of addiction can include the following:[7]

  • Changes in social groups or social behaviors 
  • Inability to stop using a substance
  • Secretive behavior
  • Odd excuses for changes in behavior
  • Stealing, unpaid bills, and other signs of financial instability
  • Withdrawal symptoms when not able to use a substance

Signs of an anxiety disorder can include the following: 

  • Extreme fear response to objectively small stimuli, such as social interactions
  • Physical symptoms of panic, such as shaking, sweating, or hyperventilating
  • Intense aversion to certain situations 
  • A sense of impending doom or danger
  • Rapid breathing or heart rate
  • Making choices based on fears and anxiety that may interfere with functionality at work or home
  • Circular thinking patterns

When the signs of anxiety begin to subside and be replaced with the signs of a substance use disorder, or if they seem more extreme and then suddenly subdued without explanation, it can indicate the use of substances. 

When behaviors become more extreme, mood swings are more pronounced, and other behaviors associated with addiction increase, it may be a sign that the person’s anxiety disorder is now co-occurring with a substance use disorder.  

Challenges of Anxiety & SUD

When someone struggling with anxiety feels that their only recourse for managing the symptoms is to use drugs or alcohol, it can be even harder to stop the behavior. Not only will there likely be a physical dependence on the drug as well as a psychological craving for a high, but there will also be the notion that anxiety is too difficult to manage without the use of substances. 

This, coupled with the compulsive behaviors associated with both anxiety and addiction can make it that much harder to avoid substance use and build a firm foundation in recovery. 

Additionally, many people who use substances to manage anxiety may not feel that they require treatment of any kind, making it that much more difficult to commit to the process of recovery.[8] Generally, professional help is needed to stop substance misuse and appropriately treat both disorders.

Treatment Options for Comorbid Substance Use Disorder & Anxiety 

The good news is that several treatments have proven to be effective in helping people to manage anxiety disorder healthfully without the use of drugs and alcohol. 

Behavioral Therapies

Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), are recommended to manage both substance use disorder and anxiety. 

CBT can teach patients coping mechanisms they can use to manage anxiety and cravings to use substances. Therapists will work with patients to identify triggers that worsen anxiety and substance use, helping them to change direction and engage in healthier behavioral patterns. 


If the substance of choice is an opioid, Medication for Addiction Treatment (MAT) may be appropriate for addiction recovery. If taking Suboxone, the patient will be able to more fully focus on therapy and recovery without dealing with opioid withdrawal symptoms and cravings.

In some instances, antidepressants may be prescribed. While benzodiazepines are very effective at managing anxiety in the short term, they are generally not recommended as an initial treatment for those in SUD treatment due to their misuse potential.[9] 

Lifestyle Changes

A comprehensive treatment program that addresses both anxiety and substance use disorder will incorporate various lifestyle changes into the care regime.[10] Possibilities include meditation, regular exercise, journaling, balanced nutrition, and creative expression.[11]

Making changes that promote an overall healthy lifestyle can help to manage stress and other issues that can trigger anxiety and the use of substances.

A Holistic Approach to Care

From medication and group therapies to personalized therapies and beyond, each person’s treatment experience will vary. 

As with all co-occurring conditions, it’s important to address both anxiety and substance misuse together when they occur in the same person. Only treating one condition will usually impede recovery on both fronts.

Continued dedication to the process of treatment can help those who struggle with comorbid substance use disorder and anxiety to build a new life in recovery.

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  1. Mental Health and Substance Use Co-Occurring Disorders. US Department of Health and Human Services. March 2022. Accessed April 2022. 
  2. Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. August 2004. Accessed April 2022. 
  3. Self‐Medication With Alcohol or Drugs for Mood and Anxiety Disorders: A Narrative Review of the Epidemiological Literature. Depression and Anxiety. July 2018. Accessed April 2022. 
  4. Anxiety and Substance Use Disorders: A Review. The Psychiatric Times. October 2008. Accessed April 2022. 
  5. Co-Occurrence of Obsessive-Compulsive Disorder and Substance Use Disorder in the General Population. Addiction. June 2011. Accessed April 2022. 
  6. Suicidal Ideation and Suicide Attempts: Comorbidity With Depression, Anxiety Disorders, and Substance Abuse Disorder. European Archives of Psychiatry and Clinical Neuroscience. 1994. Accessed April 2022. 
  7. Prevalence and Characteristics of Addictive Behaviors in a Community Sample: A Latent Class Analysis. Addictive Behaviors Report. June 2015. Accessed April 2022. 
  8. Perceived Need and Help-Seeking in Adults With Mood, Anxiety, or Substance Use Disorders. Archives of General Psychiatry. January 2002. Accessed April 2022. 
  9. Anxiety Disorders With Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations. Psychiatric Annals. November 2008. Accessed April 2022. 
  10. Substance Use Disorders and Anxiety: A Treatment Challenge for Social Workers. Social Work in Public Health. September 2013. Accessed April 2022.
  11. Meditation for Anxiety and Addiction: The Ultimate Guide. Ohio University. September 2020. Accessed April 2022.

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