Substance abuse can lead to anxiety disorders, and vice versa. Either way, both problems need to be managed and treated together.

While substance abuse is serious enough on its own, users run the additional risk of developing an anxiety disorder as a side effect of abusing drugs or alcohol. And for a certain number of people with an anxiety disorder — estimates are 20 percent or more — turning to substance abuse will add a serious complication to their emotional problem. Fortunately, there are ways to treat both, regardless of which came first.

Substance Abuse and Anxiety Disorder: The Chemical Connection
Chemicals in drugs like cocaine, marijuana, hallucinogens, and prescription anti-seizure and pain-relieving medications, as well as alcohol and even seemingly harmless substances like caffeine, can affect the way the brain functions and cause anxiety symptoms, including:

  • Constant worry and nervousness
  • Feeling of impending disaster or something bad happening
  • Panic, even feeling like you are dying
  • Insomnia and other sleep problems
  • Memory loss and problems with concentration
  • Physical symptoms like vomiting, diarrhea, fast heart rate, sweating, and difficulty breathing

Not only can these symptoms occur while using drugs, they may also last for weeks after the drug use has stopped. This is a difficult cycle to break because the anxiety, depression, and other symptoms that people feel when the drug wears off just make them want to use it again. They begin “treating” the anxiety problems that result from substance abuse with more substance abuse.

There are other complicating factors to having both conditions at once. These include a great risk of other health problems, more pronounced withdrawal symptoms when the abuse is stopped, and a higher incidence of relapse, making getting the right diagnosis and treatment all the more important.

Substance Abuse and Anxiety Disorder: Making the Diagnosis
Substance abuse and anxiety disorders are closely related. People with anxiety disorders may begin using drugs and alcohol to manage their anxiety symptoms. And people who are substance abusers initially for other reasons may develop anxiety disorder as a result of substance abuse, and then have both problems to deal with. So it’s important to first understand whether the underlying problem is addiction and substance abuse or an anxiety disorder that led to those behaviors.

Physical and mental health evaluations will be performed to diagnose substance-induced anxiety disorder. Doctors will ask about symptoms, about any drugs, alcohol, and other substances that you take, and your habits surrounding them. Tests performed on blood and urine can tell the type and quantity of substances in your body, which can help indicate whether or not this is the likely cause of anxiety symptoms.

Substance Abuse and Anxiety Disorder: Treating Both at Once
Substance-induced anxiety disorder, in theory, should be easy to treat: Take away the substances causing the anxiety and the anxiety disappears. But substance-induced anxiety disorder needs professional, medical treatment. Once the substance causing the anxiety has been identified, it will have to be stopped under controlled circumstances. Your doctor may prescribe an antidepressant or anti-anxiety medication to help make the transition easier and help you manage common substance withdrawal symptoms.

Psychotherapy and cognitive-behavioral therapy are needed to help people understand why they became substance abusers and what underlying problem they were trying to mask with their abuse. Therapy with a counselor, as well as support group therapy, can be beneficial in both substance abuse recovery and managing anxiety. This multi-part approach provides the best outcome for freeing you from the two related problems.

By Diana Rodriguez

Medically reviewed by Pat F. Bass III, MD, MPH

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