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Substance Abuse

Moderate alcohol consumption—a glass of wine with dinner or a few drinks at a party—is no cause for concern for many people.

However those with anxiety disorders may find that alcohol or other substances can make their anxiety symptoms worse. And they are two to three times more likely to have an alcohol or other substance abuse disorder at some point in their lives than the general population.

About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance abuse disorder, and about 20 percent of those with an alcohol or substance abuse disorder also have an anxiety or mood disorder.

Anxiety Disorder or Substance Abuse: Which Comes First?

Most people with alcohol or substance abuse and an anxiety disorder experience them independently, but having both can be a vicious cycle.

The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms.

Social anxiety disorder
The co-occurrence of substance abuse, particularly alcohol abuse, is common among people who have social anxiety disorder. People with this disorder report that alcohol helps lessen their social anxiety, although it often makes it worse. Alcohol abuse usually develops after the onset of this disorder.

Read more about social anxiety disorder and alcohol abuse.

Posttraumatic stress disorder (PTSD)
PTSD and substance abuse commonly occur together. People suffering from this disorder often use alcohol or drugs to try to ease their anxiety, but substance abuse can exacerbate PTSD symptoms.

Many mental health professionals treat PTSD and substance abuse together because symptoms of PTSD (intrusive thoughts and sleep disturbance) can cause a substance abuse relapse.

Panic disorder
Alcohol or drugs often cause panic attacks, and having panic disorder is a risk factor for a relapse among people with a substance abuse disorder. Alcohol abuse commonly begins before or at the same time as panic disorder symptoms.


Treating substance abuse will not eliminate an anxiety disorder, so it’s usually necessary to treat both together, particularly to lessen the chance of relapse.

People with anxiety and substance abuse disorders are at an increased risk for abuse as well as potentially dangerous interactions when they use prescription medication. Doctors prescribe medications with low abuse potential that are considered safe should a relapse occur. The choice of medication always depends on a person’s individual circumstances.

Many therapists will use therapy for people with both anxiety and substance abuse disorders.

A well-established, highly effective, and lasting treatment is cognitive-behavioral therapy, or CBT, which focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12 to 16 weeks, depending on the individual. Joining asupport group may be a good additional treatment option.


Mental Disorders, Substance Abuse Linked to Increase in ER Visits

A report from the Agency for Healthcare Research and Quality (AHRQ) finds that almost one in eight of the 95 million visits to hospital emergency departments made by adults in the United States in 2007 were due to a mental health and/or substance abuse problem. The most common reason for these visits was a mood disorder (42.7%), followed by anxiety disorders (26.1%), alcohol-related problems (22.9%), and drug disorders (17.6%).  (AHRQ-HCUP Statistical Brief 92. Mental Health and Substance Abuse-Related Emergency Department Visits Among Adults, 2007. Released July 2010) Read more.


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