What is Anxiety? Treating Anxiety and Substance Use Disorder

Anxiety disorders affect a significant portion of the population, with over 18 percent of adults in the US experiencing some form of anxiety, according to anxiety disorder and substance abuse statistics from the National Institute on Mental Health. These disorders can have a debilitating impact on individuals, affecting their work, relationships, and overall quality of life. Unfortunately, individuals with anxiety disorders may turn to substance abuse as a means of coping with their symptoms, leading to what is known as co-occurring disorders, anxiety disorders, and substance abuse presenting together.

Symptoms of Anxiety Disorders 

Anxiety disorders can manifest in a variety of symptoms that affect both the mind and body. These symptoms can be grouped into three main categories: physical, cognitive, and behavioral. Sometimes, individuals can mistake the symptoms of anxiety (such as those that present with a panic attack) for a physical problem. In order to receive proper treatment, it’s important to recognize anxiety symptoms, many of which are listed below.

Physical Symptoms of Anxiety 

Anxiety often triggers a range of physical sensations, which can include

• Increased heart rate and palpitations
• Rapid or shallow breathing
• Sweating or clamminess
• Trembling or shaking
• Muscle tension or aches
• Gastrointestinal discomfort, such as stomachaches or nausea
• Headaches or migraines
• Dizziness or lightheadedness
• Fatigue or weakness
• Restlessness or fidgeting
• Sleep disturbances, including insomnia or nightmares

These physical symptoms are the body’s natural response to stress and are often referred to as the “fight-or-flight” response. While they can be distressing, it’s important to remember that they are not dangerous and will typically subside once the anxiety-inducing situation has passed.

Cognitive Symptoms of Anxiety 

Anxiety can also affect cognition and lead to various mental symptoms, including

• Excessive worry or rumination
• Racing thoughts or difficulty concentrating
• Irritability or restlessness
• Feeling on edge or constantly vigilant
• Fear of losing control
• Catastrophic thinking or expecting the worst
• Intrusive thoughts or obsessions
• Memory difficulties or forgetfulness
• Difficulty making decisions or feeling indecisive
• Negative self-talk or self-doubt

These cognitive symptoms can significantly impact an individual’s ability to focus, make decisions, and carry out daily tasks. They can also contribute to a heightened sense of fear and anxiety.

Behavioral Symptoms of Anxiety 

Anxiety often leads to behavioral changes as individuals try to cope with their distress. Common behavioral symptoms of anxiety disorders include

• Avoidance of triggering situations or places
• Social withdrawal or isolation
• Compulsive or ritualistic behaviors
• Seeking reassurance from others
• Procrastination or difficulty initiating tasks
• Excessive reassurance-seeking
• Hypervigilance or constantly scanning for potential threats
• Substance abuse or excessive alcohol consumption
• Nail-biting, hair-pulling, or other repetitive behaviors
• Changes in appetite or eating patterns

These behaviors are often attempts to manage or alleviate anxiety symptoms. While they may provide temporary relief, they can reinforce the anxiety cycle and prevent individuals from effectively addressing the underlying causes of their anxiety.

What Are Anxiety Disorders?

Anxiety disorders are characterized by persistent and often unfounded fears that can interfere with daily life. Unlike normal stress responses, clinical anxiety is marked by excessive worry and apprehension that may not have a specific cause. Many often ask, can anxiety disorders lead to substance abuse? It is quite possible, as individuals turn to self-medication to ease their anxiety. There are several types of disorders under the anxiety umbrella, each with its own unique features and treatment approaches:

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder is characterized by a constant sense of dread and worry that may not have a specific focus. Individuals with generalized anxiety disorder and substance abuse may experience intrusive thoughts and find it challenging to control their anxiety. The worries associated with GAD can be all-consuming and may impact various aspects of a person’s life, including work, relationships, and overall satisfaction.

Social Anxiety Disorder (SAD)

Social anxiety disorder*, also known as social phobia, is characterized by an intense fear of social situations. People with social anxiety disorder and substance abuse may experience anxiety in situations such as public speaking, meeting new people, or being in crowded places. This fear can significantly impact their ability to engage in social activities, leading to isolation and a decreased quality of life.

Post-traumatic Stress Disorder (PTSD)

PTSD is not exactly an anxiety disorder; however, many individuals with this disorder present with anxiety-like symptoms. It is also a very common co-occurring disorder with substance abuse. Post-traumatic stress disorder can develop after a person experiences a traumatic event, such as military combat, a natural disaster, sexual assault, or a violent crime. Individuals with PTSD may experience flashbacks, nightmares, hypervigilance, and other symptoms related to the traumatic event. As previously mentioned, substance abuse is particularly common among individuals with PTSD, as they may turn to drugs or alcohol as a means of self-medication.

Panic Disorder

Panic disorder is characterized by recurrent panic attacks, which are sudden episodes of intense fear or discomfort. These attacks can be accompanied by physical symptoms such as rapid heartbeat, shortness of breath, and chest pain. Panic attacks can be terrifying, and individuals may develop a fear of having another attack, leading to avoidance behaviors and an increased risk of substance abuse. A common type of panic disorder is agoraphobia, which is technically defined as a “fear of open spaces.” However, agoraphobia is so crippling that individuals can be confined to their homes, where they often self-medicate.

Specific Phobias

Specific phobias involve an intense fear of a particular object, situation, or animal. Common examples include the fear of flying, the fear of heights, and claustrophobia (fear of enclosed spaces). People with specific phobias may go to great lengths to avoid their fears, which can significantly impact their daily lives.

The Link Between Anxiety Disorders and Substance Abuse

Substance abuse is more prevalent among individuals with anxiety disorders compared to the general population. Research indicates that individuals with anxiety disorders are twice as likely to experience substance abuse. There are several reasons why anxiety disorders and substance abuse often co-occur:

• Self-medicating symptoms. One theory suggests that individuals with anxiety disorders may turn to drugs or alcohol as a means of self-medicating their symptoms. Substance use provides temporary relief from anxiety, creating a cycle of dependence and addiction. For example, someone with social anxiety disorder may rely on alcohol to help them cope with social situations.
• Biochemical factors. Anxiety disorders and substance abuse are both related to chemical imbalances in the brain. Low levels of serotonin, a neurotransmitter that regulates mood, have been associated with both anxiety and substance abuse. Substance misuse can further disrupt the brain’s chemical balance, intensifying anxiety symptoms.
• Genetic predisposition. There is evidence to suggest that both anxiety disorders and substance abuse have a genetic component. People with a family history of either disorder may be more susceptible to developing these conditions. Genetic factors can influence an individual’s vulnerability to substance misuse and anxiety symptoms.

Effects of Substance Abuse & Withdrawal

The misuse of drugs or alcohol can lead to symptoms that resemble anxiety, such as nervousness, agitation, and insomnia. When individuals stop using substances, they may experience withdrawal symptoms that include anxiety and restlessness. This can create a cycle of substance abuse and anxiety, making it difficult to break free from the dependence.

Treating Co-occurring Anxiety and Substance Use Disorders

Treating co-occurring anxiety disorders and substance abuse requires a comprehensive and integrated approach. Simply addressing one aspect of the disorder without considering the other can lead to relapse or incomplete recovery. The goal is to treat both conditions simultaneously to achieve long-term success.

Evidence-based Care

Evidence-based treatments, such as cognitive behavioral therapy (CBT), have been shown to be effective in treating both anxiety disorders and substance abuse. CBT helps individuals identify and modify self-defeating thought patterns that contribute to anxiety and substance abuse. It equips patients with coping strategies to manage stress and prevent relapse.

Medication-assisted Treatment

Medication-assisted treatment (MAT) is an effective part of a comprehensive treatment plan that also includes counseling or therapy. Individuals may be prescribed MAT for substance abuse, such as Campral for alcohol use disorder (AUD) or Suboxone for opioid addiction. However, other medications may be used as well to treat the co-occurring disorder. Medication can play a role in the treatment of both anxiety disorders and substance abuse. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat anxiety symptoms. These medications work by increasing the availability of serotonin in the brain, helping to reduce anxiety and alleviate depressive symptoms.

Trauma-focused Therapies

Given the high prevalence of trauma among individuals with co-occurring anxiety disorders and substance abuse, trauma-focused therapies are crucial. Eye movement desensitization and reprocessing (EMDR) is an effective therapy for addressing past traumas and reducing the emotional distress associated with these experiences. It helps individuals reprocess traumatic memories and develop healthier coping mechanisms.

Integrated Treatment Programs

Integrated treatment programs that address both anxiety disorders and substance abuse are highly beneficial. These programs provide a comprehensive approach to recovery by combining therapy, medication management, and support for both disorders. By addressing both the underlying anxiety and the addiction, individuals have a higher chance of achieving long-term recovery.

Supportive Aftercare

After completing a treatment program, individuals should have access to ongoing support and aftercare services. This may include individual therapy, support groups, and relapse prevention strategies. Maintaining a strong support network and continuing to practice healthy coping skills are essential for long-term recovery.

Seeking Help for Co-occurring Disorders

If you or a loved one is struggling with co-occurring anxiety disorders and substance abuse, it is important to seek professional help. Treatment facilities that specialize in dual diagnosis can provide the necessary support and guidance for recovery. These facilities offer a range of treatment options, including therapy, medication management, MAT, and holistic approaches to address the individual’s unique needs.

Anxiety disorders and substance abuse often co-occur, creating a complex challenge for individuals seeking recovery. Understanding the link between these conditions and the importance of integrated treatment is crucial for successful outcomes. By addressing both anxiety disorders and substance abuse simultaneously, individuals can experience lasting recovery and improved quality of life. 

Remember, reaching out for help is a sign of strength, and there are resources available to assist you on your journey to recovery. Don’t hesitate to seek help and take the first step toward a healthier and more fulfilling life.