Anxiety Disorders and Drug Addiction

About 18% of the U.S. population suffers from some form of anxiety disorder.¹ Those who do are about 2 to 3 times as likely to have problems with addiction as those who don’t have anxiety.² When a person has both a mental health and a substance disorder, this is known as a dual diagnosis. Treatment can address both conditions.

Substance Abuse and Anxiety

Everyone experiences stress and anxiety. Yet while most people might experience anxiety every now and then in a fleeting way, for a person with an anxiety disorder, the anxiety can be unrelated to any specific situation. Or it may be seriously out of proportion to the situation at hand. A serious anxiety issue affects your ability to function in your daily life.

Some people with anxiety have a dual diagnosis, which means they have both a mental illness, such as anxiety, as well as a substance abuse disorder. In these cases, it can be hard to tell which came first: the anxiety disorder or the substance abuse disorder. Some people with anxiety may use drugs or alcohol to self-medicate or better manage their symptoms.

Comorbidity is common with anxiety and substance abuse, meaning that the 2 conditions are often found together in people. About 20% of people with anxiety or a mood disorder have an issue with substance abuse, just as about 20% of those with a substance abuse disorder suffer from anxiety or a mood disorder.²

Risk Factors

Even though anxiety and substance abuse are separate disorders, they carry shared risk factors, such as:

• Genetic vulnerability. There may be some overlap in the genetic components that increase a person’s susceptibility to developing both addiction and anxiety disorders.
• Environmental triggers. Examples include trauma and abuse, both of which can lead to anxiety as well as a greater vulnerability to using drugs.
• Involvement of similar brain regions. Brain functioning is also a common factor in both types of disorders. Key brain regions that react to reward and stress and are affected by drugs may also show irregularities in people with anxiety and other mental health disorders.
• Developmental stages. It’s possible that drug use by teens may change certain brain functions in a way that makes them more vulnerable to the effects of drugs and leads to anxiety disorders.³

Symptoms

There are numerous forms of anxiety disorders, with slightly varying symptoms. The symptoms of generalized anxiety disorder (GAD) include:⁴

• Feeling restless or on edge.
• Getting tired easily.
• An inability to concentrate.
• Being irritable.
• Tense muscles.
• Being unable to control worrying.
• Problems getting to sleep, staying asleep, or feeling rested.

Panic disorder includes symptoms such as:⁴

• Sudden attacks of fear.
• Loss of control over the feelings of fear.
• Worries and fears of another attack occurring.
• Avoiding places in which attacks have occurred.

People with social anxiety have symptoms such as:⁴

• Difficulty interacting with others and feeling very anxious about it.
• Being very worried about judgment by others.
• Having difficulty making and keeping friends.
• Avoiding people as much as possible.
• Sweating, blushing, or having problems speaking when others are around.
• Getting physically sick when having to interact with others.

A number of symptoms are associated with addiction to drugs and alcohol. A person can be diagnosed with a substance abuse disorder if they show at least 2 of these symptoms at any point in the past 12 months:⁵

• Taking more of a drug or alcohol than they meant to.
• Continued use despite the knowledge of the legal or social consequences.
• Continued use despite the knowledge of the drug’s negative impact (e.g., deteriorating medical or emotional health).
• Strong craving for the substance of abuse.
• Inability to cut back on using drugs or alcohol.
• Failure to do what you are expected to do at work, at school, or at home and an inability to live up to your responsibilities due to drugs or alcohol.
• Drugs or alcohol become more important than former interests or hobbies.
• Doing irresponsible things, like driving, while using alcohol or drugs.
• Alcohol and drugs take up most of your time. Either you are using drugs and alcohol, or you are trying to get over using, or trying to get hold of more drugs and alcohol.
• Increased tolerance of the drug or alcoholic substance to where more is required to generate the desired feelings. Cutting back or stopping use triggers withdrawal symptoms.

Anxiety After Drug Use

At times, a person may experience panic attacks or general anxiety during or after drug use. The Diagnostic and Statistical Manual of Mental Disorders explains that a person can be given a diagnosis of substance-induced anxiety disorder if the anxiety develops during or soon after intoxication and leads to impairment in social or occupational functioning.⁵

Drugs that can cause substance-induced anxiety disorder include alcohol, PCP (phencyclidine), hallucinogens, inhalants, and stimulants.⁵

Other drugs can cause anxiety when the person stops taking them and experiences withdrawal. This type of anxiety usually occurs with drugs that suppress the central nervous system and reduce anxiety, including benzodiazepines, alcohol, and opioids.

Symptoms of drug-induced anxiety from withdrawal can include:

• Shaking.
• Agitation.
• Elevated blood pressure.
• Hyperactivity.⁶

Marijuana decreases anxiety in some people. However, others may actually experience increased anxiety, especially when they use marijuana in higher doses. Many individual, environmental, and genetic factors can lead to marijuana-induced anxiety. Women, those who seldom use marijuana, and those with preexisting anxiety disorders are more vulnerable to marijuana-induced anxiety than others.⁷

Treatment

When a person has both a mental illness such as anxiety and a substance use disorder, both conditions need to be treated.¹⁴ A person who only completes drug rehab and does not receive treatment for anxiety is more likely to experience medical problems, suicide, or early death.¹⁵

In addition to living a healthy lifestyle, which includes a healthy diet, exercise, and good nutrition, medication can be an option to treat both conditions. But the person is likely to have a better outcome if treatment combines the meds with therapy.¹⁶

Medications

Anxiety disorders are frequently treated with antidepressant medication. Commonly used antidepressants include both SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine inhibitors). For short-term anxiety management, some people may be prescribed benzodiazepines, which include such drugs as Xanax and Valium. However, the risk of addiction makes these drugs less than desirable for people with a history of drug abuse.⁸

Disulfiram (Antabuse) and acamprosate (Campral) can be used to treat alcoholism. These drugs cause an unpleasant reaction when someone drinks and reduce withdrawal symptoms, respectively. Naltrexone, a drug designed to treat opioid addiction, may also work in treating alcohol addiction.⁹

There are several medication-assisted treatment drugs for people with opioid dependence. As in treatment for alcohol dependence, naltrexone may be used to block some of the rewarding effects of opioids, thereby discouraging continued use. Other drugs, such as methadone and buprenorphine, help to stop the cravings and withdrawal symptoms associated with quitting opioids, making them beneficial during detox as well as maintenance therapy.⁹

Therapies

Numerous therapies help treat anxiety and addiction. The most common treatments for addiction are:

• Cognitive behavioral therapy. Cognitive behavioral therapy, or CBT, helps a person change their thinking about drugs, as well as use skills to cope with stress. CBT also helps a person learn to identify triggers for drug abuse and how to either avoid or cope with these triggers.⁹

• Motivational interviewing. This approach enhances a person’s willingness to become engaged in the process of change. Ambivalence can be found among those who need addiction treatment, especially if the treatment program has been mandated by a court or legal program. Rather than ignoring this ambivalence, motivational interviewing acknowledges it and tries to help people work through it. ⁹
• Contingency management. Contingency management uses rewards, such as gift cards or vouchers for negative drug screens, to help people stay engaged in treatment.⁹
• Matrix Model. This approach is most commonly used to treat stimulant addiction. The program uses urine drug screens, 12-step groups, family therapy, individual therapy, and drug education.¹⁰
• Exposure therapy. This form of CBT therapy gradually exposes the person to a situation or object that makes them highly anxious. They are taught to manage anxiety at each stage of the process.¹¹
• Relaxation training. Relaxation training is often a part of CBT and exposure therapy. Mindfulness, which can include meditation or the visualization of relaxing scenes, is often incorporated. In addition, the training involves self-soothing techniques, such as the use of scents and oils. Physical relaxation involves learning to relax muscles, breathing in a calming manner, and doing activities such as yoga.¹²
• Breathing training. Breathing training involves learning to breathe deeply, from the diaphragm, holding the breath, and exhaling slowly, all of which typically can help a person become less anxious.¹²

CBT is the most common treatment for anxiety disorders. For disorders such as social anxiety or panic disorders, most patients receive 12 to 16 sessions over a 3- to 4-month period. However, anxiety disorders tend to be chronic. Recurrence is common, even after treatment. Some people need a longer course of treatment, which can last up to 50 sessions or over a year.⁸

Recovery Programs

Recovery programs are widely available. Forms of treatment include:

• Inpatient treatment. An inpatient program can provide 24/7 supervision and medical and social support to help a person stop using drugs and learn to manage their anxiety at the same time.
• Outpatient treatment. Outpatient treatment programs can be an option for some people to receive treatment for anxiety and addiction. Outpatient treatment programs vary in how often a person attends treatment. Some outpatient programs may meet for only a day or 2 per week, for 2 to 3 hours at a time. However, some programs offer an intensive outpatient program, or IOP, which usually meet for 2 to 3 days per week, typically for 3 to 4 hours per day. Other treatment programs offer what is known as partial hospitalization, or PHP, which usually meet 4 to 6 hours per day, from 5 to 7 days per week.

Such programs are sometimes the first stage of treatment. At other times, people will attend IOP or PHP as a step down from a more intense form of treatment, such as inpatient treatment. The intensity of services depends upon individual needs.

Other types of programs, which may be integrated into inpatient or outpatient programs or used as follow-up care to treatment, include:

• 12-step programs. These programs are usually a form of aftercare for someone who has been through a course of inpatient and/or outpatient treatment. But some people use them as their primary source of recovery. These groups are vital for ongoing support and sobriety.
• Support groups. These may be run by a therapist or other people who have dealt with or are dealing with anxiety. These groups are helpful for meeting other people in the same situation as you and learning about the ways that they manage their own anxiety.

If you or a loved one is struggling with anxiety and addiction, don’t wait to seek help. Call our helpline today to talk to a treatment referral specialist about the best options for recovery.

Sources

1. Anxiety and Depression Association of America. (2017). Facts and Statistics.
2. Anxiety and Depression Association of America. (2016). Substance Use Disorders.
3. National Institute on Drug Abuse. (2011). Comorbidity: Addiction and Other Mental Disorders.
4. National Institute of Mental Health. (2016). Anxiety Disorders.
5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association Publishing.
6. Substance Abuse and Mental Health Services Administration. (2005) Substance Abuse Treatment for Persons with Co-Occurring Disorders.
7. University of Washington. (2017). Effects of Marijuana on Mental Health: Anxiety Disorders.
8. University of Maryland Medical Center. (2017). Anxiety Disorders.
9. National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
10. National Institute on Drug Abuse. (2012). Matrix Model.
11. Anxiety and Depression Association of America. (2016). Therapy.
12. University of Michigan. (N.D.) Relaxation Skills for Anxiety.
13. National Institute on Drug Abuse. (2017). Commonly Abused Drugs Charts.
14. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
15. Substance Abuse and Mental Health Services Administration. (2016). Co-Occurring Disorders.
16. National Institute on Drug Abuse. (2014). Treatment and Recovery.