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Anxiety and addiction often co-occur, causing a complicated relationship between the two. Some people may self-medicate anxiety symptoms with drugs or alcohol, which can lead to an addiction, while others may use substances in the long term and develop substance-induced anxiety. On the other hand, people may develop them at the same time, as many similar risk factors exist between the two. You will see the best outcomes in recovery by treating both addiction and anxiety at the same time.
Types of Anxiety Disorders
The term “anxiety” can refer to many different things. Anxiety disorders can be separated into five different types.
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder is a chronic condition in which you experience an elevated level of worry and fear with little or no reason to feel the anxiety. Some of the specific symptoms related to this disorder include:1
- Struggling to control feelings of worry and dread
- Feeling restless, having trouble relaxing and/or sleeping
- Finding it difficult to concentrate
- Experiencing pains that can’t be explained medically, such as headaches or stomach aches
- Urinating frequently
Obsessive-Compulsive Disorder (OCD)
OCD is a disorder in which you have obsessions followed by compulsive behaviors. Obsessions are recurring, unwanted thoughts that often lead to repetitive, compulsive behaviors.2 Typically, you feel that if you perform the ritualistic behaviors, it will do away with the obsessive thought. Some of the common compulsive behaviors associated with this disorder are washing hands, counting, touching, tapping, or creating some patterns of movement to be completed.
This anxiety disorder is marked by sudden episodes of panic that happen repeatedly and interrupt your everyday life. These episodes often produce physiological symptoms like:2
- Racing heartbeat or palpitations
- Shortness of breath or a tight chest
- Feeling dizzy or lightheaded
- Stomach pains or nausea
Post Traumatic Stress Disorder (PTSD)
PTSD develops after you have experienced a traumatic event that posed physical, emotional, or psychological harm. You will often experience flashbacks of the event, and certain triggers or reminders of the trauma can initiate anxious and panicky feelings.
Social Phobia or Social Anxiety Disorder
If you have a social anxiety disorder, you may experience intense worry and fear when thinking about or engaging in social situations. This fear can be associated with a specific event, like public speaking, or more generalized to interacting with people in any setting.2
The Connection Between Anxiety and Addiction
National surveys have found that about half of people with a substance use disorder (SUD) also have a mental health disorder, which is true reversely.3 This could be for many different reasons.
Studies show that around 40-60% of your risk of developing a SUD is due to genetics.3 Mental health disorders also have a high risk due to genetic factors, leading to the thought that genetics could play a role in these two conditions existing together.
Alleviating Anxiety Symptoms
If you experience symptoms of anxiety, it can drastically interfere with your everyday life and leave you feeling exhausted and frustrated. When you begin seeking ways to lessen the feelings of anxiety, you may find that certain substances can provide temporary relief from a lot of the symptoms of anxiety. This temporary relief will wear off, though, leading you to return to the substance more and more to find that relief, which could ultimately lead to an addiction.
Chronic drug or alcohol misuse changes your brain functioning and structure in many different ways, and that long-term use could cause anxiety symptoms. For example, alcohol withdrawal and benzo withdrawal are characterized by anxiety, rapid heart rate, and sweating. For some people that may resolve after acute withdrawal is complete, but other people may experience lingering anxiety in what’s known as protracted withdrawal.
Which Substance Addictions are Common Among People with Anxiety?
Several substances are used by those who experience anxiety, including alcohol, benzodiazepines, and more.
Links between alcohol use disorder (AUD) and anxiety disorders have been studied over the years. Many people with anxiety report using alcohol to cope with their anxiety symptoms. One study showed that you are five times more at risk for developing an AUD within three years if you drink to cope with anxiety.4
Alcohol has an effect on your brain and the release of several chemicals, including GABA, serotonin, and dopamine. When you drink alcohol, your brain releases these chemicals, causing a temporary feeling of relaxation. Continued drinking can begin to interfere with our brain function, though. Studies have shown that people with AUD have abnormalities in the amygdala, the part of our brains that regulate emotions.4
Benzodiazepines are often prescribed to treat anxiety disorders. They work by binding the neurotransmitter, GABA, to receptors in the brain, which produces a relaxed feeling in the body.5 If you begin to rely on benzos to feel relief from anxiety, it could lead you to take more than prescribed or take it more often than instructed by your healthcare professional. This is what is referred to as a misuse of benzodiazepines.
Your brain has natural opiates called endorphins that are released to alleviate stress and produce calm feelings in the body. Opioid drugs act like these natural opiates in your brain to produce a similar feeling, which is why people with anxiety may misuse opioids to feel relaxed. Long-term use or misuse of opioids could worsen anxiety issues and lead to addiction.
Cannabis, also known as marijuana, though federally illegal, is legal in many states for recreational and medicinal use. Many people use marijuana to treat pain, nausea, and anxiety. It works by interacting with the stress and reward networks in the brain. This network involves dopamine and cortisol, which impact feelings of calm and stress relief. Cannabis can provide a content and calm feeling, but the withdrawal from cannabis can produce the opposite effect by releasing stress hormones and reducing dopamine.6
How Does Addiction Make Anxiety Worse?
As mentioned above, substances like alcohol, benzodiazepines, opiates, and cannabis can temporarily relieve anxiety symptoms; however, regular use of these substances produces changes in the structure and functionality of your brain that can make your anxiety worse.3 Here are just some of the ways substance use can exacerbate anxiety:
- Experiencing withdrawal symptoms when trying to stop substance use can increase anxiety symptoms.
- The stress of hiding drug use from friends and family can worsen an anxiety disorder.
- Substance addiction can cause strain on relationships and support systems.
- Like cannabis and stimulants, some drugs produce side effects that mimic anxiety, such as increased heart rate and feelings of panic.
- Continued drug use creates changes in your brain, making it more difficult to relieve anxiety without using the drug.
- As the effect of substances wears off, the release of stress hormones in the body often increases, making your anxiety worse than before you took the drug and causing your need for more of the substance.
Find a Dual Diagnosis Treatment Center
If you have both anxiety and addiction, you have what is called a dual diagnosis. Studies show that patients with dual diagnoses have higher rates of dropping out of treatment than those without dual diagnoses.3 Studies also show, however, that treatment that integrates tools for treating both diagnoses at the same time has positive outcomes compared to those who treat the conditions separately.3
A dual diagnosis treatment center will most likely involve the following:
- Medical detox, when necessary
- Cognitive-behavioral therapy (CBT) to help with coping skills and behavioral changes
- Group meetings that offer support for both your SUD and anxiety disorder
- Assistance with life issues such as housing problems, job skills, and legal problems
- Family therapy to help improve relational stress
If you or someone you know has anxiety and addiction, please call 800-405-1685 (Who Answers?) to speak with a rehab support specialist about your treatment options.
- National Institute of Mental Health. (2022). Generalized Anxiety Disorder: When Worry Gets Out of Control.
- U.S. Department of Health and Human Services. (2014). What are the five major types of anxiety disorders?
- National Institute on Drug Abuse. (2021). Part 1: The Connection Between Substance Use Disorders and Mental Illness
- Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Research: Current Reviews, 40(1).
- Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A review. The Mental Health Clinician, 6(3), 120-126.
- Stoner, S.A. (2017). Effects of Marijuana on Mental Health: Anxiety Disorders.