- What is Anxiety?
- Signs of Anxiety or Anxiety Attacks
- Underlying Risk Factors
- Anxiety & Substance Abuse Stats
- How Does Anxiety Lead to Substance Abuse?
- How Does Substance Abuse Affect Anxiety?
- Anxiety & Substance Abuse Treatment Options
- Key Sources
- Medical Disclaimer
Everyone has felt anxious at some point in their life. Events such as starting a new job or being concerned about money or health can cause worries or anxious thoughts, even amongst the most calm-headed. However, while most people experience periodic levels of anxiety in response to stress, for others, it can be a debilitating and chronic affliction.
Anxiety is a significant and growing problem in the U.S. According to the National Institute of Mental Health, 18% of Americans suffer from anxiety, which is more than any other mental health condition. Due to the chronic, intense feelings associated with anxiety, it is also no surprise that this condition often leads to substance abuse. The Anxiety and Depression Association of America, for example, estimates that as many as 20% of Americans with anxiety also have a substance abuse problem.
What is Anxiety?
Anxiety is a normal human condition. It is our bodies’ response to stress or danger, and is characterized by worried thoughts, feelings of tension, and physical changes to heartrate and blood pressure. Humans have a in-built “fight or flight” system that activates hormones like adrenaline whenever we perceive a threat or danger in our midst. However, this physiological feeling of fight or flight is temporary, and most of us go back to feeling normal once the perceived threat subsides.
For people with anxiety disorders, though, these physical and emotional sensations of fear and nervousness are constant and long lasting. Rather than experiencing short-term or momentary anxiety, these individuals can be so gripped by fear and worry that they find it difficult to carry out day-to-day tasks.
However, it’s worth being aware that anxiety is a big term that covers a lot of terrain. Below are some of the most common types of anxiety, each of which vary in terms of their severity and duration.
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder (GAD) is a common form of anxiety. Characterized by persistent and excessive worry, people with this condition often find it difficult to quell their fears. They may also worry about multiple things at once, whether it’s finances, family, work, or even societal issues. The primary feature of GAD is a constant sense of anxiety which can also seem out of proportion to the event or situation being worried about.
It is estimated that about 6.8 million Americans suffer from GAD (roughly 3.1% of the population) and that women are twice as likely to be affected as men. Individuals are diagnosed with GAD when, for 6 months or longer, the amount of time they worry uncontrollably exceeds the days that they don’t worry. They are also diagnosed if they present with 3 or more of the following symptoms:
- Feeling nervous, irritable, or on edge
- Having a sense of impending danger, panic, or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation), sweating, and/or trembling
- Feeling weak or tired
- Difficulty concentrating
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
Like most conditions, there are varying levels of severity when it comes to GAD. Some individuals can function normally and engage in regular social activities, while for others the anxiety is so intense that they find it difficult to carry out basic tasks.
Individuals with social anxiety disorder (SAD) — also known as “social phobia” — have an intense fear of being judged, rejected, or negatively evaluated by others in social situations. This leads them to develop fears of acting inappropriately or showing visible signs of anxiety (e.g., blushing, trembling, fidgeting). Due to these intense fears, people with SAD will often avoid social situations, or they may exhibit the following symptoms:
- Rapid heart rate
- Uncontrolled breathing
- Panic attacks
SAD affects some 15 million Americans and is the second most diagnosed anxiety condition in the U.S. SAD can also co-occur with other anxiety conditions, such as panic disorder, which can be triggered by phobias of specific places or situations.
Panic disorder is characterized by an overwhelming sense of fear, panic, or dread. People with this condition can develop panic attacks out of the blue, and they are often plagued with intense fears about having another attack. While panic attacks are physically harmless, individuals may feel a sense of impending doom or they may mistakenly think they’re having a heart attack. Other symptoms of panic disorder include:
- Rapid heartbeat
- Nausea and vomiting
- Chest pain
- Sensations of shortness of breath, smothering, or choking
Panic disorder affects roughly 6 million Americans (2.7% of the population) and it is twice as common in women than in men. This condition can be highly debilitating, causing people to withdraw from social life and avoid public situations, especially if they also suffer from agoraphobia. Many individuals are unsure about how to get help or are embarrassed by their condition; therefore, it’s important to know that if you’re suffering from panic disorder, help is available and you’re not alone.
Phobias are the most common form of anxiety. Affecting 19 million Americans (8.7% of the population), phobias can consist of an intense fear of enclosed spaces, animals, insects, germs, heights, driving, public transportation, flying, dental or medical procedures, and elevators. While fears over dangerous or risky situations are normal, people with specific phobias exhibit irrational fears that can lead them to have a panic attack.
Phobia conditions can also be debilitating, as individuals will avoid any situation that will trigger their intense feelings of anxiety. While some phobias develop in childhood, these can also arise following trauma, or spontaneously in early adulthood. What differentiates regular fear from a phobia is that these people will experience panic or anxiety just thinking about their phobia.
Post-Traumatic Stress Disorder (PTSD)
Anxiety associated with post-traumatic stress disorder (PTSD) is another common condition. Individuals who have experienced or witnessed distressing events are susceptible to developing PTSD which can be highly debilitating and interfere with daily life. This can include everything from natural disasters, military combat, abuse, death, and more. The U.S. Department of Veteran Affairs estimates that around 8 million Americans who experience trauma will go on to develop symptoms of PTSD which include:
- Flashbacks of the event
- Emotional numbness (and avoidance of places associated with the trauma)
- Increased arousal (feeling jumpy, or easily irritated/angry)
- Hypervigilance or paranoia
Signs of Anxiety or Anxiety Attacks
As described above, anxiety ranges in severity and can present with a variety of symptoms, depending on the type. Below are some of the most common signs of anxiety or anxiety attacks:
- Feelings of fear, worry, nervousness, panic, or uneasiness
- Difficulty relaxing or sitting still
- Difficulty falling asleep or staying asleep
- Muscle tension
- Feeling nervous, irritable, or on edge
- Having a sense of impending danger, panic, or doom
- Tachycardia or increased heart rate
- Rapid breathing, sweating, and/or trembling
- Feeling weak or tired
- Poor concentration
- Gastrointestinal issues (e.g., nausea, upset stomach)
- Nervous stomach/butterflies
- Cold, clammy, or sweaty hands and/or feet
- Excessive sweating
- Shortness of breath
- Numbness or tingling sensations in the hands and/or feet
- Heart racing or heart palpitations
- Chest pain
- Dry mouth
- Nausea or vomiting
- Sore muscles
- Racing thoughts or an inability to control your worries
Underlying Risk Factors
There is no definitive cause of anxiety, but there are life experiences or circumstances that can contribute to it. These include:
Individuals who have witnessed or experienced a traumatic event are at a higher risk of developing anxiety.
Medical conditions such as heart disease, diabetes, hyperthyroid problems, irritable bowel syndrome, or rare tumors that target fight or flight hormones, can contribute to, or cause, anxiety. Medications can also produce anxiety as a side effect.
Build-up of stress can disrupt the hormonal imbalance in the body, leading to anxiety. Anxiety can also be a result of stressful situations that the individual is having difficulty coping with.
Anxiety can run in families, either genetically or through socialized learning.
Substance Use Withdrawal
Drug misuse or weaning the body off medications or street drugs can cause anxiety.
Co-Occurring Mental Health Issues
Many psychiatric conditions also occur with anxiety, such as depression and bipolar disorder.
Anxiety & Substance Abuse Stats
According to the Anxiety and Depression Association of America, an estimated 40 million Americans suffer from an anxiety-related condition. In addition, a study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) revealed that more than 23 million Americans have struggled with drug abuse.
Other stats include:
- It is estimated that the lifetime prevalence rate for substance abuse is around 14.6% and the lifetime prevalence rate for anxiety disorders is about 28.8%.
- According to a report from the Agency for Healthcare Research and Quality (AHRQ), 1 in 8 out of the 95 million adult hospital emergency admissions were due to a mental health and/or substance abuse problem. Of these visits, 26.1% were due to anxiety.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that nearly 3 million employed adults are living with a co-occurring mental health and substance abuse disorder. However, only about 40 percent of those seek treatment for either condition, and less than 5% receive help for both issues.
How Does Anxiety Lead to Substance Abuse?
Substance abuse and anxiety disorders are one of the most common co-occurring conditions in the U.S. The two are intimately connected for several reasons that we outline below.
People who are struggling with anxiety often resort to self-medicating by using substances to cope. Whether it’s alcohol, prescription medications, or street drugs, individuals who are desperate to escape their feelings of worry and panic sometimes turn to substances for relief. People with social anxiety, for example, may turn to alcohol or cocaine to boost their confidence when dealing with social situations.
While research is still ongoing, neurotransmitters such as dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) are thought to be connected to anxiety, depression, and addiction. These chemicals are responsible for regulating mood and various bodily and mental functions. If an individual with anxiety has an imbalance in these neurotransmitters, it is thought that they are more prone to addictive behaviors.
Substance Use & Addiction Withdrawal
Some drugs can mimic anxiety or cause similar symptoms. Stimulants, especially, can generate agitation, restlessness, irritability, and obsessive or irrational fears. Conversely, stopping long-term stimulant use can cause anxiety during the withdrawal period. Many individuals report feelings of agitation, anxiety, restlessness, and irritability as the brain resets itself following stimulant substance abuse. This can lead people to relapse and begin to abuse these substances again.
How Does Substance Abuse Affect Anxiety?
Another factor when it comes to anxiety and substance abuse is how they affect each other. Here, we’ll explore some of the substances that are most commonly abused by individuals with anxiety, and explain what the effects are.
Alcohol & Anxiety
If you’re struggling with anxiety or have had a stressful day, it can be tempting to reach for a glass of wine or beer to take the edge off. However, if this becomes a habit, it can lead to increased anxiety, especially if large amounts are consumed as the body develops a tolerance and requires more to achieve the desired effects. The other downside is that if a person decides to stop drinking after they’ve established a high tolerance, anxiety can develop as a side effect of withdrawal.
While drinking on occasion isn’t a bad thing, using it as a crutch can lead to more problems. If you find yourself in a cycle of drinking to cope with anxiety, you could also end up in a cycle of anxiety as you try to control your alcohol consumption.
Stimulants & Anxiety
Stimulants are also used as a way of coping with anxiety. Some college students, for example, are known to take Adderall to deal with academic anxieties, as the drug increases focus and attention and allows them to stay up for long hours. However, over time, these stimulants can cause a person to feel anxious, particularly when the effects wear off. Also, relying on the drug as a study support can create psychological addiction and lead to more anxiety about the dependence.
In general, stimulants can have a detrimental effect on a person’s anxiety and can even increase it. The reason is that stimulants excite the entire nervous system, resulting in increased heart rate, blood pressure, temperature, etc. This excitation stimulates the production of hormones and chemicals such as adrenaline, which can cause a person to feel even more anxious than before (sometimes leading to panic).
Depressants & Anxiety
Depressants are drugs that relax the central nervous system and include substances such as alcohol, opioids (e.g., Percocet, OxyContin), and benzodiazepines (e.g., Xanax, Ativan). While depressants are often prescribed to treat anxiety, long-term use can cause anxiety, as well. This is especially the case if an individual stops taking the depressant, as the withdrawal effects will exacerbate — and, in some cases, trigger — anxiety. There are several factors involved but one of the main reasons is that depressants can mask a person’s anxiety, making it worse over time. Also, some drugs like benzodiazepines can cause disturbed sleep, which can create increased anxiety due to a lack of proper rest.
Cannabis & Anxiety
Cannabis (marijuana) is a more complicated substance, because it can act as both a depressant and a stimulant. Some individuals find that cannabis creates a relaxing effect in their body, which is why they turn to it for their anxiety. While cannabis can provide temporary relief, one of the side effects of cannabis use is anxiety — especially if it’s taken in large doses or over a long period. High levels of THC in the body are linked to negative side effects, such as anxiety, paranoia, increased heart rate, sweating, hallucinations, and more.
Anxiety & Substance Abuse Treatment Options
The good news is that despite the complexities of co-occurring conditions like anxiety and substance abuse, treatment is available. While these can be treated separately, they are best managed using multiple levels of care, beginning with detox and continuing through to inpatient/residential, outpatient, and aftercare programs.
If you need to seek help, many of these programs are found in rehab facilities or drug treatment centers across the country.
Centers that offer dual diagnosis treatment are also recommended as they are set up to diagnose and treat substance abuse and concurrent mental health conditions. Dual Diagnosis is especially useful for people who have underlying issues such as anxiety, depression, and post-traumatic stress disorder (PTSD). These programs allow clinicians to safely address these conditions while an individual withdraws from substances.
Other key treatments to be aware of when it comes to anxiety and substance abuse are:
Cognitive-Behavioral Therapy (CBT)
Once an individual has gone through detox, one of the most effective therapies for anxiety and substance abuse is cognitive-behavioral therapy (CBT). CBT helps individuals change negative cycles of thought and behavior into more positive ones, and this has shown to be especially effective for addiction and mental health conditions. Clients receiving CBT for addiction often learn how to recognize “automatic thoughts” or dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence.
CBT also helps clients find solutions to triggers that might encourage drug use. CBT is known to be effective and long-lasting, as clients can continue utilizing these strategies once their therapy sessions have ended.
Dialectical-Behavior Therapy (DBT)
Dialectical-behavior therapy is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients identify negative influences in their lives and learn how to develop healthy coping skills. This kind of therapy is useful for people who are recovering from co-occurring conditions, especially those who have anxiety or depression. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a type of interactive psychotherapy that is used to treat PTSD. Consisting of 8 phases, EMDR is led by a therapist who guides an individual through a series of rapid eye movements to help redirect negative or traumatic memories. This redirection helps the person form new connections or associations so that the memory is less emotionally distressing over time. This therapy is therefore useful for individuals with anxiety, as it helps them overcome the emotional suffering associated with traumatic events.
Seeking Safety is an evidence-based counseling model that helps individuals attain safety from trauma and/or substance abuse. The sessions can be delivered in individual or group settings, and consist of over 25 different topics, such as:
- PTSD: Taking Back Your Power
- When Substances Control You
- Setting Boundaries in Relationships
- Detaching from Emotional Pain (Grounding)
- Coping with Triggers
Seeking Safety has been successfully implemented across vulnerable populations, including the homeless, victims of domestic violence, military personnel, and more. It has also proven to be effective for all types of addictions, making it a useful therapy for individuals with PTSD and substance abuse issues.
While there are no set medications for treating comorbid anxiety and substance abuse, there are a few that have shown promise during therapy.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Some studies have shown that anti-depressant medications, such as Paxil and Zoloft, may ease concurrent anxiety and alcohol addiction. Not only are these drugs considered to be safe and effective, but they also have a low potential for abuse.
Anticonvulsant medications such as Topamax have demonstrated positive results when it comes to treating individuals with cocaine addiction and anxiety issues.
Alternative or Holistic Therapies
The purpose of holistic therapies is to treat the whole person, and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies provided at rehab centers include:
- Nutritional therapy
- Animal-assisted therapy (e.g., emotional support dogs)
- Adventure therapy (e.g., hiking or rock climbing)
- Mindfulness and meditation
- Art therapy, Music therapy
- Equine-assisted (horse) therapy
Whichever path you choose, most co-occurring anxiety and substance abuse issues should be treated simultaneously. Alongside this therapy, there are other ways to boost your recovery by making lifestyle adjustments like the ones below:
Vigorous activity can stimulate endorphins, which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises such as walking, running, swimming, cycling, or yoga.
This can help calm anxious or racing thoughts and improve cognitive function, which is useful when recovering from anxiety and addiction.
The right diet can help repair damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy.
Learning to avoid triggers like certain people, situations, or circumstances can help prevent anxiety or a desire to take drugs.
While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.
If you or a loved one are struggling with anxiety and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
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Editorial Staff. (2021). Anxiety Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml.
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Compton W.M, Thomas Y.F, Stinson F.S, Grant B.F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, 64(5), 566-576. https://pubmed.ncbi.nlm.nih.gov/17485608.
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