Summary: Anxiety can lead to addiction through a behavior called self-medication, which is when a person uses alcohol or drugs to relieve the painful, unwanted emotions and patterns of thought associated with anxiety disorders.
Key Points:
- 40 million + adults in the U.S. have anxiety.
- 25 million + adults in the U.S. have an alcohol use disorder (AUD), a.k.a. alcohol addiction.
- 44 million + adults in the U.S. have a substance use disorder (SUD), a.k.a. drug addiction.
- 25 million + adults in the U.S. have an addiction disorder and a mental health disorder.
- Less than 20 percent of people with an addiction disorder and a mental health disorder receive treatment for both.
Anxiety and Addiction: Early Diagnosis and Treatment is Essential
Some people with anxiety receive a timely, accurate diagnosis and seek evidence-based treatment from a mental health professional. However, many people with anxiety never receive an accurate diagnosis and don’t have the resources for treatment – which means they don’t get the help they need when they need it most.
People with untreated anxiety often use alcohol or drugs for temporary relief from the symptoms of anxiety. This is called self-medication. This practice is one of the most common reasons why many people with anxiety disorder also have an addiction disorder: their substance use began as a way to manage their anxiety, then became a second disorder itself.
In this article, we’ll discuss this phenomenon, called co-occurring disorders – which can refer to any mental health disorder + addiction – with a focus on co-occurring anxiety and addiction. We’ll start by clarifying exactly what we mean by anxiety.
What is Anxiety?
Anxiety is a feeling of uncertainty, apprehension, nervousness, or fear about something that hasn’t yet happened. It’s normal to experience some degree of anxiety about an upcoming event or what the future holds in general. We typically feel anxious when we’re faced with a dangerous situation, such as encountering a large, growling dog baring its teeth just a few feet away or driving on an icy road in winter. We may also feel anxious in response to a situation we perceive as dangerous or threatening, as well, such as seeing a spider crawling on the wall across the room, or walking into a social gathering where we’re worried that we won’t fit in and no one will talk to us.
Anxiety disorders are more than everyday fears, though. They’re diagnosed when anxiety causes significant problems, or when the irrational thoughts and beliefs associated with anxiety create enough distress to cause impairment in one or more areas of life, such as relationships, family, work, or school.
Types of Anxiety Disorders
Anxiety appears in a variety of ways. The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V) – the go-to diagnostic manual used by mental health professionals to diagnose mental health disorders and conditions – identifies several different types of anxiety disorders. They include:
Generalized Anxiety Disorder (GAD)
This is one of the most frequently diagnosed types of anxiety. The primary feature of GAD is persistent and excessive worry about situations and events that are unlikely to occur. Symptoms must for a minimum of six months to meet criteria for a clinical diagnosis. Additional symptoms – at least 3 of which must also be present to meet criteria for a clinical diagnosis – include poor concentration, sleep problems, muscle tension, frequent fatigue, irritable mood, and constantly feeling restless or on edge.
Panic Disorder (PD)
People who experience panic attacks often receive a PD diagnosis. In addition to the panic attacks themselves, they typically experience ongoing anxiety about future panic attacks and/or the possible implications or consequences of having an attack. Panic attacks are extremely distressing, typically brief experiences of intense anxiety, often triggered by an irrational, fearful thought or feeling. People with PD also report their panic attacks can appear with little or no warning whatsoever.
Panic attacks involve both psychological symptoms as well as physical symptoms. In most panic attacks, a person feels an overpowering certainty that something terrible is about to happen.
Panic disorder may be accompanied by agoraphobia, which is an intense fear of being in open, crowded places, especially those that are difficult to escape from. People with PD and agoraphobia may fear they’ll be in a place with no help and means of escape if they do have a panic attack. People with PD and agoraphobia may isolate themselves from people and the world entirely.
Social Anxiety Disorder (Social Phobia)
This anxiety disorder involves having an intense fear of any type of social situation, such as having to speak or perform in front of an audience (e.g. giving a presentation at work or school), being in a large crowd or small gathering (e.g. a concert or wedding), or being the center of attention in any situation.
The primary fear for those with social phobia is that they will be judged, scrutinized, embarrassed, criticized, or humiliated. As a result, individuals with this disorder tend to go out of their way to avoid social situations. If they’re unable to avoid the social situation they fear, they experience incredible anxiety and distress while they’re there. Sometimes SAD creates exactly the circumstance the individual wants to avoid. It may cause a sub-par performance during a work presentation, for instance, which causes embarrassment and more intense anxiety about the next work presentation, which causes another sub-par performance – and the cycle continues, reinforcing itself with each iteration.
Specific Phobia
A specific phobia involves an irrational, excessive, or extreme fear of specific situations, circumstances, or things. Any exposure to these situations or this causes intense distress and anxiety. People with this anxiety disorder will go to great lengths to avoid the thing or situation they fear. Sometimes the way they avoid these things is counterproductive – like using alcohol or drugs.
Other Related Disorders
Although no longer classified as anxiety disorders in the DSM-V, it’s worth mentioning posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD), since anxiety plays a significant role in both.
Posttraumatic Stress Disorder (PTSD)
For some individuals, experiencing an extremely traumatic event can lead to PTSD. Symptoms may develop soon after the trauma or appear months or years later. To receive a PTSD diagnosis, symptoms must be present for at least a month. They include nightmares, flashbacks, anger, tantrums, being easily startled, hypervigilance, and poor sleep. When left untreated, these symptoms can last an entire lifetime. People with PTSD often experience intense distress in response to anything associated with their initial traumatic experience, which is why they strive to avoid anything – activities, people, or places – that remind them of it.
Obsessive-Compulsive Disorder (OCD)
People with obsessive-compulsive disorder experience persistent and intrusive thoughts, urges, or images – their obsessions – that cause significant anxiety. They engage in rituals and behaviors – their compulsions – to reduce the emotions associated with their obsessions and compulsions. Extreme urges, the need for everything to be neat and orderly, and fear of germs or any type of contamination are common examples of obsessions among people with OCD. Compulsive behaviors include constantly counting things, repeatedly putting things in a specific order, checking on things multiple times, and excessive, repetitive washing or cleaning of objects or themselves.
Those are the most common anxiety disorders. Now we’ll explain how anxiety disorders can lead to addiction.
The Connection between Anxiety Disorders and Addiction
It’s not difficult to imagine why someone with anxiety might develop an alcohol or substance use disorder. Alcohol, marijuana, and sedatives like benzodiazepines can provide temporary relief from negative feelings, painful emotions, and general psychological distress. However, every time a person uses these substances to manage their emotions or the symptoms of anxiety, they reinforce the connection between the substance and the relief. This creates a cycle that becomes difficult to break, and can lead, ultimately, to disordered use of that substance, a.k.a. addiction.
Research confirms that anxiety often co-occurs with alcohol and/or substance use disorder. A large study, conducted over a decade and published in 2015, called The National Epidemiologic Survey on Alcohol and Related Conditions, found that nearly 18 percent of the 43,000+ respondents with a substance use disorder also met criteria for a clinical anxiety disorder. The study indicated that the specific type of anxiety disorder plays a role in specific substance most likely to be misused.
Here’s what they found about the relationship between specific anxiety disorders and addiction.
Generalized Anxiety Disorder (GAD)
Individuals with generalized anxiety disorder may turn to alcohol to self-medicate their anxiety and sleep difficulties. They may also self-medicate with benzodiazepines and other sedatives, including marijuana. A confounding factor for people with GAD and other anxiety disorders is that short-term pharmacological treatment using benzodiazepines can be effective in reducing symptoms, but the risk of dependence and subsequent addiction is high.
Social Anxiety Disorder (Social Phobia)
Like GAD, individuals with social anxiety disorder may use alcohol to self-medicate. Alcohol helps make social situations feel more tolerable. However, the relief is temporary, and the chronic use of alcohol in social situations does two things: it make anxiety worse, and can result in alcohol addiction.
Panic Disorder (PD)
People with PD may use alcohol to relieve symptoms of anxiety, which – as we mention above – can lead to alcohol addiction. The relationship of PD and AUD is further complicated by the fact that panic attacks are one of the symptoms of alcohol withdrawal. People may also self-medicate panic symptoms with benzodiazepines and/or marijuana. However, for some people, the side of effects of cannabis use include anxiety, paranoia, and panic attacks. Benzodiazepines, often prescribed by physicians to manage panic attacks, carry a potential risk of misuse and addiction. Also, the use of stimulants such as cocaine or amphetamines may provide a temporary sense of control over anxiety symptoms, but also – over time – trigger or exacerbate PD.
Posttraumatic Stress Disorder (PTSD)
People with posttraumatic stress disorder (PTSD) are among the most vulnerable to alcohol and substance use disorders. The symptoms of PTSD can be overwhelming, and it’s common for people to attempt to control their symptoms and painful emotions with alcohol, marijuana, and/or prescription sedatives. Combat veterans, victims of sexual assault, victims of childhood abuse, and victims of any kind of emotional or physical trauma may develop PTSD and have an increased risk of developing addiction.
In some cases, it’s difficult to determine which developed first: the anxiety disorder or the substance use disorder. Symptoms of withdrawal – as well as effects of some types of substances – are often similar to anxiety symptoms, particularly those associated with generalized anxiety disorder. This makes diagnosis a challenge, especially when a person is engaged in chronic, daily alcohol or drug use. Chemical imbalances in the brain play a role in the development of many psychiatric disorders. When alcohol drug use further impairs brain function, the clinical picture becomes more complicated.
Treatment for Co-Occurring Anxiety and Addiction
Treatment for co-occurring anxiety requires specialized knowledge and skill. When anxiety and addiction disorders occur together, the symptoms and negative consequences escalate over time – unless they’re treated. Research shows the most effective approach to treating co-occurring anxiety disorders and substance use disorder is to treat them simultaneously following an integrated care model. Integrated treatment for co-occurring disorders helps reduce both the risk of relapse and the recurrence of anxiety symptom.
Evidence-Based Treatments for Anxiety and Addiction
- Cognitive Behavioral Therapy (CBT)
- Exposure Therapy
- Prolonged Exposure Therapy (PET)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Complementary therapies such as mindfulness, yoga, meditation, experiential therapies, and immersion in nature.
Cognitive Behavioral Therapy (CBT) is one of the most well-researched and effective treatments for both anxiety disorders and SUD. It focuses on identifying and changing the underlying beliefs and thought patterns that contribute to the distressing emotions and self-destructive behavior associated comorbid anxiety and SUD.
Exposure Therapy is a form of CBT used primarily for treating specific phobias. It’s also used to treat OCD. It involves gradually increased exposure to the feared object or situation to help diminish the fear and anxiety associated with it.
Prolonged Exposure Therapy is a specific type of exposure therapy often used in the treatment of PTSD. It involves a combination of in vivo exposure and imaginal exposure to triggers and memories associated with trauma. It can help individuals realize they do not need to avoid thoughts and memories that no longer pose a real threat.
Eye Movement Desensitization and Reprocessing (EMDR) is a type of therapy originally used to treat emotional trauma. Developed in the 1980s, EMDR is now used in the treatment of a variety of psychiatric disorders. It’s used in some treatment settings, particularly with patients who have co-occurring PTSD and SUD.
Complementary therapies help people find the right combination of clinical treatment and lifestyle changs that synthesize the entire treatment experience and increase the likelihood that a life in recovery will resonate with them in a practical, daily, hands-on way. When a person finds what works now and in their lives, they have a better chance at achieving sustainable, long-term recovery.
Treatment Goals for Co-Occurring Anxiety and Addiction
Integrated treatment for co-occurring anxiety and addiction disorders is designed to help people manage their anxiety symptoms, change unhealthy patterns of behavior, eliminate the need for self-medication, and achieve total health and wellness. Total health is more than the absence of symptoms, and recovery is more than the absence of alcohol or drug use. When a treatment program helps a person thrive on all levels – physical, emotional, social, and spiritual – then they increase their chance of successful, sustainable, long-term recovery.
