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Co-Occurring Anxiety and Substance Use

Anxiety co-occurs at a high rate in men and women who also struggle with drug and alcohol addiction. When these two conditions combine, negative symptoms associated often increase. This may lead to a poorer prognosis with regard to healing from the combined conditions. Studies indicate that those who suffer from both will have a more intense disability and require lengthier forms of treatment in order to address these conditions simultaneously.

Why Anxiety Disorders and Substance Misuse Co-Occur

Among the general public, anxiety disorders make up the most diagnosed mental illness with approximately 29% of all people suffering from it at some point in their life. When it comes to individuals dealing with substance use disorders, studies have indicated that 18% suffer from co-occurring anxiety disorders, and about 30%-45% of men and women in treatment for drug or alcohol addiction are diagnosed with anxiety disorders as well. At its highest rate of co-occurrence, anxiety disorders and drug use often have a “lifetime comorbidity rate” of 60%.

Substance Abuse and Co-Occurring Anxiety
Specific Drugs That

Co-Occur With Anxiety

Co-occurring substance abuse and anxiety is a serious combination of disorders that only increases in severity based on the specific drugs used. Some studies have indicated that men and women who struggle with anxiety are more likely to abuse drugs than alcohol. Interestingly, it has been found that in most cases anxiety disorders precede the use of drugs or alcohol. In these cases, men and women who suffer from anxiety may use different medications, illicit substances, or alcohol as a form of self-medication to deal with the uncomfortable and oftentimes unmanageable symptoms caused by their anxiety. Conversely, there are some cases where an individual uses drugs or alcohol and then develops anxiety as a result of that abuse.



Whether prescribed or taken outside of the bounds of a doctor’s recommendation, benzodiazepines are often used to treat symptoms of anxiety. These medications can be prescribed and used safely, but when taken long-term they can become extremely addictive. Unfortunately, the longer a person uses these medications, the less effective they become unless the dosage is increased. That increase, however, can pose a negative and deadly threat, especially when combined with other substances. Studies have shown that approximately 30% of the opioid overdose cases in the U.S. also showed traces of extremely high, illicit benzodiazepine use. 

When abused, benzodiazepines can actually increase anxiety within the individual or cause anxiety in a person who did not previously suffer from the disorder. Adolescents and young adults often take benzos like Xanax at parties or recreationally with friends, but addiction and anxiety can set in very quickly when these drugs are abused. Other associated symptoms include doctor shopping, blackouts, poor decision-making, mood changes, and risk-taking behaviors. Withdrawal from benzodiazepines is extremely dangerous, often leading to relapses because of increased anxiety and uncomfortable physical symptoms.


Opioid abuse is also linked to individuals with anxiety disorders with about 60% of abusers suffering from a lifetime occurrence of co-occurring anxiety. Of this 60%, about 29% were never prescribed opioids for pain and received these drugs from somewhere other than a doctor. One study also found that about 12% of men and 21% of women struggling with opioid use disorders had not been diagnosed with an anxiety disorder but met the lifetime criteria for it. The two main implications of opioid use with co-occurring anxiety suggest that these individuals will have decreased distress tolerance and increased anxiety related to pain, particularly pain caused by opioid withdrawal.


In general, when alcohol is used alongside anxiety it is to decrease the uncomfortable side effects associated with that anxiety. Alcohol use is linked to decreased inhibition, increased talkativeness, an overall sense of euphoria, feelings of relaxation, and impulsive behaviors. If an individual suffers from anxiety, particularly in social settings, he or she may then drink in excess to combat those feelings. When a person continues using alcohol as an anti-anxiety, the body and brain crave the substance and increase symptoms of anxiety in order to prompt the individual to continue drinking. 

Studies have also shown that the initial use of alcohol can promote the development of an anxiety disorder by inducing anxiety when alcohol is not present within the individual’s system. The main reason for this is that alcohol use and abuse increase GABA activity in the brain. As continued use of alcohol stimulates those receptors, the brain begins to establish a new normal level. If alcohol is not present, the brain will experience a deficit in GABA activity, thus inducing symptoms of anxiety in order to initiate the drinking process to receive stimulation.


Though stimulant use is not the primary substance linked to anxiety disorders, some studies have found that about ⅓ of men and women who used stimulants or cocaine also struggled with anxiety disorders as well. The use of stimulants speeds up the processes within the brain and the body. This means that continued use causes the body to operate at a level that is abnormal, but that over time the body will become used to this new normal and crave stimulants in order to achieve that same effect. When stimulants, such as Adderall or cocaine, are not present within the body, individuals may feel increasing anxiety and other side effects that prompt continued use.

Anxiety Treatment

Treating Co-Occurring Anxiety

Because anxiety is so common, both in individuals who struggle with substance abuse and those who do not, there is a vast amount of literature discussing the best ways to treat these conditions. The main point is to seek treatment for both conditions at the same time. In most cases, anxiety causes substance abuse or substance abuse causes anxiety. Because of this, it is critical to treat them simultaneously so that neither causes the other again. 

The most effective place to receive treatment for both is through a dual diagnosis facility that provides specific plans for each individual with regard to their specific combination of conditions. Some of the treatment options that can help address these co-occurring anxiety disorders include cognitive behavioral therapy, SSRI medications, and exposure therapies.

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Stories of Anxiety Recovery

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