The relationship between anxiety and substance use disorder

Anxiety disorders are the most common type of mental health condition in the world, affecting over 300 million people globally. On its own, anxiety can be very challenging to live with. Unfortunately, many people with anxiety also live with substance use disorder, which can make symptom management more complex. Some reports show that almost all (97%) people who live with substance use disorder also experience anxiety disorder symptoms.

The relationship between anxiety and substance use disorder is multifaceted. Research shows that, sometimes, people with pre-existing anxiety may self-medicate with alcohol and drugs. At other times, the substances themselves can lead to increased anxiety. 

Regardless of which comes first, co-occurring substance use disorders and anxiety disorders can be difficult to treat — but there is hope. Many people with co-occurring anxiety and substance use disorders have learned how to manage both effectively.

Effects of harmful substance use on anxiety disorders

Using substances, including alcohol use and certain drugs like stimulants, can make anxiety worse. Many people use alcohol as a way to cope with anxiety, especially social anxiety. To make matters more complicated, substances can sometimes reduce feelings of anxiety temporarily. People sometimes describe alcohol as “liquid courage” and believe it makes them less anxious and inhibited. 

In reality, the reduction in anxiety that you might think you feel is actually a reduction in impulse control. You have less self-control than you usually do when you’re under the influence, which makes you feel less anxious about certain behaviors. That can often lead to risky or dangerous behaviors.

Alcohol and “hangxiety”

The way alcohol can make anxiety worse is often colloquially referred to as “hangxiety.” This term refers to the idea that you may feel more anxious after the alcohol leaves your system and you sober up. Often, this anxiety comes from worries about your behavior while you were drunk. For example, you might worry that you said something inappropriate or betrayed a loved one. In more severe cases, these worries can develop into social anxiety disorder.

Anxiety can also be a symptom of alcohol withdrawal, especially if you’ve used alcohol in large quantities over a long period of time. Alcohol affects your brain in many ways, including suppressing certain brain functions like impulse control. Alcohol also mimics GABA activity, which decreases mental chatter and anxiety while you’re under the influence. But as the alcohol leaves your body and GABA activity attempts to return to normal, your anxiety could rebound and come back much worse.

Stimulants and anxiety

Stimulants include cocaine, methamphetamine, MDMA, and more. This class of drugs is highly linked to anxiety, in large part because of the way it affects your body. Stimulants interact with your body’s central nervous system to cause feelings of hyperarousal, restlessness, and agitation. You might feel a euphoric high but also feel more anxious.

In addition, your brain can get so used to the “fake” neurotransmitters, like dopamine, that stimulants cause it to no longer make appropriate amounts itself. This can cause severe anxiety and depression during stimulant withdrawal.

Although it’s not illegal, caffeine is also a stimulant, and it has also been linked to heightened anxiety and even panic attacks for some people.

Substance use disorder and risky behaviors

Research shows that substance use disorder often co-occurs with post-traumatic stress disorder (PTSD). The reasons behind this link are complex (and PTSD often precedes substance use), but one of the reasons is that using substances may make you more likely to engage in impulsive and risky behaviors. 

For example, you may be more likely to drive under the influence, get into violent altercations, or engage in unsafe sex. You might also experience traumatic medical emergencies, like overdosing, due to the substance use itself.

Aside from these potentially dangerous behaviors that often come along with substance use disorder, harmful substance use can also cause a wide variety of other, more common life problems. For example, you might find that substance use negatively affects your work life and finances. Or you might feel like you have to constantly hide and lie about your substance use, leading to stress and anxiety.

Effects of anxiety on substance use disorder

Not only can you experience anxiety as a result of substance use, but the relationship can also go the other way. Although the relationship is complex and it’s difficult to determine with certainty which comes first, research has found that, in a majority of cases, anxiety comes before substance use disorder. 

Many people use substances as a way to self-medicate anxiety. For example, if you live with social anxiety disorder, you might feel too anxious to attend a party without drinking large quantities of alcohol. Or you might be so plagued with constant racing thoughts that you feel like using drugs and alcohol is the only way to calm yourself down. Although self-medicating may lessen your anxiety in the short term, it usually makes it worse in the long run.

Self-medication isn’t only unhelpful, but it can also be dangerous or even deadly. Anxiety is a treatable condition, and a mental health professional can recommend therapeutic interventions — including therapy, medication, or lifestyle changes (or a combination of all three) — that can help you feel better.

Unfortunately, there are many reasons that people might choose to self-medicate with drugs and alcohol rather than seek out professional mental health treatment, including:

• Stigma: Although we’ve come a long way, there’s still a high level of stigma against receiving mental health support, especially in certain communities.
• Lack of health insurance: Many Americans continue to be uninsured, which can make the cost of mental healthcare prohibitive.
• Lack of local resources: Many rural or remote areas are experiencing a mental health provider shortage. 

Risk factors for co-occurring anxiety and substance use issues

In addition to the ways that substance use and anxiety can lead to and exacerbate each other, there could also be other risk factors that contribute to both conditions. These include:

Genetics

Research shows that some of the same genetic variabilities could contribute to both anxiety and harmful substance use (as well as other mental health conditions like depression). This means that if you have a close relative with either anxiety or substance use disorder (or both), you may be more likely to develop either of these conditions.

Traumatic life events

Traumatic stress and substance use disorder appear together frequently, especially in veterans. Trauma is the emotional response to an event that’s deeply terrifying or life threatening. If you’ve experienced trauma, including during your childhood (like child abuse or neglect), you may be more at risk for PTSD, anxiety disorders, and substance use disorder.

Other mental health conditions

Other mental health conditions can also be risk factors for both substance use disorder and anxiety disorders. For example, people who live with ADHD are more likely to also have both anxiety and substance use disorder. Depression is another mental health condition that’s highly correlated with both.

Treating co-occurring anxiety symptoms and substance use disorder

Treating co-occurring anxiety and substance use disorder can be more complex than just treating one or the other, but it is possible. Many people who live with anxiety and substance use disorder have made progress and gotten out of the vicious cycle that these two conditions can lock you into.

When treating any co-occurring conditions, it’s essential to address both during treatment. This is because one condition likely affects the other. For example, if underlying anxiety is leading you to self-medicate using drugs or alcohol, then, without addressing the anxiety, you may fall back into the same patterns and relapse.

Your history of substance use disorder can also affect the best treatment options for you. Some anxiety treatments, like certain medications, carry a risk of abuse or addiction. Your mental health provider can weigh the benefits against the risks and make the treatment decisions that’s best for your unique situation. It’s important to always be honest with your treatment provider about your history of both substance use and anxiety.

Some therapy types that may be effective for treating co-occurring substance use disorder and anxiety symptoms include:

• Cognitive behavioral therapy (CBT): CBT is the most widely used therapy method for both anxiety and substance use disorder. It helps you reframe negative thinking patterns and adopt healthier behaviors.
• Exposure-based therapies: Exposure therapy helps you confront your fears step by step while learning skills to cope with these fears. Exposure therapy is particularly helpful for social anxiety disorder and PTSD, and research has found that it can be used for those with co-occurring substance use disorder. 
• Seeking Safety: Seeking Safety is a group-based manualized treatment model designed for co-occurring PTSD and substance use disorder. It helps you learn new skills that can help you better manage both conditions.

Find care with Rula

Living with substance use disorder and anxiety can feel difficult, but it’s not insurmountable. The good news is that you can get the treatment you deserve and learn to manage both of these conditions. 

When you’re ready, Rula’s therapy-matching platform can help you find a therapist who can help you meet your mental health goals. Plus, in just a few clicks, you can find someone who takes your insurance and is available to meet as soon as tomorrow.

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