Anxiety And Substance Abuse: How they ConnectIf you’re a human being, there’s a good chance you’ve experienced some anxiety at some point in your life. You might think of anxiety as nervousness. However, anxiety is not only an emotional or psychological feeling. It also creates unpleasant or hard-to-bear sensations in the body. Most people feel anxious from time to time. However, if your anxiety is out of control, unbearable, or unfounded, you may suffer from an anxiety disorder.

Because anxiety feels so unpleasant, many people with anxiety disorders choose to self-medicate. The can use chemical substances to quell their feelings. Things like drug and alcohol can help temporarily make them feel better. What many people don’t realize is that substances can actually cause increase anxiety in the long run.

Read on to understand more about how anxiety and substance abuse link. You can also learn why the connection is so hard to break and how one can play into the other.

What is Anxiety?

Anxiety is an emotion that causes feelings of fear or anticipation of a future threat. Some amount of anxiety is common for everyone. However, when anxiety is excessive or overblown, or not based in reality, it can be a sign of an anxiety disorder. An anxiety disorder can be incredibly disruptive to a person’s life. According to, more than 40 million Americans have an anxiety disorder. Also, at least 40% of all American adults have experienced an anxiety disorder at some point in their life. Anxiety doesn’t just make people feel the emotions of fear and nervousness. It has a physical component with the following symptoms:

  • Sweating
  • Weakness
  • Having trouble concentrating
  • Trouble sleeping
  • Feeling tense
  • Increased heart rate
  • Hyperventilation
  • Shaking or trembling
  • Racing thoughts
  • Etc.

There are several different types of anxiety disorders. Some people have generalized anxiety. Others have more specific types of anxiety, like PTSD after a traumatic event.

Substance Use and Its Affect on Anxiety

Chemical substances like drugs and alcohol can be a temporary relief for people who suffer from anxiety. This is because when a person suffers from anxiety, parts of their brain (the amygdala and prefrontal cortex) are overactive. Drugs and alcohol can have sedative effect and depress these parts of the brain. This helps a person temporarily stop feeling some of the effects of their anxiety.

Alcohol is a depressant, and it has a sedative effect. The higher a person’s blood alcohol level is, the more they may experience an increased feeling of relaxation. People who have unmitigated anxiety that feels unpleasant may begin to rely on alcohol to reduce stress or make their body feel better. However, according to a study at the University of North Carolina at Chapel Hill, regular alcohol consumption can rewire the brain. This means that the brains of people who rely on alcohol to calm their nerves can no longer naturally mitigate their own stress. People who do not consume alcohol to calm themselves remain naturally able to quell their own anxiety simply using their brain. Those who use substances have to turn to the substance again and again each time they feel anxious.

Beyond alcohol, people can abuse a wide range of substances, both prescription and illicit, to help control their anxiety. Other addictive substances include benzodiazepines like Xanax, Ativan, Klonopin, and Valium and prescription sleep aids, like Ambien and Lunesta. People also take opioids like Vicodin, morphine, heroin, etc.; and marijuana, which elevate a person’s mood and increase a feeling of relaxation.

When people become addicted to drugs or alcohol, then stop using them, they go through withdrawal. The symptoms of withdrawal often mimic anxiety. This means that stopping these substances can anxiety worse. Withdrawal symptoms include things like sweating, trembling, nausea, and an increased heart rate.

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The link between anxiety and substance use disorders is not just anecdotal. In fact, scientific studies have proven that there is often a direct connection between the two. Experts believe there commonly comorbidity in people who suffer from them. In a study published in Social Work and Public Health, researchers explain, converging evidence from epidemiologic and treatment studies indicate that anxiety disorders and substance use disorders commonly co-occur, and the interaction is multifaceted and variable. Epidemiological studies and investigations within clinical substance abuse populations have found an association between anxiety disorders and substance use disorders. Specific anxiety disorders including generalized anxiety disorder, panic disorder, and post traumatic stress disorder have all been associated with substance use. The association with obsessive-compulsive disorder is less robust, and some research has found a negative association. The risk of nicotine dependence is significantly higher among individuals with an anxiety disorder, and conversely, smoking has been found to be associated with trait anxiety and anxiety disorders.

According to the Anxiety and Depression Association of America (ADAA), 20% of Americans with an anxiety disorder also have a substance use disorder. Also, about 20% of all people who have a substance use disorder also have an anxiety or mood disorder. In a study published by the Psychiatric Times, researchers looked at the direct relationship between anxiety and substance use. What they found is that comorbidity is common and that when a person suffers from both, each condition helps play into the maintenance of the other. Researchers found that there were multiple ways that the two conditions played into each other:

  • Someone suffers from an anxiety disorder and uses substances to self-medicate
  • Someone has an anxiety disorder caused by the effects of substances on the body and brain
  • Someone is genetically predisposed to anxiety or they have the genes for both disorders.

Researchers found that most commonly, people suffered from anxiety first and then chose to medicate with alcohol. (about 75% of respondents).

Treating Anxiety and Substance Abuse Disorders

Scientists have been able to link anxiety disorders and substance abuse disorders. Thus, there has been a focus on figuring out how to treat the two together. In a study published in the Harvard Review of Psychiatry, experts found, general conclusions appear to support that addressing one of these disorders does not consistently confer benefits for the other. Thus, with the exception of substance-induced ADs, treating both disorders appears to be the best clinical course of action. Although the research in this area is too limited to draw definitive conclusions at this time, it appears that integrated treatments (i.e., those that incorporate treatment for both disorders) may offer a number of benefits over concurrent treatments (i.e., simultaneously providing separate treatments for anxiety and SUDs) with respect to outcome. Moreover, a small study of returning veterans with co-occurring PTSD and SUDs found that 66% preferred an integrated treatment approach.

Experts believe that treating the two at the same time may result in the best outcome, since one can feed the other if left untreated. Sometimes, a patient does not feel ready to treat one of the conditions. In these cases, doctors believe it is best to start with the disorder they’re most ready to treat. Then, they can on to move to the other disorder. Treatment options for both substance abuse and anxiety disorders currently include pharmacotherapy and psychotherapy.

Experts know that anxiety and substance abuse often co-occur. Yet, there has been little research done about the most effective way to treat them. In the Harvard Review of Psychiatry, researchers concluded, “Co-occurring anxiety disorders and substance use disorders present a particular public health problem and clinical challenge. Treatments that address both disorders may be necessary to reduce symptoms in both areas and to achieve improvements in functioning. Enhanced understanding of the nature of the development and maintenance of these disorders when they occur together may help to advance the development of novel treatment strategies for this population.”

Overcoming Anxiety and Substance Abuse for a Freer Life

At the end of the day, anxiety and substance abuse connect directly. If you think that you suffer from these conditions, consider getting help for both. By treating both your anxiety and stopping your substance use, you can help your body and brain learn to better deal with stress and hopefully live a more comfortable, worry-free life.

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