Substance abuse and addiction commonly co-occurs with mental health conditions, such as anxiety disorders like generalized anxiety disorder and panic disorder—a term often referred to as a dual diagnosis. In fact, about half of all people with a drug or alcohol addiction also experiences a psychiatric illness at some point—and reverse is true as well.1

To heal from substance addiction and co-occurring anxiety, both disorders need to be addressed with an integrated treatment approach. Unfortunately, not everyone gets the treatment they need, particularly in Texas. Of the states with the highest percentage of adults who didn’t recent mental health treatment, Texas ranks fourth.2 People with anxiety and co-occurring substance abuse should seek out a Dallas dual diagnosis treatment program specializing in these two conditions.

Types of Anxiety Disorders

Drug and alcohol addiction often co-occur with various anxiety disorders. These anxiety disorders can manifest in a variety of ways, exhibiting a range of symptoms, which cause significant distress and impairment in a person’s life.

Note: Although obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) share several anxiety symptoms, they are no longer categorized as anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—rather, they fall under a new category, Trauma-and Stressor-Related Disorders.

Generalized Anxiety Disorder

People with generalized anxiety disorder exhibit excessive worry and concern, which occurs more days than not for at least 6 months. This anxiety is related to several activities, situations, or events, such as work, relationships, finances, or school.3,4

Symptoms of generalized anxiety disorder include:3,4

    • Muscle tension
    • Difficulty controlling worry
    • Feeling restless or on edge
    • Getting fatigued very easily
    • Problems concentrating
    • Irritability
    • Difficulty falling or staying asleep
    • Restless sleep

Panic Disorder

Individuals with panic disorder experience recurrent panic attacks. A panic attack is the sudden onset of intense discomfort or fear that peaks within a few minutes. Symptoms of a panic attack include:3,4

    • Shaking or trembling
    • Sweating
    • Intense nausea
    • Dizziness or light-headedness
    • Shortness of breath or feelings of choking
    • Heart palpitations or increased heart rate
    • Chest discomfort or pain
    • Hot or cold sensations
    • Numbness or tingling
    • Derealization (feeling detached from your surroundings)
    • Fear of dying
    • Fear of losing control

Often, people with panic disorder will spend a great deal of time worrying about when the next panic attack will come on, and they will go to great lengths to avoid triggers and situations that cause panic attacks.4

Separation Anxiety Disorder

Although many people frequently associate separation anxiety disorder with children, it can be diagnosed in adults as well. The only difference is the length of time symptoms must persist before someone may be diagnosed. Children can be diagnosed in as few as 4 weeks, whereas adults must exhibit symptoms of separation anxiety disorder for at least 6 months.3

People with separation anxiety disorder are afraid of being away from those they are attached to, whether that person is a parent, spouse, sibling, or close friend. Due to their excessive fears, they avoid being separated at all costs and avoid being alone.4

Symptoms of separation anxiety disorder include:3

    • Excessive distress when anticipating or experiencing separation from attachment figure
    • Significant concern about losing the attachment figure or about potential harm
    • Significant worry about experiencing an event that may cause separation from attachment figure
    • Refusal to leave the attachment figure to go to school, work, or out with loved ones
    • Refusal to sleep away from home for the night or go to sleep without the attachment figure nearby
    • Recurring nightmares related to separation
    • Recurring complaints of physical ailments (nausea, stomachache, headache) when separated from attachment figure.

Specific Phobia Disorder

People with specific phobia disorder have intense fear and anxiety related to one type of situation or object, such as:4</p>

    • Spiders
    • Snakes
    • Dogs
    • Flying
    • Heights
    • Blood
    • Receiving injections

Social Anxiety Disorder (Social Phobia)

Social anxiety disorder is characterized by intense anxiety, worry, or fear about one or several social situations in which the person is subject to potential scrutiny by other people. These situations range from social interactions to being observed while eating or drinking to performing in front of an audience. This intense fear generally causes them to avoid social situations in which they can be embarrassed, rejected, or judged.3,4

Other signs and symptoms of social anxiety disorder include:3

    • The anxiety and fear cause significant impairment in life functioning
    • Social situations nearly always cause anxiety or fear
    • Social situations are constantly avoided
    • The anxiety or fear is out of proportion to the actual threat
    • The anxiety lasts at least 6 months

Why Anxiety and Substance Abuse Commonly Co-Occur

People with an anxiety disorder are about 2-3 times more likely to struggle with a substance addiction than the general population. An estimated 20% of people with an anxiety disorder have a drug or alcohol addiction and 20% of those with an addiction have an anxiety disorder.5

As you can see, both conditions influence one another, and sometimes it can be difficult to discern which came first. Additionally, just because they co-occur, one disorder does not necessarily cause the other—they may simply occur simultaneously.1

There are three possible reasons that anxiety and substance abuse may commonly c-occur:1

  • Substance use and addiction can lead to the development of an anxiety disorder: This is because drug and alcohol abuse change brain function and structure, which can increase susceptibility.
  • Anxiety can contribute to the development of an addiction: People with an anxiety disorder may temporarily self-medicate their unwanted symptoms with drugs or alcohol, which in turn creates a vicious cycle.
  • Shared risk factors can contribute to both: Both anxiety and substance use disorders are heritable and share environmental factors like trauma.

Underlying Causes of Anxiety and Addiction

Although researchers are still exploring the various causes of anxiety disorders, they have established several risk factors that may influence the development of one or more of these conditions, such as:3

  • Substance abuse
  • Other mental illnesses, such as depression
  • Life stressors, such as a loss of a loved one
  • Trauma
  • Genetics/Family history
  • Temperament, such as neuroticism or behavioral inhibition
  • Childhood maltreatment
  • Childhood physical or sexual abuse
  • Parental overprotection

Substance addiction shares many risk factors with anxiety disorders, such as childhood abuse and maltreatment, other mental health conditions, life stressors and trauma, and genetics.3

Implications of Comorbid Anxiety and Addiction

Both substance addictions and co-occurring anxiety disorders affect the course of treatment as well as treatment outcome for the counterpart condition. This means that if you receive mental health treatment for your anxiety disorder but not your drug or alcohol addiction, then the addiction is going to negatively impact your treatment outcome, as substance use can cause anxiety symptoms. And if you receive substance abuse treatment that doesn’t take your anxiety into consideration, then you could potentially relapse post-treatment if you are experiencing distressing anxiety symptoms and don’t know how to cope.

Here’s how anxiety affects the outcome for substance use disorders:6

  • Anxiety is related to increased utilization of substance abuse treatment services
  • Anxiety is related to an increased severity of alcohol addiction
  • Anxiety is related to more severe alcohol withdrawal syndrome
  • Anxiety is related to higher relapse rates after addiction treatment

Here’s how substance addiction impacts the outcome for an anxiety disorder:6

  • Substance addiction is associated with a higher risk of suicide in people with panic disorder
  • Substance addiction decreases recovery rate of generalized anxiety disorder

Dual Diagnosis Treatment for Substance Abuse and Anxiety

Because substance addiction and anxiety influence treatment outcomes, it’s imperative that people with addiction and co-occurring anxiety attend a dual diagnosis treatment program in Dallas or elsewhere.

Dual diagnosis treatment programs specialize in providing integrated and comprehensive care that fully addresses both conditions and how they affect one another.

Dual diagnosis treatment programs in Dallas offer a combination of treatment methods and interventions that are tailored to meet each person’s needs. Everyone’s addiction is different, and everyone’s anxiety disorder manifests in a unique way. The treatment team at the Dallas dual diagnosis treatment program will perform an intake assessment, which evaluates:

  • Medical history
  • Substance abuse history
  • Anxiety disorder history
  • Any other mental illnesses
  • Family history of substance abuse and mental health conditions
  • Previous withdrawal episodes
  • Previous treatment programs

Using this information, they’ll create a treatment plan that may consist of interventions, such as:4,6

  • Medications for anxiety: They likely won’t prescribe anxiolytics that are addictive, such as benzodiazepines, although they may prescribe selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Paxil.
  • Medications for addiction: They may prescribe an FDA-approved medication, such as naltrexone for alcohol addiction or buprenorphine for opioid addiction. However, they will only do this if it is safe to take with the other medications.
  • Cognitive-Behavioral Therapy (CBT): A type of psychotherapy in which a therapist facilitates understanding about the connection between thoughts, feelings, and behaviors to curb anxiety symptoms and change drug-seeking behaviors.
  • Dialectical Behavioral Therapy (DBT): A type of therapy that teaches mindfulness, distress tolerance, acceptance of negative emotions and situations, impulse control and emotional regulation skills, and interpersonal skills.
  • Contingency Management: This treatment approach utilizes rewards to encourage abstinent and healthy behaviors.
  • Group Therapy: A substance abuse counselor facilitates a group session in which members learn sober social skills, drug refusal strategies, and more.

If you need help finding a dual diagnosis treatment program in Dallas or another part of Texas, give us a call at 1(214) 935-2287. Our caring and compassionate treatment support specialists can assist you.

Substance Abuse and Anxiety Resources

  1. National Institute of Mental Health. (2021). Substance Use and Co-Occurring Mental Disorders.
  2. Kaiser Family Foundation. (2021). Mental Health and Substance Use State Fact Sheets.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.).
  4. National Institute of Mental Health. (2018). Anxiety Disorders.
  5. Anxiety & Depression Association of America. (n.d.). Substance Use.
  6. Smith, J. P., & Book, S. W. (2008). Anxiety and Substance Use Disorders: A ReviewThe Psychiatric times25(10), 19–23.



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