Understanding Anxiety Disorders and SUD

Thanks to a better understanding of mental health, we now know much more about anxiety disorders and substance use disorder than we did in previous generations.

For instance, we now understand that people who live in stressful urban areas or in constant economic insecurity are far more likely to develop lifelong anxiety disorders compared to those who live in rural regions or have financial stability. People with SUD also have similar environmental risks. What’s more, we now know that both conditions also have shared genetic components.^1,2,3,4,5

We now also understand that having anxiety disorder makes an individual 2-3 times more likely to have a substance use disorder (SUD) than others in the general population. About 20% of people diagnosed with an anxiety disorder have a problem with substance misuse and about 20% of people diagnosed with SUD have an anxiety disorder.^1,4,5

The relationship between the two conditions is complex. Using substances, particularly stimulant drugs, can lead to anxiety disorder. The reverse is also true — pre-existing anxiety disorders can greatly increase the chance someone will use drugs. Both conditions may also occur at the same time, without one necessarily influencing the other.^1,4,5

To sum up, the main relationships between anxiety and SUD tend to be the ones below:^1,4,5

• Substance use and SUD can directly lead to the development of an anxiety disorder.
• Behavior caused by anxiety can lead to substance misuse as a coping strategy.
• Anxiety and SUD share environmental and genetic factors, and one can develop independently of the other.

What Causes Anxiety Disorders?

There is yet no definitive answer to what ultimately causes all anxiety disorders, and the apparent known causes vary from case to case. However, there are a number of known risk factors that are known to coincide with a higher rate of anxiety disorders.^1,4,5

• Substance misuse
• Traumatic events during childhood or teen years, where there is peak brain growth
• Depression
• Constant stress from work, school, or personal life
• Economic insecurity
• Being constantly shamed as a child
• Parental overprotection
• Trauma
• Genetics
• Temperament
• Childhood maltreatment
• Childhood abuse

Substance use disorders share many risk factors with anxiety disorders, particularly the existence of childhood trauma and maltreatment. Many genetic factors are also likely to play a part in both, as well.

How Does Anxiety Affect SUD Treatment Outcomes?

People who have both an anxiety disorder and SUD typically experience a number of complications from this comorbidity. Some of these include:⁵

• Increased use of depressant drugs such as alcohol, opioids, and benzodiazepines
• Increased relapse rates after treatment for SUD
• More severe withdrawals from alcohol and drugs
• More difficulty quitting drugs and alcohol
• Higher risk of developing severe SUD
• Increased risk of suicide and violence
• Decreased long-term recovery rates
• Difficulty finding appropriate treatment programs

How is Co-occurring Anxiety and SUD Treated?

Ideally, individuals who are diagnosed with both an anxiety disorder and SUD need to enter a specialized dual diagnosis treatment program, rather than one that addresses just either condition. This is due to the reciprocal nature of these two disorders, where one tends to worsen the other.

Regardless of the specific relationship of the two conditions in a given case, managing anxiety symptoms is an extremely vital part of SUD recovery programs. Addressing anxiety symptoms, even when an anxiety disorder is not known to be present, can break the behavioral feedback loops that encourage drug use, which reduces the risks of relapses while buying time for the affected individual to heal from their substance misuse.

Everyone’s case is different, so treatment strategies can differ depending on the case. Interventions for co-occurring anxiety and SUD tend to include the following:^1,3,4,5

• Medication-assisted Treatment for SUD. When appropriate, clinicians may prescribe medications for the specific type of SUD, such as buprenorphine for opioid use disorder or naltrexone for alcohol use disorder.
• Anti-anxiety Medications. Clinicians are likely to prescribe non-habit-forming SSRIs such as sertraline to help level the patient’s mood. They may prescribe controlled doses of benzodiazepines unless the patient has a history of misusing these drugs.
• Dialectical Behavioral Therapy (DBT). Patients with severe anxiety disorders may not be ready to receive standard cognitive-behavioral therapy (CBT), as they may not yet be emotionally stable. Dialectical behavioral therapy (DBT) is a subtype of CBT that helps improve emotional regulation and distress tolerance through mindfulness and other related practices. When they become more stable, they may receive regular CBT or other appropriate psychotherapy.
• Motivational Interviewing. This approach “gamifies” anxiety and SUD treatment and rehabilitation by rewarding desirable behaviors.
• Group Therapy. A trained SUD counselor facilitates group sessions in which different patients with similar cases can learn from each other’s insights and experiences.

Find Help for Co-occurring Anxiety and SUD

Dual diagnosis cases are best handled by treatment programs that specialize in them. Call Dallas Drug Treatment Centers at +1(214) 935-2287 to find treatment programs in the Dallas-Fort Worth area that specialize in co-occurring anxiety and SUD.

Resources

1. National Institute of Mental Health. (2021). Substance Use and Co-Occurring Mental Disorders.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders(5th ed.).
3. National Institute of Mental Health. (2018). Anxiety Disorders.
4. Anxiety & Depression Association of America. (n.d.). Substance Use.
5. Smith, J. P., & Book, S. W. (2008). Anxiety and Substance Use Disorders: A Review. The Psychiatric Times, 25(10), 19–23.