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Co-Occurring Disorders: Addiction and Anxiety

Anxiety disorders are the most common mental health disorders in the United States.1 Approximately 40 million adults, or 18.1% of the adult population in the United States, meets the diagnostic criteria for an anxiety disorder.1 People with anxiety disorders typically experience excessive fear or worry and engage in behaviors (usually unhealthy) to help them avoid or manage the anxiety.2 Anxiety disorders also commonly appear alongside substance use disorders (commonly known as addiction), a condition known as a co-occurring disorder, meaning that there is a mental health disorder in the presence of a substance use disorder.3 Studies have shown that up to 50% of people diagnosed with a substance use disorder also meet the criteria for a diagnosable anxiety disorder.3

Co-occurring mental health disorders require specialized treatment. Oftentimes, the most effective treatment for substance use disorders and co-occurring mental health disorders are those which treat the disorders simultaneously.4 This type of treatment, known as dual diagnosis treatment, is often highly tailored and specialized depending on the patient’s circumstance, and can lead to positive outcomes.4 This page will help you understand what an anxiety disorder is, how it interacts with substance use disorders, and how to find treatment can help you enter into recovery from both anxiety and addiction.

How Substance Use and Anxiety Are Linked

Substance use disorders (SUDs) and anxiety disorders frequently co-occur. Studies show that sometimes people have an anxiety disorder and develop a substance use disorder later, and in other cases, the person may have a substance use disorder and develop an anxiety disorder.5

There are four reasons anxiety disorders and substance use disorders often occur together:

  • Self-medicating to manage symptoms of anxiety. People may use substances, particularly alcohol, to self-medicate and reduce anxious feelings. Those with generalized anxiety disorder and panic disorder can be at risk for developing a substance use disorder secondary to self-medicating. 6
  • Biochemical factors. Acute stress and anxiety can change brain chemistry and alter how our body responds on the molecular level. Similar changes occur when one uses substances regularly. 7
  • Genetic predisposition. It’s suggested that one’s vulnerability to developing a substance use disorder is roughly 40 – 60% attributable to one’s genetics. Use of substances to manage anxiety can increase the likelihood of developing an addiction in someone whose genetic makeup is prone to developing a substance use disorder, especially if there is a family history of addiction or mental health disorders.7
  • Managing the effects of withdrawal. People may become increasingly anxious when they are using or withdrawing from a substance, or when they are dealing with cravings or desires to use drugs. You may develop a substance-induced anxiety disorder.8

The exact relationship between anxiety and substance abuse remains unclear, integrated, dual diagnosis treatment for substance use disorders and co-occurring mental health disorders does seem to lead to more positive outcomes in patients.4

Types of Anxiety Disorders

Anxiety disorders include a broad classification of specific disorders that include, but are not limited to the following:

  • Generalized Anxiety Disorder is a condition characterized by overwhelming worries that are often out of proportion to the daily stressor. You may worry about money, your health, your job, or other issues. Symptoms may include restlessness, feeling tired, difficulty concentrating, irritability, tight muscles, or problems with sleep and must last for at least 6 months.9
  • Social Anxiety Disorder (sometimes called social phobia) is a condition in which one experiences fear or anxiety about social situations. Those with social anxiety disorder may experience intense fear over what others might think of them. Oftentimes, this fear is out of proportion to the potential risk, and those with social anxiety disorder may choose to avoid social situations to limit these fears. The symptoms of social anxiety disorder must occur for a six-month duration for a diagnosis to be made. 9
  • Panic Disorder is a condition in which one experiences unexpected and intense feelings of fear. Symptoms include chest pain, shortness of breath, sweating, shaking, heart palpitations, and gastrointestinal symptoms. People often report feeling like they are having a heart attack or feel as though they are dying.9
  • Phobias. Phobias are an intense fear or anxiety about a specific object or situation. Some examples of common phobias include the fear of flying, spiders, heights, and seeing blood. Sometimes people are terrified of leaving their homes. Symptoms will typically need to last for 6 months for a diagnosis to be made. Sometimes, people may go to great lengths and alter their behaviors to avoid engaging with their phobias. 9

How to Treat Co-Occurring Anxiety and Substance Use Disorders

Oftentimes a specialized approach that simultaneously treats both substance abuse and a co-occurring anxiety disorder can lead to positive outcomes. It’s important to coordinate with medical professionals to determine what sort of rehab programs would be best for you. This may entail a variety of interventions:10,11

  • Detox. Detox clears the body of the abused substance and is a precursor to rehab treatment. While detox can occur naturally, it is common to experience physical withdrawal symptoms that can be severe or even fatal. Hence, medical detox is often the safest option. During medical detox, you may be placed on medications to help manage the withdrawal symptoms.
  • Inpatient treatment (residential treatment). During inpatient and residential treatment, patients will stay at a medical facility and receive around-the-clock care. Treatments and therapies can vary greatly but will generally be aimed at helping you understand the underlying causes of your substance abuse and anxiety, in order to develop healthy coping mechanisms. Inpatient programs can last for a few weeks to a few months, while residential programs can last several months to a year.
  • Outpatient treatment. Outpatient treatment is generally seen as a follow-up to a more intensive inpatient track and involves patients seeing medical professionals on a regular basis while living at home. Outpatient services can provide psychotherapy, case management services, and regular assessment while allowing you to return to normal life functions, such as work or school.
  • Medication-Assisted Treatment (MAT). Medication-Assisted Treatment (MAT) is a treatment that combines medication with behavioral therapy. The medications prescribed could be to help you mitigate the withdrawal symptoms of detox, or to help manage the symptoms of anxiety.

Does Insurance Cover Treatment for Co-Occurring Disorders?

The Affordable Care Act (ACA) requires insurance providers to cover services for mental health and substance use disorders.12 The ACA also requires insurance companies to cover rehabilitative services when necessary.12 Coverage may vary based on several factors including your location, insurance type and plan, and the required intensity and length of treatment. The US Department of Veteran’s Affairs (VA) and TRICARE (insurance for military service-members and their dependents) also offer coverage for treating mental health and substance use disorders in veterans and their dependents. Check with your insurance provider to see what resources are available to you and for guidance in how to access care.

Finding Co-occurring Disorders Treatment Centers Near Me

If you are experiencing symptoms of anxiety or feel that you may have a substance use disorder, contact your medical provider. Your medical provider can assist you in finding resources to address your symptoms. Community mental health agencies can also assist you in finding care for anxiety and addiction. Employee Assistance Programs through your employer are another resource for finding services.

If you are a veteran, contact the VA regarding your symptoms and find out what is available for you. American Addiction Centers can also help you locate treatment options specialized in treating co-occurring anxiety and substance use disorders. American Addiction Centers operates a 24-hour helpline to help you find providers that work with your insurance.

Help is available. If you are suffering with a co-occurring disorder, it’s important that you receive specialized treatment and care to address your condition. Treatment for substance abuse and anxiety is effective and available.