Anxiety and Addiction: Co-Occurring Disorders

Many people suffer from addiction, mental illness, or both. According to the 2020 National Survey on Drug Use and Health, around 17 million adults aged 18 or older in the United States had any mental illness and a substance use disorder (SUD) in the past year.¹ When a mental health disorder and SUD exist together, it is referred to as a co-occurring disorder.²

Certain co-occurring disorders are more common than others. Anxiety disorders and SUDs are among the most prevalent and common co-occurring disorders in the country.³

This piece will further explore the symptoms of anxiety disorders, the link between anxiety disorders and addiction, and what effective treatment options are available for someone with these co-occurring disorders.

What Is an Anxiety Disorder?

An anxiety disorder is a mental health disorder characterized by excessive fear and anxiety that hinders a person’s ability to function normally.⁴

Anxiety, or temporary worry, is a normal part of life, and for many people, anxiety doesn’t negatively impact their ability to function.

For people with diagnosable anxiety disorders, the symptoms of anxiety impact their ability to function in areas including at work, at home with their family, and at school.⁵

Several types of anxiety disorders exist, and some of the most prevalent ones that commonly co-occur with substance use disorders will be explored further.

What Are the Different Types of Anxiety Disorders?

The 3 types of anxiety disorders that are likely to co-occur with addiction include:⁶

• Generalized anxiety disorder (GAD).
• Social anxiety disorder.
• Panic disorder.

While these 3 types of anxiety disorders may share certain symptoms, they are all distinct. The intensity of symptoms and symptom triggers can vary greatly.

For example, in GAD, a person experiences chronic and persistent anxiety and dread for months or years.⁵

Social anxiety disorder is specific to social situations, and it refers to a person who experiences intense fear or dread of being watched and judged by other people.⁵

With panic disorder, a person experiences acute, random, and frequent panic attacks, which are intense feelings of fear, discomfort, and a sense of losing control even when no danger or threat is present.⁵ These attacks can be so severe that many people who experience a panic attack believe they are having a heart attack.⁴

What Are the Symptoms of Anxiety Disorders?

Symptoms of anxiety disorders manifest in different ways, and an anxiety diagnosis is dependent on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5).

To meet the criteria for GAD, you must experience excessive worry or anxiety that occurs more days than not for at least 6 months, find it difficult to control the fear, and experience at least 3 of the following symptoms:⁴

• Feeling on edge or restless
• Becoming easily fatigued
• Having trouble concentrating or feeling like your mind is going blank
• Irritability
• Muscle tension
• Sleep problems, including difficulty falling or staying asleep, or restless and unsatisfying sleep

Symptoms of social anxiety include an intense fear or anxiety about at least one social situation such as meeting unfamiliar people, having a conversation, performing in front of others, or being observed and:⁴

• The social situation almost always evokes feelings of fear and anxiety.
• The person fears acting in a way that will cause embarrassment.
• The anxiety and fear are disproportionate to the actual threat the social situation poses.
• The social situations are avoided or tolerated with extreme anxiety or fear.
• The avoidance, fear, and anxiety cause significant impairment in occupational, social, or other important areas of functioning.
• The avoidance, fear, or anxiety is persistent and lasts for at least 6 months.

Symptoms of panic disorder include a sudden surge of intense anxiety and fear that reaches its peak within a few minutes and includes 4 or more of the following symptoms:⁴

• Heat sensations or chills
• Sweating
• Chest pain
• Heart palpitations, pounding heart, or fast heartbeat
• Feeling of choking
• Pain in the abdomen or nausea
• Shortness of breath
• Trembling or shaking
• Feeling faint, dizzy, lightheaded, or unsteady
• Fear of losing control or “going crazy”
• Fear of dying
• Parathesis (tingling or numbness in hands and feet)
• Depersonalization (being detached from oneself) or derealization (feelings of unreality)

How Are Anxiety Disorders and Substance Use Disorders Related?

Researchers have found connections between substance use and mental health disorders; however, the correlation doesn’t mean that one necessarily causes the other.⁷ The relationship between anxiety disorders and substance use disorders is complex and nuanced, affected by external factors, protective factors, and common risk factors.

It is therefore difficult, if not impossible, to determine the exact cause of co-occurring disorders in most people.

Overlapping risk factors can make you more vulnerable to developing both an anxiety disorder and a substance use disorder.⁷

Common Risk Factors for Anxiety and Substance Use Disorders

A person with an anxiety disorder has a higher risk of developing a substance use disorder, and vice versa. Studies show that nearly 15% of people with an anxiety disorder also had SUD within the past year, and among people with SUD, almost 18% met criteria for an anxiety disorder.³

Anxiety disorders and substance use disorders impact some of the same neurotransmitters in the same areas of the brain, including those responsible for decision-making and reward mediation, as well as emotions and impulse control.

Because of this, each disorder can influence the other’s severity of symptoms and having both disorders can worsen the course of the other.

There are also other common factors that can increase your risk of developing co-occurring disorders. These include:⁷

• Genetic vulnerabilities. It is estimated that between 40% and 60% of your vulnerability to addiction is due to genetic factors and complex interactions between genetics and environmental factors can increase a person’s risk of developing a substance use disorder and mental illness.
• Family history. Having a parent or blood relative with one or both of these conditions is a strong risk factor.
• Epigenetic factors. Epigenetics involves the study of how the environment impacts genetic expression. Some researchers believe that environmental factors such as stress act on genetic vulnerabilities during developmental stages to increase your risk for addiction and mental health disorders.
• Environmental factors. Many environmental factors including trauma, chronic stress, and adverse childhood experiences can increase your risk for co-occurring disorders.

Treatment for Anxiety and Addiction

A doctor or mental health professional can diagnose you with co-occurring disorders by evaluating you for each disorder.⁸

Rather than treating each disorder separately, integrated treatment, where both disorders are treated concurrently, has been found to be superior to separate treatment for each disorder.⁹ Finding an integrated treatment program that is designed for dual diagnosis can address both mental health and substance misuse simultaneously.

Dual diagnosis treatment may involve a combination of medication and therapy to treat both disorders.

What Kind of Medication Can Treat Anxiety and Substance Use Disorders?

Several medications have been approved to treat substance use disorders and anxiety. For substance use disorders, medications are only available for certain types of substances. For example, with alcohol use disorder, the following medications have been FDA approved:¹⁰

• Naltrexone—Helps reduce heavy drinking.
• Disulfiram—Prohibits the breakdown of alcohol by the body, which leads to adverse symptoms such as flushing of the skin and nausea. These unpleasant side effects may help people abstain from alcohol.
• Acamprosate—Makes it easier to maintain abstinence by easing negative effects associated with quitting alcohol that sometimes leads to relapse.

For opioid addiction, the U.S. Food and Drug Administration has approved the following medications:^11,12

• Buprenorphine and methadone—Reduces or eliminates withdrawal symptoms, blunts or blocks the effects of other opioids, and reduces or eliminates cravings to use opioids.
• Naltrexone—Blunts or blocks the effects of other opioids and reduces or eliminates cravings to use opioids.

The first-line medications used to treat anxiety disorders include antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) or selective serotonin norepinephrine inhibitors (SNRIs). Benzodiazepines can be used for short periods but may pose too much risk to those with a sedative or opioid use disorder. Both SSRIs and SNRIs pose lower risks and higher benefits.¹³

What Kind of Therapy Is Used to Treat Anxiety Disorders and Addiction?

You may receive several therapies during treatment. Some common types of therapy found to be effective in the treatment of co-occurring disorders include:⁹

• Cognitive behavioral therapy (CBT)—Focuses on identifying, avoiding, and coping with situations, thoughts, and feelings that contribute to substance use.
• Dialectical behavior therapy (DBT)—Designed to reduce behaviors that lead to self-harm, including drug use and suicidal thoughts and attempts.
• Contingency management or motivational incentives—Uses a reward system to enhance your motivation to change and comply with treatment.
• Exposure therapy— Involves repeated exposure to a feared situation, object, traumatic event, or memory. This helps to desensitize someone to a stimulus that triggers substance use/anxiety and helps them develop healthy coping mechanisms.

Finding the Right Treatment Facility for Anxiety and Addiction

The presence of 2 or more disorders can complicate both treatment and diagnosing co-occurring disorders. Integrating screening and treatment for co-occurring disorders with an individualized treatment plan can lead to more positive health outcomes and higher quality of care for people with co-occurring disorders.¹⁴

That’s why it’s important to find the right treatment center that addresses your individual mental health and addiction needs.

Additional factors to consider when choosing a treatment facility include the:

• Cost of treatment and insurances accepted.
• Location.
• Licenses and accreditations for rehab centers are held.
• Available levels of addiction treatment.

Recovery First, an inpatient rehab near Miami, specializes in co-occurring disorders and offers many levels of care and individualized rehab programs including:

• Inpatient addiction treatment.
• Outpatient drug rehab.
• Substance use treatment programs for Veterans.

Paying for Treatment for Co-Occurring Disorders

Recovery First is an addiction treatment center that accepts health insurance to help cover the cost of treatment. The cost of treatment depends upon certain factors such as your insurance coverage, length of stay, and services received. You can quickly now.

If you do not have insurance, other options may be available to you to help cover the cost of treatment. Anxiety and addiction can be treated. Start the admissions process for rehab now. Call to speak with an admissions navigator and begin your recovery journey.