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Substance Abuse and Anxiety Disorders

Many individuals who seek out treatment for dependency on alcohol or drugs also suffer from an anxiety disorder. According to one study, 37.9% of U.S. adults with a substance use disorder also have at least one mental illness. In addition, 18.2% of adults with a mental illness also struggle with a substance use disorder.1

People who live with anxiety and substance abuse can feel trapped in a “vicious circle” as one disorder worsens the other. An individual grappling with anxiety might turn to drugs or alcohol for relief. Unfortunately, doing so can aggravate anxiety disorders. As anxiety increases, so does the frequency of drug and/or alcohol abuse.

The causal relationship between substance abuse and anxiety disorders can work in the opposite direction as well. A lot of people begin abusing substances without the influence of an anxiety disorder. But as their alcohol or drug abuse deepens, they begin to develop symptoms of anxiety. As a result, they increase their consumption of alcohol or drugs in an effort to find relief.

What Is an Anxiety Disorder?

Anxiety is an unpleasant sensation that everyone experiences from time to time. For people who suffer from an anxiety disorder, however, these sensations are much more intense and longer-lasting. In fact, anxiety disorders can make the demands of everyday living difficult or impossible to cope with.

There are many types of anxiety disorders, and their symptoms vary to some extent. Symptoms most frequently seen in patients with anxiety disorders include the following:

  • Outbursts of anger
  • Muscle tension
  • Insomnia
  • Incessant dwelling on negative thoughts
  • Difficulty concentrating
  • Quick heartbeat
  • Dry mouth
  • Sweating
  • Trembling
  • GI disorders
  • Feelings of “doom”
  • Shortness of breath

It is widely believed that anxiety disorders derive from a combination of genetic and environmental factors. Risk factors include shyness in childhood, biological relatives with a history of mental illness, and traumatic experiences at an early age. Anxiety disorders can be aggravated by abuse of alcohol or drugs.

What Is Dual Diagnosis?

When a patient is diagnosed with a substance abuse disorder and a mental disorder, this is called a dual diagnosis. Anxiety is just one of a number of mental health conditions that can contribute to a dual diagnosis disorder. Other mental health disorders commonly seen in dual diagnosis patients include:

Major depressive disorder (MDD)

This is characterized by a persistent low mood and an absence of pleasurable feelings. It is often accompanied by a variety of physical complaints, such as sleep disturbances and decreased appetite. Women are more likely than men to experience MDD.

Post-traumatic stress disorder (PTSD)

This mental disorder results from a traumatic event, such as sexual abuse or severe traffic accident. People with PTSD often experience distress when exposed to stimuli that remind them of their trauma.

Bipolar disorder (manic depression)

This is characterized by periods of elevated mood (mania) alternating with periods of low mood (depression).

An individual is diagnosed with bipolar I disorder if they have had one or more manic episodes. Most bipolar I patients also experience at least one depressive episode, but this is not necessary for diagnosis.

Bipolar II is diagnosed when the patient has an episode of hypomania (less severe than mania) and a major depressive episode. Individuals with bipolar II are frequently misdiagnosed as having a depressive disorder. If the patient has experienced at least one confirmed manic episode, they are instead classified as bipolar I.

It is possible for a dual diagnosis patient to have more than one mental health disorder, such as anxiety and depression. Similarly, they may abuse more than one type of substance.

The concept of dual diagnosis was developed in the 1990s. It came into being in response to deficiencies in conventional treatment methods. Prior to the advent of dual diagnosis treatment, two primary therapeutic methods had prevailed:

Sequential treatment

This used to be the most common form of treating patients with dual disorders. It is based on the idea that the patient must overcome one disorder before they can tackle the other effectively.

Many therapists insist that the substance use disorder should be treated initially. However, some critics of that approach think that the mental disorder should take priority. Others simply prefer to start with whichever disorder developed first.

In a sequential treatment program, the patient begins therapy in one type of therapeutic setting. Once they have obtained acceptable results, they enter the other setting. For instance, the patient may begin with a substance abuse team, then get treatment from a mental disorders team.

The difficulty with this approach is that it simply doesn’t deliver consistent results. It is associated with a high incidence of patient relapse.

Parallel treatment

Another formerly common therapeutic method involves treating the patient’s mental and substance abuse disorders at the same time. The patient is treated by two separate medical teams: one specializing in mental disorders and the other in substance abuse.

Although this approach is closer to what is offered by a dual diagnosis program, it also has its shortcomings. In many cases, the separate medical teams, who are oftentimes located in different facilities, fail to communicate with each other effectively. As a result, the patient can get conflicting or inaccurate advice.

Dual diagnosis programs avoid these problems by having one team of medical professionals treat all of the patient’s disorders at the same time. Individuals with anxiety and substance abuse should get help from medical professionals who can treat both of these co-occurring disorders.

Common Types of Anxiety Disorders Comorbid with Substance Abuse

Anxiety disorders come in multiple varieties. Here are some of the ones that frequently co-occur with substance use disorders:

Generalized anxiety disorder (GAD)

This disorder is characterized by constant worry that is not directed solely at any particular cause. People with GAD often suffer from insomnia, fatigue, moodiness, and chronic restlessness.

Social anxiety disorder (SAD)

Sometimes called social phobia, this disorder is characterized by intense fear of social settings. Individuals with social anxiety disorder regularly experience nausea and trembling when socializing with others. Many sufferers isolate themselves from others as far as possible.

Panic disorder

This is characterized by recurring panic attacks that involve a sudden onset of intense fear. They are often accompanied by shaking and shortness of breath. These episodes can be triggered by exposure to stressful stimuli, but sometimes they have no obvious cause. Panic attacks generally last no more than ten minutes, but they can be extremely stressful while they last.

For years, post-traumatic stress disorder (PTSD) was considered an anxiety disorder. Today, it is classified by the DSM-5 as a “trauma- and stressor-related disorder.” However, many PTSD sufferers do develop symptoms of anxiety disorders as well.2

Difficulties of Diagnosing Comorbid Disorders

When treating dual diagnosis patients, it should not be automatically assumed that one disorder was the “root cause” of the other. Nor should it be assumed that treatment options should be aimed exclusively at fixing the apparent source of the disorder. Those kinds of assumptions belong to an older viewpoint of addiction treatment, and are considered outdated.

With many dual diagnosis patients, it can’t even be determined with confidence which disorder really came first. Some patients are unable to recall when they began abusing a substance or when they started experiencing symptoms of mental disorder. Even in cases when the patient can recall these events, it’s not always true that one disorder caused the other. Each disorder may have arisen by itself.

Sometimes, subclinical symptoms play a significant role in the development of a patient’s substance use disorder. But because these symptoms are subclinical in nature, they are usually overlooked by addiction treatment specialists. Consequently, the patient may be denied valuable insights into their condition.

In many dual diagnosis cases, both disorders seem to share the same genetic or environmental triggers. Common triggers include childhood trauma or biological relatives who have the same conditions. These patients are particularly ill-served by therapists who insist that one disorder must have caused the other.

Treating dual diagnosis patients requires addressing both problems at the same time—the substance abuse as well as the anxiety disorder.

Treatment Programs for Dual Diagnosis Disorders

Every dual diagnosis case has its own characteristics and challenges. For that reason, a dual diagnosis therapist must tailor the treatment program with the patient’s unique circumstances in mind. Addiction treatment programs can include one or more types of therapy, such as:

Individual therapy

The patient undergoes individualized sessions with a medical professional.

Group therapy

The patient participates in therapeutic sessions alongside a small group of other patients who have the same diagnosis.

Family therapy

Members of the patient’s family join the therapy session to support their loved one.

Cognitive behavioral therapy (CBT)

The patient participates in talk therapy sessions with a counselor to manage negative thought patterns.

Medical detox

A supervised process intended to enable the patient to stop abusing drugs and/or alcohol. It is often the first step in a dual diagnosis program.

Furthermore, post-rehab support groups, such as 12-step programs, offer valuable long-term assistance to individuals who want to avoid relapse.

Contact Adelante Recovery Center

Located in Corona del Mar, CA, Adelante Recovery Center is a luxury residential inpatient addiction treatment facility. Specializing in a holistic approach to recovery, we offer programs for individuals addicted to alcohol, heroin, meth, cocaine, or other substances. Our trained therapists are skilled in many types of treatment, such as detox, dual diagnosis, and CBT therapy. Please contact us to learn more about our services.


  1. https://www.drugabuse.gov/drug-topics/trends-statistics/infographics/comorbidity-substance-use-other-mental-disorders
  2. https://www.ptsd.va.gov/professional/articles/article-pdf/id36604.pdf

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