The Relationship Between Anxiety & Substance Use

Do you struggle with both anxiety and substance abuse? If so, you’re not alone. Research shows that approximately 20% of Americans with an anxiety disorder also struggle with substance abuse. Similarly, 20% of people with a substance use disorder also struggle with anxiety. 

The two conditions often go hand-in-hand, which can be debilitating for individuals and their loved ones. But why do people struggling with anxiety disorders often self-medicate with mood-altering substances like drugs or alcohol? Moreover, do substances exacerbate symptoms of anxiety?

Let’s get into exploring how this complicated relationship works. 

Anxiety or Substances? What One Occurs First?

Surprisingly, it’s not always apparent to decipher which condition arises first. That’s because co-occurring disorders often happen around the same time. 

We know that anxiety can have its roots in early childhood. Many people with anxiety disorders report histories of experiencing anxiety symptoms throughout their life. Often, they identify their symptoms worsen as they get older. 

People start using drugs or alcohol for all kinds of reasons. Some people have family members who actively use substances, which may predispose them to experiment themselves. Others give in to the intense demands associated with peer pressure. Additionally, some people start using substances because they’re curious to see how they work.

Drugs and alcohol can initially evoke tremendously positive feelings. Users describe sensations of relief, relaxation, pleasure, and even euphoria. If someone struggles with anxiety, it makes sense why they turn to substances to alleviate some discomfort.

That said, some people start experimenting with substances without any previous histories of anxiety. It’s only after they begin habitually using them that the anxiety starts to manifest. This doesn’t mean that the substances caused the anxiety. Substance use is associated with numerous stressors like financial issues, legal complications, relationship problems, and mental health changes- all of which can trigger anxiety. 

woman meeting with therapist

How Do They Reinforce Each Other?

Substance use and anxiety can become a vicious cycle. Over time, some people report needing drugs or alcohol to feel normal. If they’re not under the influence, they might feel even more depressed or anxious. 

Likewise, with chronic use, people can build a tolerance to the substances. That means they need more of the drug to feel the desired effect. If they stop taking the drug abruptly, they’ll experience distressing withdrawal symptoms. Subsequently, many people continue taking substances just to avoid withdrawal effects. 

Some people may believe they function better when taking substances. For example, someone with social anxiety may feel more confident around others when they’re intoxicated. Someone struggling with panic attacks may abuse narcotics because they provide a sense of sedation. 

Likewise, it’s not uncommon for people to abuse prescribed anxiety medication. In America, 12.5% of adults receive a benzodiazepine prescription for substances like Xanax, Klonopin, or Ativan. However, almost 20% of prescribed users misuse their medication.

What Happens Over The Long-Term?

Substance use doesn’t help anxiety, and anxiety doesn’t help substance use. Over the long-term, most people experience more and more problems related to their mental health. These problems can include:

  • Low self-esteem
  • Problems with concentration and focus
  • Interpersonal struggles
  • Issues with work or school
  • Health problems 
  • Heightened feelings of paranoia or psychosis

People often feel trapped in their conditions. They continue using more and more substances to numb the painful feelings. But the painful feelings persist and seem to emerge with a vengeance. It often feels like a vicious lose-lose cycle for individuals and their loved ones.

Unfortunately, many people lose hope after struggling with both conditions. They may assume they’re either broken or doomed. Some may reach out for help, but they feel judged or unsupported by others. As a result, many people don’t receive the adequate treatment and support they need. 

group therapy additiction meeting

What Should Treatment Include?

When it comes to recovering from mental illness, many efforts are often short-sighted. The substance use often takes center stage in treatment. This focus isn’t necessarily wrong- substance use is dangerous and potentially life-threatening- but treatment must examine the underlying factors triggering drug and alcohol consumption.

Comprehensive treatment should include a recovery plan that integrates both anxiety and substance use. You can’t treat one without the other. To do so will likely lead to a relapse in one or both conditions. 

Effective treatment first focuses on medically stabilizing the individual. You can’t perform optimally in psychotherapy if you’re under the influence. In fact, mental health professionals won’t typically meet with clients who aren’t sober for their sessions. If you can’t stop taking substances, you may need a higher level of care, such as medical detox.

After stabilization, recovery should focus on learning new coping skills to manage distress. This also includes identifying anxiety and substance use triggers and developing a reasonable relapse prevention strategy. Coping skills can consist of a combination of relaxation techniques, social interactions, and distraction activities. 

There isn’t a single best treatment method. People often benefit from a variety of resources including:

  • Individual psychotherapy
  • Psychiatric medication
  • Group therapy
  • Family/couples therapy
  • Peer support
  • Holistic treatment (yoga, acupuncture, meditation, etc.)

It should be noted that recovery represents a lifelong process. Relapses are common, and people often ebb and flow with their symptoms. The ups and downs don’t indicate failure- instead, they often reveal the need to create new patterns and habits.

Final Thoughts

The relationship between anxiety and substance use is complicated. That said, recovery is possible. As cliche as it sounds, the first step is identifying the problem. The second step is doing something about it. By recognizing your distress and intervening, you give yourself the opportunity for change. 

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