Co-Occurring Anxiety & Substance Use Disorder

Many people who experience a substance use disorder (SUD) in their lives also are diagnosed with another mental health disorder, and vice versa. According to the 2020 National Survey of Drug Use and Health, an estimated 17 million adults aged 18 or older in the United States had a mental disorder and an SUD in the past year.¹ When a mental health disorder like an anxiety disorder and a substance use disorder occurs at the same time, it is known as a co-occurring disorder, or a “dual diagnosis”. Certain mental health disorders that co-occur alongside SUD may be more common than others. Anxiety disorders, for example, and SUDs are among the most common co-occurring disorders in the U.S.²

This article will discuss co-occurring anxiety and substance use disorders, the symptoms and causes, and how a co-occurring disorder is treated.

What Is Anxiety Disorder?

Temporary fear, worry, and anxiety are a natural part of life and don’t necessarily constitute an anxiety disorder. An anxiety disorder, however, refers to the constant presence of worry or fear that doesn’t go away, can worsen over time, and can interfere with your ability to function in different areas of your life, such as at work, at school, and with your family.³

The duration of symptoms, triggers, and symptoms may vary across the different types of anxiety disorders (such as generalized anxiety disorder, panic disorder, and social anxiety disorder) and can also be impacted by factors specific to the individual, such as genetics and environment.

Co-Occurring Anxiety Disorder and Drug or Alcohol Addiction

Co-occurring disorders exist when substance use disorders occur alongside any type of mental health condition, such as, depression, post-traumatic stress disorder, bipolar disorder, and attention-deficit hyperactivity disorder (ADHD).

Individuals who experience this co-occurring disorder can experience less favorable outcomes for both their substance use disorder and anxiety disorder.⁴ Some of these outcomes can include:⁴

• Increased number of hospitalizations.
• Poorer functioning.
• Problems with interpersonal relationships.
• More severe symptoms.
• Decreased quality of life.

What Are the Symptoms of Co-Occurring Anxiety and Addiction?

Symptoms of co-occurring disorders can range in intensity and duration. The severity of symptoms is based on factors specific to the individual as well as the type of substance use and mental health disorder they are experiencing.

In terms of anxiety disorders, there are several different types. These include, but are not limited to, generalized anxiety disorder, panic disorder, and social anxiety disorder.

Symptoms of Generalized Anxiety Disorder (GAD)

Individuals who have generalized anxiety disorder may experience symptoms for long periods of time, such as for months or even years.³ These symptoms can include:³

• Feelings of restlessness.
• Fatigue.
• Irritable mood.
• Problems concentrating.
• Sleep problems.
• Struggling to control feelings of worry.

Symptoms of Panic Disorder

Panic disorder is characterized by unexpected and frequent panic attacks. Those who experience panic disorder often feel like they are losing control or are in extreme danger.³ Symptoms can include:³

• Trembling.
• Pounding heartbeat.
• Feelings of impending doom.
• Sweating.
• Chest pain.

Symptoms of Social Anxiety Disorder

Being fearful of what other may think is a primary characteristic of social anxiety disorder. Symptoms can interfere with an individual’s ability to go to work or engage in regular, daily activities.³ Additional symptoms include:³

• Pounding heartbeat.
• Blushing.
• Sweating.
• Feeling uptight in the body.
• Feeling self-conscious.
• Problems making eye contact.

Symptoms of Substance Use Disorders

Symptoms of substance use disorders can present behaviorally, emotionally, and physically and can include:⁵

• Using a substance for longer periods of time than originally intended.
• Having a desire to stop using or cut down on use but being unable to do so.
• Spending excessive amounts of time obtaining, using, or recovering from substance misuse.
• Experiencing cravings for continued use.
• Neglecting responsibilities at home, work, or school.
• Continuing to misuse substances despite it causing interpersonal problems.
• No longer participating in important activities due to substance misuse.
• Continuing to misuse substances despite it being physically hazardous to do so.
• Continuing to misuse substances despite knowing that doing so worsens an existing physical and/or mental health problem.
• Requiring more of the substance to achieve the desired effects.
• Developing withdrawal symptoms when unable to use in the normal amount or at all.

When someone is experiencing a co-occurring anxiety disorder and substance use disorder, they can simultaneously display symptoms associated with both conditions.

Risk Factors of Co-Occurring Anxiety Disorder and Addiction

Co-occurring disorders are complex, and each can influence the development, course, and treatment of the other. The complexity and bidirectional nature of these disorders means there isn’t exactly a “cause” of co-occurring disorders, however, researchers have identified various shared factors that can increase one’s risk of developing both mental health and a substance use disorder.

Risk factors that can increase an individual’s risk for developing co-occurring disorders include:⁶

• Epigenetic factors: Epigenetics refers to the study of how the environment impacts genetic expression, and scientists believe that certain environmental factors (such as stress) can result in alterations in the way neural networks function, which can affect behavior. These epigenetic changes in gene expression can be passed down, and when they act on genetic vulnerabilities during specific developmental stages, it can increase a person’s risk of developing both substance use and mental health disorders.
• Genetic vulnerabilities: It is estimated that 40%–60% of one’s vulnerability to addiction is due to genetic factors, and research suggests that there are many genes that can contribute to a person’s risk of developing both SUDs and mental illness.
• Environmental factors: Many environmental factors can increase one’s risk for co-occurring anxiety and substance use disorders, including chronic stress, trauma, and adverse childhood experiences, such as abuse and neglect.
• Similar brain region involvement: Multiple areas of the brain, such as the areas that are responsible for decision-making, impulse control, regulating emotions, mediating reward, and neurotransmitters, are impacted by mental health disorders and addiction and can increase vulnerability to both. Drug and alcohol use that affects the same parts of the brain as anxiety can trigger an underlying vulnerability.⁶ Similarly, an individual with anxiety may feel their symptoms are alleviated by using substances that affect a similar area of the brain that, at least at first, may relieve their anxiety symptoms.⁶

How To Help Someone With Anxiety and Substance Use Disorder

If you know someone struggling with anxiety and SUD, you may be struggling with how to help a family member with an addiction. Fortunately, there are things you can do to support them in positive ways. Professional treatment for co-occurring disorders is available that can help your loved one recover from a cooccurring SUD and anxiety disorder with the appropriate care.

Furthermore, if a friend or family member is struggling with these co-occurring disorders you can:⁷

• Identify an appropriate place and time to discuss your concerns.
• Be direct and specific with what you’re feeling and observing.
• Actively listen and validate that you’ve heard what they’ve said.
• Offer to help them find appropriate treatment options.
• Show patience and remember that change takes time.

Treatment for Co-Occurring Anxiety and Addiction

At Sunrise House, we recognize the benefits and importance of treating co-occurring disorders and offer different levels of addiction treatment that include integrated intervention, such as inpatient addiction treatment and outpatient drug and alcohol rehab. Call us right now at to speak with a compassionate admissions navigator who can help you start the admissions process and for rehab. If you don’t have insurance or have questions regarding ways to pay for rehab, an admissions navigator can also help answer questions about payment options.

You don’t have to continue to live with anxiety and addiction. Call Sunrise House or go online to get started on the road to healing and recovery.