The Connection between Substance Abuse and Anxiety Disorders

Anxiety is a common mental health condition—approximately 284 million people in the world live with an anxiety disorder. 

However, studies indicate that having an anxiety disorder or substance use disorder (SUDs) increases the likelihood of developing the other disorder. In fact, individuals with anxiety disorders are two to three times more likely to develop a SUD, than individuals who do not have anxiety.

This connection can be due to the fact that people with anxiety may turn to substances as a way of coping with their symptoms, or it could be due to biological factors such as genetic predisposition. 

However, regardless of the cause, it is crucial to understand this relationship to provide effective treatment for those suffering from both disorders. Research has shown that treating co-occurring disorders can be more challenging than treating substance use disorders alone, highlighting the importance of early intervention.

In this article, we explore the link between anxiety disorders and SUDs and learn about effective treatment approaches.

Also Read: Social Isolation: How Does It Impact Your Substance Use Patterns?

What are anxiety disorders?

Typically, anxiety is a temporary response to a fearful or threatening situation. However, for those living with anxiety disorders, this response does not subside even after the threat has been resolved. 

Individuals with anxiety disorder deal with persistent worry or fear disproportionate to their situation. Anxiety disorder is a broad classification which includes specific conditions such as generalised anxiety disorder, panic disorder, specific phobias, and more.

What are substance use disorders?

Substance use disorder is a treatable mental health condition that affects an individual brain and behaviour. Individuals with substance use disorders are unable to control their use of legal and illegal drugs, alcohol, or other substances. Individuals with SUDs continue their use of substances, even when they see the harm it can cause to their physical well-being, mental health, and social relationships. 

Understanding the link between substance use disorders and anxiety disorders

SUDs and anxiety disorders frequently co-occur, suggesting a link between the two. Additional studies have also reported that besides increasing the risk of SUDs, anxiety disorders may lead to substance use.

However, though anxiety disorders may have some roots in one's childhood, there is no definitive link that shows that one condition leads to the other.

Also read: Understanding the Link Between Addiction and Personality Disorders

Substance use due to anxiety symptoms

When using substances, people describe feeling happy, euphoric, or relaxed. Using these substances can, thus, help people avoid their symptoms and escape the reality of living with anxiety.

Unfortunately, these relaxing effects last only for a short while, and continued use can worsen your feelings of anxiety over time. 

Let's understand why.

The 'high' from drugs or alcohol floods your brain with dopamine and serotonin, the "feel good" hormones that make you feel happy. 

But continued use of these substances can trigger your brain to produce less of these hormones, making you feel even less relaxed or happy when you are sober. Thus, over time, individuals become dependent on these substances to make them feel relaxed. 

Anxiety due to substance use

Some substances, such as alcohol, inhalants, hallucinogens, marijuana and stimulants, worsen feelings of anxiety. As individuals start using substances to feel happy or relaxed, it can increase their tolerance for these substances.

Over time, individuals may need to start using more of these substances to achieve the same happy feeling. This dependence on substances can cause individuals with no prior history of anxiety disorders to develop withdrawal-related or drug-induced anxiety symptoms, which can further develop into a substance-induced anxiety disorder.

Which happens first—anxiety or substance use?

For co-existing conditions, it can be difficult to point out which disorder occurs first, and it doesn't always mean that one causes the other.

While anxiety may have roots in one's childhood, it isn't necessarily the sole cause of substance use. Individuals may start using substances for various reasons, such as being curious to see how it works or being peer pressured. 

The initial positive feelings associated with substance use can make people want to use them more, especially if they deal with symptoms of anxiety. Over time, they may become dependent on these substances, which can worsen symptoms of anxiety when they are sober.

However, substance use may not be the sole trigger for an individual's anxiety symptoms. Often, substance use is associated with other stressors, such as financial troubles, issues at work or school, or even relationship problems, all of which can trigger symptoms of anxiety.

What happens in the long term?

When substance use and anxiety coexist, it can become a vicious cycle. Individuals become dependent on substances to feel 'normal', or even enhance their functioning in certain situations.

For example, an individual with stage fright may feel more confident performing in front of a large audience, when they are intoxicated. 

But, this reliance on substances to feel normal or relaxed can lead to people building a higher tolerance over time. Hence, they will need more of the drug to feel the desired effect. 

If they stop using these substances at any point, they may experience distressing withdrawal symptoms, such as worsening feelings of anxiety. As a result, people may continue taking substances just to avoid withdrawal effects, reinforcing their behaviour.

Can SUDs and anxiety disorders be treated?

As complicated as the relationship between anxiety and substance use may be, help is available. Treatment for SUDs and anxiety involves psychotherapy and may involve medication in some cases.

Comprehensive care for SUDs and anxiety should focus on treating SUDs first, as it helps stabilise the individual. If they are struggling with withdrawal symptoms, psychotherapy will not be effective. 

Once the individual starts to feel better, psychotherapeutic interventions are used to help individuals learn effective coping skills, identify their triggers, and create a relapse plan. 

Recovery is often a lifelong journey, so it's important to be kind to yourself; experiencing relapses or fluctuations in symptoms is not uncommon. 

Remember, a relapse is not a sign of failure, but rather an indication that a new plan may need to be created. Identifying the issue is only the first step towards change; the second step is taking action. 

Asking for help requires courage, it is not always easy to recognise and acknowledge your distress, but doing so helps you access the support you need.

Sources:

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4. Dattani, S. (2021, August 20). Mental Health. Our World in Data. https://ourworldindata.org/mental-health#anxiety-disorders
   

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