Anxiety and Addiction

Anxiety and Addiction

Forty million adults suffer from anxiety, making it the most prevalent mental disorder in the US. Unfortunately, less than 40% receive treatment. Perhaps this is why people who suffer anxiety are twice as likely to suffer from addiction than people without anxiety, and people with anxiety represent 30% of people with addiction.

The connection between the two is a relatively recent observation. Before the 20th century, anxiety was not a common diagnosis, so it’s possible that if your medical history includes addiction, undiagnosed anxiety may also be present.

As research into the connection between these two conditions continues to develop, Right Path knows treating either of these conditions requires empathy, compassion, and time. Treating them simultaneously is even more important since people with anxiety are more likely to relapse into addictive habits than their peers.

Types of Anxiety Disorders

The term anxiety is a general catch-all phrase people use when worried about something, but it becomes a medical condition when it gets out of control for more than six months.

There are several types of anxiety:

Generalized Anxiety Disorder (GAD)

People with GAD feel a continual sense of dread for no specific reason. Often their worries are unrelated and more pervasive than what a person typically experiences.

Social Anxiety Disorder (SAD)

People with SAD feel intense anxiety at the thought of interacting with others, whether it’s being in a crowd or giving a speech.

Post-Traumatic Stress Disorder (PTSD)

After experiencing a traumatic event, a person may develop PTSD, making them anxious about their trauma experiences.

Panic Disorder

Panic Disorder often overlaps with another type of anxiety. For example, someone with SAD may suffer panic attacks at the thought of giving a speech. Panic attacks are characterized by short, intense bouts of sheer terror.

Specific Phobias

People with a phobia have an intense, unfounded, debilitating fear of a specific object, situation, or animal. Common examples include arachnophobia (the fear of spiders), claustrophobia (the fear of enclosed spaces), and acrophobia (the fear of heights).

The Link Between Anxiety and Depression

The Link Between Anxiety and DepressionAnxiety and depression are often linked, but it’s often a chicken-or-egg question. In some cases, a person with anxiety self-medicates with a substance like alcohol. For example, a person anxious about large group situations may drink to “take the edge off during a social event.” Over time, the body adapts, and the person needs to drink more to help the anxiety at bay, leading to addiction.

In other cases, the addiction itself causes anxiety. Depending on the substance being abused, such as cocaine, heightened anxiety and paranoia may be a side effect. Detoxing from drugs and alcohol often involves feelings of paranoia, and people with anxiety often experience more powerful symptoms of withdrawal, exacerbating their condition.

Because of this link, recovery is often more difficult for people with these dual diagnoses, as both must be treated simultaneously. Relapse in one area will often lead to a relapse in the other.

Similarities Between Anxiety and Addiction

Researchers believe one of the reasons anxiety and addiction occur together so often is because they share similar underlying causes:

Family history

  • Chemical imbalances in the brain
  • Overexposure to stress
  • Other mental disorders

Researchers have also observed similar symptoms in both conditions:


  • Insomnia and other sleep issues
  • Irritability
  • Nervousness
  • Paranoia
  • Nausea
  • Loss of interest in hobbies
  • Depression

Treatment of Dual-Diagnoses

Treatment for dual diagnoses can be challenging, but there are options. The treatment plan must address both diagnoses.

Regardless of the treatment, the process will begin the same:

  • A doctor will perform a physical exam to determine any health conditions.
  • Blood and urine samples will be tested for underlying conditions that may be causing the addiction or anxiety.
  • A psychological exam will occur to determine the existence of a psychological disorder such as PTSD or GAD.

Once co-occurring disorders are diagnosed, stakeholders will need to determine a treatment path that considers all diagnoses. For example, someone with SAD probably wouldn’t benefit from a 12 step-style program, which requires group meetings and sharing personal experiences in front of people you don’t know. That person would be more likely to skip sessions because they induce anxiety, which would make them less effective. Instead, mindfulness therapy or talk therapy with a specific therapist the patient is familiar with would be more likely to succeed.

Cognitive Behavior Therapy (CBT)Cognitive Behavior Therapy (CBT) is successful in treating both disorders. CBT involves reprogramming thinking and behavior processes. As a result, the patient learns how to handle specific situations, allowing them to gain coping skills, which increases confidence.

Eye Movement Desensitization and Reprocessing, or EMDR, also has a history of success with patients dual-diagnosed with anxiety and addiction, especially if both result from trauma. In EMDR, the patient is asked to focus on a traumatic event while following a doctor’s lateral hand movements, which mimics the brain’s activity during REM-cycle sleep, which is the most effective type of sleep. This allows the brain to process the trauma and heal.

Some people think that recovering addicts may not take prescription drugs for their anxiety disorders, but this is not always the case. A doctor can prescribe SSRIs like sertraline that are generally considered low-risk for addiction.

Right Path Knows Co-occurring Disorders

Treating a dual diagnosis of anxiety and addiction requires specialized and careful care. At Right Path Addiction Centers, we can help whether the addiction caused anxiety or the anxiety led to the addiction.

Written by Sergey Zhitar, MD Medical Director

Native of Moldova, Dr. Zhitar is Board Certified in Addiction Medicine as well as Internal Medicine and completed his training at UPMC Shadyside, Pittsburgh, PA in 2000.