Anxiety Disorders

Anxiety Disorders & Substance Abuse

Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people’s lives with overwhelming anxiety and fear.

Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, AD is chronic, relentless, and can grow progressively worse if not treated.

AD And Alcohol Abuse

For people with AD, using alcohol and/or drugs can make anxiety symptoms worse and can even trigger panic attacks. Moreover, the risk and occurrence of alcohol abuse is high in people with anxiety disorders. This makes alcohol use an important issue to consider for people with anxiety disorders.

According to a major study conducted by the National Institute on Alcohol Abuse and Alcoholism, about 20% of Americans with a current anxiety or mood disorder (such as depression ) also have a current alcohol or other substance abuse disorder, and about 20% of those also have a current anxiety or mood disorder.

People with AD are two to three times more likely to have an alcohol or drug abuse disorder at some point in their lives than the general population, and vice versa.

However, the risk and frequency of alcohol abuse is more common among people with certain AD than others.

While having co-occurring alcohol/drug abuse and anxiety disorders can make an individual’s situation more complex, the good news is that these disorders are treatable, separately and together.

Which Occurs First – Anxiety Or Alcohol Abuse?

Possible Reasons For Co-Occurring Conditions Include:

  • Alcohol abuse and anxiety disorders are independent of one another, meaning that one does not cause the development of the other. However, the symptoms of one can make the symptoms of the other worse.
  • An anxiety disorder leads an individual to use alcohol or other substances to “self-medicate,” or attempt to alleviate their anxiety symptoms on their own, which does not help, and only makes their anxiety worse.
  • An alcohol or drug abuse problem causes heightened anxiety during certain periods of abuse, such as during the actual time of drinking or drugging and withdrawal states. Anxiety symptoms may be eliminated completely if substance abuse stops.
  • Substance abuse problems can lead to the development of a substance-induced AD. Substance abuse can also damage parts of the brain that keep anxiety in check.

Anxiety And Substance Abuse Disorder

Having both an anxiety disorder and substance abuse disorder can have a “vicious cycle” effect.

For example, someone with an anxiety disorder may use alcohol and/or drugs to alleviate their anxiety symptoms.

However, this could cause them to experience even more anxiety which then leads to even more drinking and drugging.

Other Complications May Include The Following:

  • People with the co-occurring disorders are at high risk for many additional problems such as hospitalizations, financial problems, family problems, and medical illnesses.
  • People with both disorders may have lower treatment compliancethan people with just one disorder.
  • People with both an anxiety and substance abuse disorder have an increased risk of relapse into alcohol and drug abuse than people who have a substance abuse problem without anxiety.
  • People with both disorders may be at an increased risk for experiencing dangerous interactions between prescription medication and alcohol (in the event that they relapse into alcohol abuse) than people with an anxiety disorder alone.
  • People with an anxiety disorder may have more pronounced substance abuse withdrawal symptoms than substance abusers without anxiety.

Each AD has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It’s chronic and fills one’s day with exaggerated worry and tension, even though there is little or nothing to provoke it.

Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work.

Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. People with GAD can’t seem to shake their concerns.

Their worries are accompanied by these physical symptoms:

  • Fatigue
  • Headaches
  • Muscle aches/tension
  • Difficulty swallowing
  • Trembling
  • Twitching
  • Irritability
  • Sweating
  • Hot flashes

GAD affects about 4 million adult Americans and about twice as many women as men. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems.

GAD is commonly treated with medications. GAD rarely occurs alone, however; it is usually accompanied by another anxiety disorder, depression, or substance abuse.

Social Phobia (Social AD)

Social phobia, also called social anxiety disorder, involves overwhelming anxiety and excessive self-consciousness in everyday social situations.

People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions.

Their fear may be so severe that it interferes with work or school, and other ordinary activities. They often worry for days or weeks in advance of a dreaded situation.

Social phobia can be limited to only one type of situation such as, a fear of speaking in formal or informal situations, or eating, drinking, or writing in front of others. In its most severe form, a person can experience symptoms almost anytime they are around other people.

Social phobia can be very debilitating; it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.

Physical Symptoms Of Social Phobia

  • Blushing
  • Profuse sweating
  • Trembling
  • Nausea
  • Difficulty talking

People who suffer from social phobia, may be painfully embarrassed by these symptoms and feel as though all eyes are focused on them.

Unpleasant feelings may linger, as they worry about how they may have been judged or what others may have thought or observed about them.

Social phobia affects about 5.3 million adult Americans. Women and men are equally likely to develop social phobia. Social phobia often co-occurs with other AD or depression.

The disorder usually begins in childhood or early adolescence, and there is some evidence that genetic factors are involved.

Substance abuse or dependence may develop in individuals who attempt to“self-medicate” their social phobia by drinking or using drugs.

Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images.

Panic Disorder

People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.

Symptoms Of A Panic Attack

  • Heart will pound
  • Feel sweaty
  • Weak
  • Faint
  • Dizzy
  • Hands tingle or feel numb
  • Flushed or chilled
  • Nausea
  • Chest pain
  • Smothering sensations
  • A sense of unreality, fear of impending doom or loss of control.

Panic attacks can occur at any time, even during sleep. An attack generallypeaks within 10 minutes, but some symptoms may last much longer.

Panic disorder affects about 2.4 million adult Americans and is twice as common in women as in men.

It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited.

Left Untreated, the disorder can become very disabling. Panic disorder is often accompanied by other serious conditions such as depression, drug abuse or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred.

Some people’s lives become so restricted that they avoid normal, everyday activities such as grocery shopping or driving. In some cases they become housebound. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person.


Depression often accompanies AD and, when it does, it needs to be treated as well.

Symptoms of depression include feelings of sadness, hopelessness, changes in appetite or sleep, low energy, and difficulty concentrating.

Most people with depression can be effectively treated with antidepressant medications, certain types of psychotherapy, or a combination of both.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD), involves anxious thoughts or rituals you feel you can’t control. You may be obsessed with germs or dirt, so you wash your hands over and over.

You may be filled with doubt and feel the need to check things repeatedly. You may have frequent thoughts of violence and fear that you will harm people close to you.

The disturbing thoughts or images are called obsessions, and the rituals performed to get rid of them are called compulsions.

OCD afflicts about 3.3 million adult Americans. It strikes men and women in approximately equal numbers and usually first appears in childhood, adolescence, or early adulthood. One-third of adults with OCD report having experienced their first symptoms as children.

Depression or other AD may accompany OCD, and some people with OCD also have eating disorders.

In addition, people with OCD may avoid situations in which they might have to confront their obsessions, or they may try unsuccessfully to use alcohol or drugs to calm themselves.

If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home.

Treatment Of Anxiety And Substance Abuse

The vast majority of people with both substance abuse and AD experience them independently, with some anxiety episodes being induced by alcohol or drugs.

This is an important point for both patients and therapists, who should not assume that treating substance abuse will solve an anxiety disorder on its own. Treating both disorders together is often necessary.

Effective treatments for AD are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.

If you think you have an anxiety disorder, you should seek information and treatment.

All AD should be discussed with a doctor when determining an individual treatment plan.

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