Anxiety and Substance Abuse: Correlation or Cause

woman managing stress

Individuals with an anxiety disorder often find alcohol and other substances of abuse to worsen their anxiety symptoms. This population is two to three times more likely to have an alcohol or any other substance abuse disorder in comparison to individuals who do not have an anxiety disorder.

About 20 percent of Americans with an anxiety disorder, eating disorder, or mood disorder such as depression have an alcohol or other substance use disorder. Also, about 20 percent of those with an alcohol or substance use disorder have an anxiety or mood disorder.

Anxiety and substance abuse – Causation or correlation?

Post-Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), panic disorder, and social phobia are all forms of anxiety disorders. These disorders are recognized by the National Institutes of Mental Health, and the disorders can be reinforced by substance abuse.

A study, published in the journal Psychiatric Services, found that in a sample of 326 patients with substance abuse disorder, 48 percent also had considerable anxiety or anxiety in combination with depression.

Studies of military veterans or populations likely to have experienced traumatic events also showed the rates of anxiety co-occurring with addiction to be even higher.

Additional research also depicts that not only do anxiety and substance abuse co-occur frequently, but anxiety may cause substance abuse as well. Hence, it is safe to conclude that there may be causation as well as correlation.

Image of fractured face dealing with Anxiety and substance abuseThis can be verified from studies that show anxiety preceding substance abuse. It also illustrates how using interventions to reduce anxiety further decreases the future prevalence of substance abuse.

A study of children treated for anxiety disorders assessed rates of substance abuse 7.4 years later in those who had responded to treatment and those who remained anxious.

The result was a sharp contrast: children who learned to lessen or manage anxiety were less likely to abuse substances than children (now adolescents and young adults) whose anxiety persisted. The authors concluded that if childhood anxiety disorders were left unaddressed, the consequences could include substance abuse.

The self-medication model

The symptoms of one disorder can make the symptoms of another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms.

The root cause lies in the troubling symptoms of PTSD, depression, and anxiety that the patient tries to mask by using drugs and alcohol. Psychological disorders are often dependent upon an overactive amygdala, which keeps signaling the likelihood of harm, threat, rejection, or disapproval even though there exists no immediate concern.

The effects induced by drugs and alcohol focus the user’s attention elsewhere. They may either rile up feelings of excitement and anticipation of reward or tackle anxiety directly by repressing amygdala activation. Hence, the addictive behaviors “medicate” anxiety and associated feelings.

Addressing anxiety and substance abuse together

Negative Effects of Alcohol Abuse on DiabetesAs with any co-occurring condition, successful treatment and sustainable recovery are highly dependent upon treating both the conditions together.

When treating substance abuse disorders, the likely underlying anxiety needs to be addressed.

If it is not, then most likely, the reason for using these substances for the patient will still remain leading to an eventual relapse.

Similarly, when treating anxiety, letting substance abuse go untreated will likely result in more anxiety.

However, the challenge of treating co-occurring disorders is that substance use disorders and addictive behaviors are all intricately woven into the structure of the brain.

Evidence-based treatments such as mindfulness practices, exercise, meditation, and psychotherapy have received much attention in the treatment of co-occurring disorders.

Such interventions are specially designed to create new, healthier pathways in the patient’s mind alongside focusing on physical health that had been compounded by substance abuse.






About the Author:

Sana Ahmed photoSana Ahmed is a journalist and social media savvy content writer with extensive research, print, and on-air interview skills. She has previously worked as a staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from the London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Reviewed and Approved by Jacquelyn Ekern, MS, LPC on August 26, 2019
Published August 26, 2019, on

About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.