When someone has a dual diagnosis of an anxiety disorder and a substance use disorder, both disorders must be addressed concurrently. There are comprehensive treatment programs that are equipped to effectively treat both issues simultaneously.
What Is an Anxiety Disorder?
Everyone experiences occasional issues with nervousness and anxiety.
The type of anxiety that occurs in most people with day-to-day routines is not considered to be clinically significant. Anxiety disorders represent psychological disorders that share a similar feature of primarily being driven by excessive anxiety and/or fear.
Clinically, anxiety represents feelings of uneasiness or nervousness when contemplating a future threatening situation, whereas fear represents the emotional response you have to an impending immediate situation. When you are diagnosed with an anxiety disorder, the anxiety you are experiencing is so severe that it significantly interferes with your ability to function and/or causes you significant distress.
Types of Anxiety Disorders
The American Psychiatric Association (APA) recognizes several major types of anxiety disorders. All these disorders share dysfunctional anxiety as their main feature and result in significant problems or impairment in daily functioning.
In addition to anxiety disorders, it is generally accepted that anxiety occurs in the presentation of most other forms of mental health disorders listed in APA’s diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). Often, individuals with depression, bipolar disorder, psychotic disorders, personality disorders, and other mental health issues have anxiety that may be severe enough to be diagnosed as a separate anxiety disorder.
There are six major anxiety disorders listed in the DSM-5:
- Separation anxiety disorder
- Specific phobia
- Social anxiety disorder
- Panic disorder
- Generalized anxiety disorder
Only a licensed medical professional can diagnose an anxiety disorder.
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More on Anxiety Disorders
Separation Anxiety Disorder
Separation anxiety disorder is typically diagnosed in young children. It is the most common anxiety disorder in children under the age of 12. It can occur in adults, but this situation is rare unless the adult has some other co-occurring issue like a developmental disorder or another severe psychiatric disorder.
The disorder is diagnosed in a person who displays anxiety or fear as a result of being separated from a person with whom they have become closely attached, but the anxiety or fear is excessive for the situation and developmentally inappropriate. For instance, toddlers often go through a phase where they display anxiety and fear when being separated from their primary caregiver, and this is not considered to be developmentally inappropriate. Depending on the severity and duration of the anxiety, and the age of the child, it may be deemed an issue.
The person must demonstrate four or more of eight potential symptoms of the disorder that are listed in the DSM-5 to qualify for the diagnosis. These behaviors will typically have to last at least four weeks in children and adolescents, and at least six months or longer in adults, for the diagnosis to be made.
Phobias consist of excessive fear or anxiety about a specific object or situation. The fear or anxiety is highly disproportional to the actual threat involved, and the object almost always produces a response of immediate fear or extreme anxiety in the person.
Common phobias include those related to creatures, like snakes or spiders, or activities, such as flying or being in enclosed places.
Most of the objects that are associated with specific phobias could be considered to be potentially threatening, but the fear and anxiety the person displays is inappropriate for the type of threat the object presents. For instance, someone with a snake phobia (ophidiophobia) will often display excessive fear and even terror to plastic snakes, pictures of snakes, or even thinking about a snake.
Social Anxiety Disorder
Social anxiety disorder is diagnosed when the person has excessive fear or anxiety in at least one social situation where they believe they will be judged by others.
The number of situations that can be associated with social anxiety disorder are vast, including meeting a stranger for the first time, speaking in public, and even being watched by others while they are eating or reading.
Like all of the anxiety disorders, the actual experience of fear or anxiety is out of proportion to any threat or scrutiny that most people would experience in the same situation. This means that simply feeling anxious when giving a speech in front of a group will most likely not lead to a diagnosis of a social anxiety disorder unless you were to display extreme anxiety that significantly interfered with functioning in other areas of life and the fear was out of proportion to the actual threat that may occur.
Public speaking is one of the major fears that most people have. In order to be diagnosed with social anxiety disorder due to a fear of public speaking, the reactionary behavior would have to be extreme and cause serious impairment nearly every day.
People who are diagnosed with panic disorder present with two major issues. First, they experience recurrent and unexpected panic attacks. Second, they display at least a month of excessive worrying about having a panic attack, and they engage in maladaptive behaviors that are designed to avoid panic attacks in the future. They may avoid situations that provoke anxiety, such as going to work or leaving their home.
Panic attacks are very intense and extreme sensations of fear that affect all areas of functioning. The person will experience significant physical issues, such as sweating, trembling, a pounding heart, nausea, chills, and chest pains. They will also experience substantial emotional distress, such as reporting that they are having a heart attack or feeling as if they are dying.
In order for panic disorder to be diagnosed, a person must have a history of panic attacks, and they must also demonstrate excessive concern and engage in maladaptive behaviors aimed at avoiding future panic attacks.
Symptoms that are similar to a panic attack can also be the result of metabolic issues, such as hyperthyroidism or cardiovascular problems. Individuals who suffer from panic attacks should have a complete physical to rule out these causes.
Agoraphobia was at one time considered to be a manifestation of panic disorder, but in recent years, it has been recognized as a standalone disorder.
People with agoraphobia experience extreme anxiety or fear about being in situations where they believe they cannot effectively escape. In order for agoraphobia to be diagnosed, they must display this extreme fear in two or more different situations.
Numerous situations can produce this extreme anxiety, such as being:
- In a crowd of people.
- Away from a safe place, such as their home.
- In an open space.
- In a place that feels crowded, such as a theater, store, or school.
- On public transportation, such as a bus or airplane.
People with agoraphobia will display anxiety that is similar to a panic attack when they are in these types of situations. In some cases, they will feel this high level of anxiety when they even think about being in these situations.
Generalized Anxiety Disorder
In order to be diagnosed with generalized anxiety disorder, someone needs to display constant excessive worry or anxiety nearly every day for at least six months.
This anxiety or excessive worry is focused on many different activities or events. It may lead to restlessness, fatigue, difficulty concentrating, irritability, tension, and/or difficulty sleeping. The person constantly feels on edge and has anxiety in most situations.
Anxiety Due to Substances or Medical Conditions
In all of the above listed anxiety disorders, the disorder cannot be diagnosed if the anxiety is due to the effects of drug or alcohol use, or if it is due to the effects of some other medical condition like a cardiovascular condition (heart disease). When symptoms that would qualify for an anxiety disorder are due to these causes, the person is diagnosed with the appropriate cause of their anxiety, such as a substance- induced anxiety disorder.
The causes of the other anxiety disorders listed above are not generally well understood, but they are considered to result from a combination of influences, such as heredity, environment, and life experiences.
Anxiety Disorders & Substance Use Disorders
If you are diagnosed with an anxiety disorder, you are automatically at an increased risk to also be diagnosed with a substance use disorder.
An older but still heavily cited research study suggested that nearly 20 percent of the people in the study who were found to have a substance use disorder also had a diagnosable anxiety disorder. The conclusions of this classic study suggest that the odds of having a substance use disorder and a co-occurring anxiety disorder were greater than the odds of just having an anxiety disorder alone.
Likewise, research studies suggest that about 20 percent of people who satisfy the diagnostic criteria for any anxiety disorder will also be diagnosed with a co-occurring substance use disorder.
Because children are typically diagnosed with separation anxiety disorder, people with this diagnosis have a far lower rate of substance abuse than people with the other anxiety disorders listed above.
The following are the most common drugs of abuse in people with anxiety disorders:
- Central nervous system depressant drugs other than alcohol, such as prescription benzodiazepines or pain-relieving medications
What’s Behind the Link Between Anxiety Disorders & Substance Abuse?
There been many different explanations for the strong relationship between substance abuse and dysfunctional anxiety.
Some researchers have hypothesized that people with substance abuse issues are at increased risk to develop psychological disorders, such as anxiety disorders. They cite numerous cases where substance abuse occurs before someone begins to experience other psychiatric symptoms, such as dysfunctional anxiety.
Another common explanation is that people with anxiety disorders use drugs to self-medicate their anxiety, leading to the development of a substance use disorder after the person began to experience dysfunctional anxiety.
However, neither of these explanations is fully satisfactory. If you are at an increased risk to develop any type of mental health disorder, the factors that increase your risk to develop that disorder also increase your risk to develop other psychological disorders. This includes an increased risk to develop substance abuse.
Combinations of factors increase this risk, including genetics, learning disorders, exposure to trauma or stress, neglect, and other issues.
Treatment for Co-Occurring Disorders
A dual diagnosis, also known as co-occurring disorders, is when someone has been diagnosed with a mental health disorder and a substance use disorder at the same time.
If you are diagnosed with an anxiety disorder and a substance use disorder, you should be treated for both disorders together. Trying to ignore your anxiety disorder and attempting to treat your substance abuse will not work; alternatively, ignoring your substance abuse and attempting to treat your anxiety will cause numerous problems. The only way to approach the situation is to treat you as a whole person and address all your issues together.
Treatment for any anxiety disorder should incorporate both medications and behavioral inventions, such as various forms of psychotherapy that are specialized to treat the specific anxiety disorder in question.
Medications can be used to treat the symptoms of anxiety disorders, but most of these medications are designed for short-term use. Benzodiazepines like Xanax or Valium can reduce even the most severe anxiety that occurs in panic attacks, but you will develop tolerance to them very quickly. If you have a substance use disorder along with your anxiety disorder, you may begin abusing these medications.
In some cases, antidepressants can be used to address issues of anxiety, but other interventions should also be included with the medication. Medication is not enough on its own to effectively address the disorder.
Most types of therapy used to treat anxiety disorders involve the use of cognitive-behavioral techniques, stress management techniques, and exposure techniques. Exposure therapy involves gradually confronting the client with the anxiety-provoking situation in order to develop resistance to it.
Therapy can be delivered in individual sessions or group sessions. It can be supplemented with peer support group participation, such as 12-step groups for specific anxiety disorders.
Ultimately, therapy has the advantage of offering lifetime solutions to dysfunctional anxiety. Whereas medications offer a short-term fix, therapy can provide the foundation for a lifetime of effectively managing the condition.
Oftentimes, those with anxiety disorders participate in therapy in some form for the rest of their lives. The intensity of the therapy generally dissipates over time. While they may initially start with daily therapy sessions in a structured treatment program, they may eventually only meet with their therapist once a week or even once a month.
A Comprehensive Approach
Treatment for a co-occurring substance use disorder often involves medical detox if necessary and the use of other medications to control cravings for certain drugs. Therapy will address the client as a whole, addressing both the substance abuse and the anxiety disorder, and how they intertwine.
Participation in peer support groups, like Alcoholics Anonymous or Narcotics Anonymous, is often recommended as a supplement to therapy. While these meetings don’t take the place of therapy, they can serve as a valuable support network in recovery.
Clients will also be encouraged to create an aftercare plan with their treatment team. This plan builds a structure for life in recovery, including many activities that support a healthy, balanced life. An aftercare plan might include regular exercise, a healthy diet, daily attendance at support group meetings, meditation, and consistent therapy sessions.
Information on Mental Health Disorders
If you would like to learn more about mental health in general,
please view our guide an overview on mental health related disorders.