Your Guide to Substance Abuse and Anxiety Disorders

You’ve probably heard friends say, “I’m having a panic attack!” when they refer to a particularly stressful situation. Maybe they’re worried about an upcoming test or job interview, or they’re nervous about a big date, a doctor’s appointment or a loved one’s surgery.

Being worried or even especially anxious, however, isn’t a panic attack. Panic attacks and other anxiety disorders differ from normal worries the way a broken foot differs from a blister. Blisters go away with time and a change of shoes. A broken foot requires medical intervention or else it won’t heal properly.

Read on to learn more about anxiety disorders and the addiction that can often result from self-medicating.

Anxiety Disorders and Their Roots

Anxiety disorders include panic disorder, generalized anxiety disorder, social anxiety, phobias, post traumatic stress disorder and obsessive-compulsive disorder. Each of these six issues has situational, psychological and medical roots. Although people often feel ashamed to admit they have an anxiety disorder, each is treatable with a combination of therapy, medication or both. It may take a while to find the right treatment program, but many people find relief from crippling anxiety disorders.


Among all six disorders, changes in brain chemistry are thought to trigger the disorder. Genetics plays a part in each, with people more likely to develop one of these disorders if someone in their family has been diagnosed with one. Situational factors may play another role, especially in phobias and social anxiety.

In all cases, people with the disorder can’t control their reactions to the situations they face. Telling someone with an anxiety disorder to “just get over it” is like telling that person with a broken foot to just hop along and ignore the broken bones. It doesn’t work.

Anxiety and Drug Addiction

Many people with anxiety disorders turn to substances such as alcohol and various drugs to feel better. Some are even prescribed drugs such as Klonopin and other benzodiazepines to control their symptoms, only to find that they’ve become addicted to prescription drugs, too.

There’s a strong connection between anxiety disorders and substance abuse. Anxiety disorders occur in approximately 28.8 percent of the population. Substance abuse disorders occur in about 14 percent. Patients with an anxiety disorder are 2.6 percent more likely to experience an alcohol problem and 6.2 percent more likely to use drugs.


This guide explores the definition of each anxiety disorder, what might potentially cause them, and how doctors treat them. Then, we’ll look at the links between anxiety and substance abuse, and how a dual diagnosis made by an addiction and recovery professional can help you address both issues. Lastly, we’ll share information on how to get help for both anxiety and addiction problems so that you can recover from both. It is possible to recover from an anxiety disorder and addiction, and to lead a productive, happy life again.

Let’s get started with a look at the true meaning of panic attacks, obsessive compulsive disorder (OCD) and other anxiety disorders.

What Are the Differences Between Anxiety Disorders?

Each anxiety disorder has specific characteristics. These characteristics are experienced by the individual as both psychological factors and actual physical sensations, feelings and physiological changes. About 40 million people in the United States suffer from one or more anxiety disorders.

Panic Disorder

In the United States, about six million people or 2.7 percent of the population suffers from panic disorder. Women are more likely than men to have an actual panic attack and panic disorder.


During a true panic attack, you feel as if you can’t breathe. You may feel faint or dizzy, and your heart races as if you’ve run a marathon. Your mouth may go dry, your hands tingle, and you feel you’re going to faint, vomit or go crazy. The feelings come on suddenly and can go away just as suddenly.

Panic disorder is only diagnosed after you’ve experienced several panic attacks and other diseases are ruled out. Panic attacks often coincide with major depression, so your doctor may also screen you for depression as well as panic disorder.

Generalized anxiety disorder (GAD)

Everyone feels anxious from time to time. For people with generalized anxiety disorder, anxiety rises to a feverish pitch and never really goes away.

People suffering from GAD may find themselves worrying about everything and anything. Will they get to work on time? What will they do if the car breaks down? Is that bump on my nose a pimple or cancer? It’s a never-ending cycle of worrisome thoughts that — even when logically explained away — recur and focus on other things. It’s as if your mind is a mouse running on a squeaky wheel, and the wheel never stops entirely. It slows down only long enough for the mouse to pick up speed again.

GAD affects 6.8 million adults in the United States. As with panic disorder, women are more likely to experience GAD than men.

Social Anxiety Disorder

About 15 million people experience social anxiety disorder. It affects women and men about equally.


Social anxiety disorder is characterized by intense anxiety surrounding social events to the point that someone cannot even stand to attend them. It’s more than shyness — it’s a crippling anxiety that prevents people from joining social functions and enjoying life.


We’re all aware of common phobias, such as a fear of snakes, heights or enclosed spaces (claustrophobia). About 19 million people nationwide experience phobias to some extent.

Some learn how to work around their phobias, like the person who never takes an elevator or refuses to ride in a crowded subway car. Others find that one phobia can lead to another until they’re paralyzed with fear.

Phobias are characterized by intense fear and loathing of something or an intense fear and anxiety in a specific, contained situation. In other words, the fear and anxiety aren’t generalized, but limited to a very specific named object or situation.

Post Traumatic Stress Disorder (PTSD)

PTSD has become more widely known as servicemen from Vietnam and other conflicts have come forward to report their symptoms and struggles. PTSD affects 7.7 million people nationwide.


It’s not limited to people who have been through an actual battle. Anyone who has suffered grave trauma can succumb to PTSD. Rape and assault survivors, burglary and fire survivors, and survivors of traumatic, long-term physical, mental and sexual abuse all report symptoms of PTSD.

It is characterized by a constellation of symptoms that include anxiety, panic attacks, flashbacks and memories, depression and other symptoms. Most are triggered by an event that reminds people of the initial trauma, although sometimes the brain’s processing mechanisms can simply pull up the flashback and recreate the trauma all on their own. PTSD can be misdiagnosed as other anxiety disorders if doctors don’t have a patient’s entire personal and life history to review.

Obsessive Compulsive Disorder (OCD)

At the end of the anxiety disorder spectrum is obsessive compulsive disorder. It’s a disorder made famous by television detective Adrian Monk of the “Monk” series. While OCD affects only a relatively small number of people — around 2.2 million out of the entire population of the United States — for those under its grip, it can make life miserable.

People who suffer from an obsessive compulsive disorder obsess over something, then perform a ritualized action or compulsion to relieve the anxiety around the obsession. They may feel compelled to repeat the activity a specific number of times or in certain ways to alleviate the anxiety.

Someone with OCD may wash their hands a certain number of times to prevent germ contamination or touch a door knob a specific number of times to feel more secure. They need order and ritual to feel better, and avoid actions that can trigger an attack. Sometimes the rituals connected to an obsession make sense, but sometimes they seem unconnected.

There are other variations of these major anxiety disorders, but this list of the big six covers most of the disorders related to substance abuse and anxiety. For those reading this who see themselves in these descriptions, know that help is available to you. If you’re self-medicating with drugs or alcohol, it’s time to admit you have a problem and get treatment for both your anxiety disorder and addiction.

What Causes Anxiety Disorders?

That’s the million-dollar question. No one is sure what actually causes these anxiety disorders. Some are better understood than others. For example, doctors know that post traumatic stress disorder is “caused” by a traumatic event. But no two people react the same to a traumatic event. Two people can be the victims of an armed robbery, and one develops PTSD while the other is fine after a while. Doctors aren’t sure why.


The most likely explanation is genetics. Our genes set the stage for how we develop, making a blueprint for our physical and physiological state. Despite mapping the human genome, scientists are still exploring the genetic landscape, identifying many different chromosomal changes that cause specific diseases or predilections for disease.

Researchers do know that anxiety disorders run in families, so genetics must play a role in their development. If you know someone in your family suffers from depression or an anxiety disorder, other family members are about 30 to 40 percent more likely to share those traits.

Another risk factor for developing an anxiety disorder is social or situational. Someone raised in a violent, abusive or chaotic environment may be at greater risk of developing anxiety disorders later in life. They can also be at greater risk for developing substance abuse problems.

Medical conditions also seem to be a factor for anxiety disorders. Researchers have found that sleep apnea, irritable bowel syndrome, chronic fatigue syndrome and even PMS may be linked to anxiety disorders, but the links are poorly understood. Researchers know these conditions often go together, but knowing which came first is hard to discern.

Keep in mind that people are amazingly resilient. Even if you have every single risk factor for a disease such as an anxiety disorder, you may not necessarily develop one.

Self-Medication for Anxiety

Many people who do develop anxiety disorders are embarrassed by them. Social anxiety, for instance, may lead people to drink more at parties to alleviate the anxiety. This, in turn, can create a domino effect. As the alcohol wears off, they may feel anxious again and reach for more alcohol. Such people may be using drugs as self-medication for anxiety.

Substance abuse counselors have long known that people who enter treatment for drug and alcohol problems often have underlying anxiety disorders. It’s common for people to self-medicate for anxiety.

Many people turn to alcohol, prescription tranquilizers and illegal drugs to relieve their anxiety symptoms. At first, they may work. But as withdrawal sets in, what originally helped quell anxiety symptoms only magnifies them.

People with an anxiety disorder are two to three times more likely to also be alcoholics. They’re even more likely to be diagnosed with a drug problem. It’s all part of the cycle of self-medication for anxiety that must be treated for someone to recover completely.


Substance Abuse and Anxiety Disorder: Frequently Abused Substances

People with an anxiety disorder tend to turn to the same drugs to relieve their feelings of panic, anxiety and depression. Many of these drugs are, in fact, depressants themselves. It seems counterintuitive to take a depressant drug to treat a depression-related disease, but the sedating effects of these drugs often make anxious people feel better.

The most commonly abused drugs associated with anxiety disorder include:

  • Alcohol — Alcohol suppresses the central nervous system and certain centers of the brain related to anxiety. Anxious people may feel more relaxed temporarily after drinking. Alcohol has a boomerang effect, and as it wears off, it tends to generate higher levels of anxiety. This may make anxious people drink more or drink more quickly to keep the anxiety at bay, which can lead them more quickly into alcoholism and dependence.
  • Benzodiazepine — Benzodiazepines are prescription drugs used to treat anxiety, depression, insomnia and even seizures. In small, controlled doses, they can be effective against panic attacks when used as directed. Problems arise when patients take the drugs for longer periods than prescribed or in combination with other drugs or alcohol. These drugs can be very dangerous to withdraw from without medical supervision.
  • Heroin — Heroin and other opioids produce a strong feeling of elation and well-being. Such drugs can make people who suffer from PTSD and severe anxiety forget their fears and relax. They are extremely addicting, dangerous drugs.

How Is Substance Abuse and Anxiety Disorder Diagnosed?

There’s no laboratory test to diagnose an anxiety disorder. While recent research has shown that an MRI, or a scan of the brain, shows differences between the brains of people with OCD or depression and normal brains, scientists are far from having a simple, reliable test to identify anxiety disorders. It’s mostly a question of observing your symptoms and sharing them with a skilled practitioner who can sort through them and diagnose your problem.


It can be really difficult to tell if your anxiety disorder came first, or the addiction came first. Sometimes people develop anxiety disorders after they become substance abusers as their bodies react to the continuous presence and absence of drugs. When they stop taking drugs, they feel anxious, so they take them again. Anxiety becomes a roller coaster of addiction, anxiety and back to addiction again.

For people who have both an anxiety disorder and a substance abuse problem, they have what’s called a dual diagnosis. Dual simply means two problems. You have a problem with substance abuse and a second problem with an anxiety disorder.

To diagnose a concurrent anxiety disorder, you’ll probably need to be free from substances for about two weeks to a month. It’s only after a period has elapsed that your therapist and addiction counselors can observe your true behavior. They can listen to what you’re saying and see if there’s something more going on than just recovery.

You’re also an important part of your diagnosis. You should observe symptoms and report them to your therapist. For example, if you find yourself having a sudden dry mouth, faint feelings, a pounding heart and a feeling of impending doom, you just might be having a true panic or anxiety attack. Keep a journal of your feelings and symptoms and tell your doctors, counselors and therapists about them.


Psychiatrists who treat people with anxiety disorder often want to meet several times with a client to understand their symptoms completely. Only after they’ve met with you and listened to your history and symptoms can they rule out potential medical disorders that can mimic panic disorder. Your psychiatrist might want you to get blood tests done or see an internist for a checkup, for example, to rule out hypoglycemia and thyroid issues that can mimic anxiety disorders.

How Are Anxiety Disorders Treated?

There are many effective anxiety disorder treatments available now. These include:

  • Acclimation therapy for phobias — Gradually exposing people to the object of their phobia to help them get over it.
  • Cognitive behavioral therapy (CBT) — For panic disorder, generalized anxiety disorder, phobias, PTSD and OCD.
  • Eye Movement Desensitization and Reprocessing (EMDR) — A relatively new yet simple therapy that has shown great promise with clients suffering from PTSD and other anxiety disorders.
  • Talk therapy — Such as individual therapy and group therapy.
  • Exercise — Has been shown to alleviate depression and anxiety symptoms.
  • Medications including selective serotonin reuptake inhibitors (SSRIs) — To treat anxiety, depression and panic disorder.


Whether you need medication, therapy or both is up to you and your doctor. Your doctor will suggest what they think is best for you. The choice is always yours about how to approach your health care.

SSRIs are not habit-forming or addictive. While they should not be discontinued abruptly due to the neurological changes they build in the brain, they aren’t habit-forming. Their effects are felt gradually over time rather than a quick “high” such as benzodiazepines or tranquilizers. Many people with dual diagnosis find that a combination of therapy and medication works well, or therapy alone.

As part of your program of recovery, you’ll be encouraged to take up some healthy physical exercise and eat nutritious, balanced meals. These two simple acts are great for everyone, but especially important for recovering addicts and people with anxiety disorders.

Exercise alleviates anxiety, releases stress and boosts endorphins, the naturally occurring “feel good” brain chemicals. Eating a balanced diet helps your body produce the neurotransmitters it needs to balance your brain chemistry and prevent panic attacks. It’s all part of a solid program of recovery.

Recovery From Substance Abuse and Anxiety Disorders at 12 Keys Rehab

You don’t have to suffer from substance abuse and anxiety disorders alone. At 12 Keys, we have worked with many clients who have come to us with both. No matter how you may have struggled in the past, today is a new day. We can help you.

12 Keys offers holistic recovery programs. We treat you like an individual — and we help you heal on every level. At 12 Keys, you won’t have to fit into a cookie-cutter approach to recovery. Instead, we offer you choices for your recovery that we think work best for you. You and the compassionate addiction specialists at 12 Keys will customize a treatment plan specifically for your needs, goals, challenges and interests.

A recovery program at 12 Keys will include the 12 steps of recovery. This is a time-tested approach to addiction and recovery, and we really believe in it. We’ll help you find a sponsor and give you plenty of time to attend 12 step meetings.

We also have therapists and addiction counselors to meet with privately and in groups to talk about your anxiety, your past drug abuse and how the two may be affecting you now. EMDR treatments can help you release old hurts, traumas and memories to get past post traumatic stress disorders. Cognitive behavioral therapy can help you reframe and rethink your reaction to situations and memories. Depending on what you need and what you want, we’ll put together a schedule just for you.

In between recovery work, there’s time to take a walk, go for a swim or just hang out in one of the many lounge areas throughout 12 Keys. Some are outside so you can enjoy the gorgeous Florida scenery. We include your family in your recovery, and you have access to electronic devices to keep in touch with others. Recovery is individual, but it’s not a solo effort.

12 Keys makes a difference, and we want to make a difference in your life, too. You can call us anytime, day or night, and any day of the week to talk to an admissions counselor about coming to 12 Keys. Contact us today to get started on your unique journey to long-term recovery and a better life.

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