Anxiety is part of ordinary life, but an anxiety disorder is different from temporary worry. The National Institute of Mental Health describes anxiety disorders as conditions in which anxiety does not simply go away, can occur across many situations, and may worsen over time. Generalized anxiety disorder, panic disorder, social anxiety disorder, and phobia-related disorders are among the recognized types.
Substance use disorders can occur alongside anxiety disorders. When a mental health disorder and a substance use disorder occur in the same person, they are often called co-occurring disorders. That combination can make symptoms harder to interpret and treatment more complicated, but both conditions are treatable.
Why Anxiety and Substance Use Can Become Connected
There is no single pathway from anxiety to addiction. Some people use alcohol or drugs in an attempt to reduce fear, tension, insomnia, panic, or social discomfort. Substance use may provide short-term changes in how someone feels while creating new risks or worsening symptoms over time. In other cases, substance use, intoxication, withdrawal, medication effects, or other health problems can produce symptoms that resemble or intensify anxiety.
That distinction matters. Feeling anxious while intoxicated or during withdrawal does not automatically establish a primary anxiety disorder. Likewise, having an anxiety disorder does not mean a person will develop a substance use disorder. A careful assessment looks at the timing of symptoms, substances and medications involved, periods of abstinence or reduced use, medical history, and how symptoms affect daily functioning.
What Co-Occurring Treatment Means
SAMHSA recommends integrated approaches for people with co-occurring mental health and substance use disorders. In practice, integrated care means the two problems are not treated as unrelated issues. Screening and treatment are coordinated so that clinicians can consider how symptoms, medications, substance use, withdrawal risk, and recovery goals interact.
Treatment may involve psychotherapy, medication when appropriate, substance use disorder services, peer or recovery support, and attention to sleep, housing, family, work, and other factors affecting stability. The exact combination depends on the person rather than on the diagnosis alone.
A useful treatment plan also avoids assuming that every symptom has one cause. Panic, restlessness, insomnia, racing thoughts, tremor, sweating, and difficulty concentrating can have several explanations. Assessment may need to consider anxiety disorders, substance effects, withdrawal, medication effects, and medical conditions before deciding what treatment is appropriate.
Therapy for Anxiety and Substance Use
Psychotherapy is a common part of anxiety treatment and can also be incorporated into substance use disorder care. Treatment may focus on recognizing anxiety patterns, changing unhelpful responses, developing coping skills, reducing avoidance, and learning ways to respond to cravings or distress without returning to substance use.
The important point is coordination. A person should not have to choose between addressing anxiety and addressing substance use. SAMHSA describes integrated treatment as a way to improve the quality of care by treating the whole person and coordinating mental health and substance use interventions.
Medication Requires Individualized Review
Medication can be appropriate for some anxiety disorders, but medication decisions become especially important when substance use is part of the clinical picture. A prescriber should know about alcohol, opioids, sedatives, stimulants, cannabis, over-the-counter products, and other prescribed medications being used.
Benzodiazepines deserve particular caution. The FDA requires boxed warnings for this medication class because of risks including misuse, addiction, physical dependence, and withdrawal. Combining benzodiazepines with opioids, alcohol, or other central nervous system depressants can increase the risk of severe sedation, breathing problems, overdose, and death.
Physical dependence is not the same thing as addiction. A person can become physically dependent on a benzodiazepine even when taking it as prescribed. Because abrupt discontinuation or rapid dose reduction can cause serious withdrawal reactions, including seizures, someone who has been taking a benzodiazepine regularly should not suddenly stop it without medical guidance. Tapering plans need to be individualized.
Medication for anxiety should also not be changed simply because a person enters addiction treatment. The safer approach is medication reconciliation: identify what the person is taking, why it was prescribed, whether it is helping, possible interactions, and whether changes should be made under appropriate medical supervision.
Alcohol, Sedatives, and Withdrawal Safety
Anxiety can be a withdrawal symptom, which makes abrupt self-directed detox especially risky with certain substances. Alcohol withdrawal and benzodiazepine withdrawal can become medically dangerous. Severe confusion, hallucinations, seizures, or other rapidly worsening symptoms require emergency medical attention.
Someone who may be physically dependent on alcohol or benzodiazepines should seek medical guidance rather than attempting an abrupt unsupervised stop. Treatment settings can assess withdrawal risk and determine whether medically managed withdrawal is needed before or alongside ongoing treatment.
Opioid Overdose Safety Still Matters
If opioids are part of a person's substance use, overdose prevention should be included even when anxiety is the main reason they first seek help. Naloxone can reverse an opioid overdose. If an opioid overdose is suspected, administer naloxone if available and call 911. A person who responds to naloxone still needs emergency evaluation because naloxone can wear off while opioids remain active.
Using opioids with benzodiazepines, alcohol, or other sedating substances can increase overdose risk. Treatment planning should therefore include an accurate review of all substances and medications rather than focusing on only one drug.
What to Look for in a Treatment Program
For someone dealing with both anxiety and substance use, useful questions include:
- Does the program routinely screen for both mental health and substance use disorders?
- Can mental health and addiction treatment be coordinated rather than handled as separate problems?
- How does the program assess alcohol, benzodiazepine, or other withdrawal risks?
- Is medication management available when needed?
- How are opioid overdose prevention and naloxone addressed when opioids are involved?
- What therapy approaches are available for anxiety, substance use, and co-occurring conditions?
- How does the program plan for continuing care after a more intensive level of treatment ends?
A program does not need to provide every service under one roof, but there should be a clear process for coordination and referral when another provider is involved.
Finding Help
SAMHSA's FindTreatment.gov can be used to locate mental health and substance use treatment services. SAMHSA's National Helpline at 1-800-662-HELP (4357) also provides treatment information and referral support.
If anxiety, substance use, or another mental health problem has reached a crisis point, call or text 988 for the Suicide & Crisis Lifeline. If there is an immediate medical emergency, a suspected overdose, severe withdrawal, trouble breathing, a seizure, or an immediate danger to someone's life, call 911 or go to the nearest emergency department.
Recovery Can Address Both Conditions
Anxiety and addiction can reinforce each other, but treatment does not have to wait for one problem to disappear before addressing the other. A coordinated assessment can separate symptoms that may have different causes, identify urgent withdrawal or overdose risks, and create a plan that addresses both mental health and substance use.
The goal is not to label every anxious feeling as a disorder or every substance use episode as addiction. It is to understand what is happening, reduce immediate risk, and connect the person with care matched to their needs.
Frequently Asked Questions
Can anxiety cause addiction?
Anxiety does not automatically cause addiction. Some people use substances to cope with anxiety, and anxiety disorders and substance use disorders can occur together. Their relationship differs from person to person and should be assessed individually.
Can substance use make anxiety worse?
Yes. Intoxication, withdrawal, sleep disruption, medication interactions, and the consequences of substance use can contribute to anxiety symptoms. The pattern depends on the substance and the individual.
Can anxiety and addiction be treated at the same time?
Yes. SAMHSA recommends integrated approaches for co-occurring mental health and substance use disorders so both conditions can be assessed and treated in a coordinated way.
Should I stop a benzodiazepine if I am entering addiction treatment?
Do not abruptly stop a regularly used benzodiazepine on your own. FDA warnings note that sudden discontinuation or rapid dose reduction can cause serious withdrawal reactions, including seizures. A qualified prescriber can assess the medication and create an individualized plan when changes are appropriate.
Where can I find treatment for anxiety and substance use?
FindTreatment.gov provides a federal treatment locator for mental health and substance use services. SAMHSA's National Helpline at 1-800-662-HELP (4357) can also provide treatment information and referrals.
Source Notes
National Institute of Mental Health — Anxiety Disorders
https://www.nimh.nih.gov/health/topics/anxiety-disordersSAMHSA — Co-Occurring Disorders and Other Health Conditions
https://www.samhsa.gov/substance-use/treatment/co-occurring-disordersSAMHSA — Screening and Treatment of Co-Occurring Disorders
https://www.samhsa.gov/mental-health/serious-mental-illness/co-occurring-disordersSAMHSA — Substance Use Disorder Treatment for People with Co-Occurring Disorders (TIP 42 Advisory)
https://www.samhsa.gov/resource/ebp/advisory-substance-use-disorder-treatment-people-co-occurring-disorders-based-tip-42FDA — Benzodiazepine Drug Class Boxed Warning
https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-classCDC — Reversing Opioid Overdoses with Lifesaving Naloxone
https://www.cdc.gov/overdose-resources/pdf/Naloxone-Fact-Sheet-508.pdfSAMHSA — FindTreatment.gov
https://findtreatment.gov/988 Suicide & Crisis Lifeline
https://988lifeline.org/
This article provides general educational information only and is not medical advice, diagnosis, or treatment. Always seek the guidance of a qualified health provider with questions about substance use, withdrawal, or mental health. If someone may be overdosing — unresponsive, not breathing, blue lips — call 911 immediately.