Anxiety & Addiction Treatment

Anxiety disorders and substance use disorders co-occur at very high rates. Studies show that approximately 20% of people with an anxiety disorder also have a substance use disorder, and about 20% of people with a substance use disorder have an anxiety disorder—rates significantly higher than in the general population. The relationship is bidirectional: anxiety can lead to substance use as self-medication, and chronic substance use can cause or worsen anxiety symptoms. Common patterns include using alcohol or benzodiazepines to manage social anxiety or panic attacks, using stimulants which then trigger or worsen anxiety, and experiencing rebound anxiety during withdrawal from sedatives or alcohol. Integrated treatment addressing both conditions simultaneously is essential for sustainable recovery.

Substance-induced anxiety disorder occurs as a direct result of substance use, intoxication, or withdrawal, and typically resolves within days to weeks of sustained abstinence. Examples include anxiety during stimulant intoxication, panic during alcohol or benzodiazepine withdrawal, and persistent anxiety with chronic marijuana or stimulant use. Independent anxiety disorders existed before substance use began, persist during periods of abstinence, and require ongoing treatment. Distinguishing between the two can be challenging and typically requires several weeks of abstinence to observe whether anxiety symptoms persist. However, treatment often begins before this distinction is clear, using evidence-based anxiety treatments (CBT, SSRIs) while addressing substance use. Both conditions require treatment regardless of which came first or caused what.

This depends on the type of anxiety medication and your specific situation. SSRIs and SNRIs (Zoloft, Lexapro, Effexor, Cymbalta) are first-line medications for most anxiety disorders and are safe, non-addictive options appropriate for people in recovery. Buspirone is a non-addictive anti-anxiety medication useful for generalized anxiety disorder. Hydroxyzine is an antihistamine with anti-anxiety properties, also non-addictive. Beta-blockers like propranolol can help with physical anxiety symptoms. However, benzodiazepines (Xanax, Valium, Klonopin, Ativan) carry high addiction risk and are generally avoided in people with substance use disorders except in specific circumstances under close medical supervision. Our psychiatric providers work with each client to find effective, safe anxiety treatment options that support rather than jeopardize recovery.

Exposure therapy is a highly effective evidence-based treatment for anxiety disorders, particularly panic disorder, social anxiety, specific phobias, and OCD. The treatment involves gradually and systematically confronting feared situations, objects, or sensations in a controlled, safe manner. Through repeated exposure, individuals learn that their feared outcomes rarely occur and that anxiety naturally decreases even without escape or avoidance. Types of exposure include in vivo exposure (facing real-life situations), imaginal exposure (vividly imagining feared scenarios), and interoceptive exposure (deliberately inducing physical sensations associated with anxiety). Research shows exposure therapy produces lasting anxiety reduction, with effects often superior to medication alone. For people with co-occurring substance use, exposure therapy is particularly valuable as it provides non-pharmacological anxiety management skills crucial for long-term recovery.

Initially, yes—anxiety often increases during early recovery, which can be discouraging. This occurs for several reasons: acute withdrawal from alcohol, benzodiazepines, or other sedatives causes rebound anxiety that can be severe but temporary; you are no longer using substances to numb or suppress anxiety; you are facing life circumstances and emotions that were avoided during active use; and your brain's stress response systems need time to recalibrate. However, this is temporary. For most people, baseline anxiety significantly improves after several weeks to months of sustained abstinence, particularly from alcohol and sedatives which directly worsen anxiety long-term despite providing short-term relief. With proper treatment addressing both conditions—therapy, non-addictive medications when appropriate, and coping skills development—most people find their anxiety becomes more manageable in recovery than it ever was while using substances.

Yes, anxiety commonly causes significant physical symptoms, which can be frightening and may lead people to seek emergency care or believe they have a serious medical condition. Common physical anxiety symptoms include rapid or pounding heartbeat, chest tightness or pain, shortness of breath or feeling of suffocation, dizziness or lightheadedness, trembling or shaking, sweating, nausea or stomach upset, numbness or tingling sensations, muscle tension and pain, and headaches. These symptoms result from activation of the fight-or-flight response, causing release of stress hormones and physiological changes preparing the body for danger. While very uncomfortable, these symptoms are not medically dangerous (though ruling out medical causes is important). Learning to recognize these as anxiety symptoms rather than signs of imminent catastrophe is an important part of anxiety treatment. Techniques like diaphragmatic breathing, progressive muscle relaxation, and cognitive restructuring help manage physical anxiety symptoms without medication.