Anxiety Disorder & Substance Abuse: Two Peas In A Pod

Anxiety disorders are one of the most common mental illnesses in the country.

In fact, mental health problems are more common on average in the Bellevue area compared to the rest of Washington and even the United States as a whole.

And living with an anxiety disorder can make it hard to focus, accomplish tasks, stay healthy, and ultimately live a happy and productive life.

But when they occur alongside an addiction to drugs like opioids, benzodiazepines, or alcohol, these problems can end up being even more severe.

This guide takes a deep dive into anxiety disorders. What are they? What are the different types? How do they come into play with addiction? And how can they be treated with there is a substance use disorder involved as well?

Let’s take a look.

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What Is an Anxiety Disorder?

Anxiety is a normal part of life as a human. It’s what causes people to spring into action in critical situations.

And without it, many wouldn’t be motivated to get essential tasks done throughout the day. This anxiety is part of the fight or flight system – basically the body’s way of telling us “it’s time to get in gear” and perform some sort of action.

However, when we experience continued and intense anxiety, sometimes for no reason at all, that’s when it becomes an actual disorder. For people with an anxiety disorder, the brain’s fight or flight mechanism is triggered over and over again, causing intense symptoms of panic and worry in the face of situations that just don’t call for it.

And sometimes these symptoms can be so overwhelming that people suffering from this disorder avoid situations, don’t engage in certain activities, and may even fear for their lives for no reason at all.

Some people may even turn to substance abuse as a way to self-medicate and try to cope with these symptoms of anxiety, even though professional treatment is both widely available and highly successful.

More common than most people might think.

In fact, anxiety disorders are actually the most common mental illnesses in the United States. They affect 40 million adults every year – about 18.1% of the total population.

Despite just how common they are though, the overwhelming majority of people suffering from these diseases don’t actually get the professional treatment they need. Just 36.9% of people suffering from an anxiety disorder get help, even though they are highly treatable.

And just like the debilitating shame and guilt often associated with addiction, the stigmas surrounding mental health can often lead to anxiety disorder victims suffering through these conditions for years, decades, and even their entire lives.

An anxiety disorder won’t present in everyone the same way. And on top of that, there are several different types of anxiety disorders that bring along different symptoms as well (more on that below).

But in general, anxiety disorders tend to have a few recognizable symptoms to watch out for. These include:

  • Excessive worrying
  • Feeling agitated
  • Restlessness
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Tense muscles
  • Trouble falling or staying asleep
  • Panic attacks
  • Avoiding social situations
  • Irrational fears

While anxiety disorders are one of the most common disorders in the United States, it can also be one of the most debilitating too.

The symptoms can assault victims throughout the day, making them feel anxious, worried, and panicked from sun up to sun down. Focusing on a task at hand – like work or school – can be nearly impossible. They can also be brought on sporadically, leading to intense bouts of panic too.

And part of the problem is that these symptoms can come on for seemingly no reason at all. That fear of anxiety onset, then, can make sufferers feel on edge nearly every hour of the day.

Needless to say, it can be exhausting living with an anxiety disorder.

Below are a few ways that people have explained what it’s like living with an anxiety disorder.

“I’m standing on the train when I feel a tight pain in my chest, my heart beating too fast. I am suddenly aware that I cannot breathe. I am drowning. My body breaks out into great bouts of sweat, heart rising to my face. I’m going to pass out, panic rushes over me. I get pins and needles down both arms and legs, and my hands begin to cramp, curling up towards my wrists.”

- Isabella Mitchell via The Mighty

“I couldn’t pinpoint what started it, what prompted the rush of color to my face, the shortness of breath, the quick onset of intense fear. But I began sobbing, wrapped my arms around my body, and hurried back to the room I’d just moved into — a triple with two other college students.

There was nowhere to go — nowhere to hide my shame at this intense and unexplainable emotion — so I curled up in bed and faced the wall.

What was happening to me? Why was it happening? And how could I make it stop?”

- Caroline Catlin via Healthline

Below is a video that explains just what it’s like living with an anxiety disorder every single day.

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Types of Anxiety Disorders

The mental health field has come a long way in how it classifies anxiety disorders. And while at one time these disorders were lumped into one overarching umbrella term, they have now been separated out into their own distinct classes.

According to the U.S. Department of Health and Human Services, there are five major types of anxiety disorders: Generalized Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), and Social Phobia (or Social Anxiety Disorder).

Called GAD for short, this type of anxiety disorder involves chronic and excessive anxiety, usually about issues that don’t warrant it. These issues can be anything – from money and family to work, health, and even natural disasters.

The criteria for having GAD are feeling worry that’s difficult to control more often than not for at least six months.

Generalized anxiety disorder is quite common in the United States. And as many as 6.8 million adults (or 3.1% of the population) experiences it in any given year. On top of that, women are particularly prone to experiencing GAD and are twice as likely as men to suffer from it.

Obsessive-compulsive disorder can be an incredibly distressing anxiety disorder, and it can often make it hard to function normally from day to day.

It’s characterized by two recurring symptoms in particular: obsessions and compulsions. Obsessions are defined as unwanted intrusive thoughts, images, or urges whereas compulsions are ritualistic behaviors and routines used to help reduce anxiety or distress.

According to the National Institute of Mental Health (NIMH), about 1.2% of adults in the U.S. had OCD in the past year. On top of that, more females (1.8%) had OCD in the past year than males (0.5%).

Below are the symptoms of OCD as characterized by the Anxiety and Depression Association of America (ADAA).


  • Constant, irrational worry about dirt, germs, or contamination.
  • Excessive concern with order, arrangement, or symmetry.
  • Fear that negative or aggressive thoughts or impulses will cause personal harm or harm to a loved one.
  • Preoccupation with losing or throwing away objects with little or no value.
  • Excessive concern about accidentally or purposefully injuring another person.
  • Feeling overly responsible for the safety of others.
  • Distasteful religious and sexual thoughts or images.
  • Doubting that is irrational or excessive.


  • Cleaning — Repeatedly washing one’s hands, bathing, or cleaning household items, often for hours at a time.
  • Checking — Checking and re-checking several to hundreds of times a day that the doors are locked, the stove is turned off, the hairdryer is unplugged, etc.
  • Repeating — Inability to stop repeating a name, phrase, or simple activity (such as going through a doorway over and over).
  • Mental rituals — Endless reviewing of conversations, counting; repetitively calling up “good” thoughts to neutralize “bad” thoughts or obsessions; or excessive praying and using special words or phrases to neutralize obsessions.

Panic disorder is a type of anxiety disorder where an individual experiences recurring panic attacks – sudden periods of intense fear that can happen quickly and unexpectedly. They can also occur in response to certain situations as well.

A panic attack can feel similar to a heart attack. And in fact, many people suffering from panic attacks seek medical attention thinking that they are actually having a cardiac event.

Some of the most common symptoms of a panic attack include:

  • Chest pain
  • Heart palpitations
  • Shortness of breath
  • Sweating
  • Trembling or shaking
  • Feelings of impending doom
  • Feelings of being out of control
  • Dizziness
  • Abdominal distress

For many, these events can be so distressing that they end up avoiding places, situations, or behaviors that they associate with the attack. They will even do so to the detriment of their career, personal life, or even health.

The ADAA states that around 2 to 3% of Americans experience panic disorder in a given year. And like many other anxiety disorders, women are about twice as likely to experience it as men.

PTSD is an anxiety disorder that occurs as a result of a traumatic experience. These experiences are usually events where serious physical harm occurred or was threatened. Some of these events may include personal assaults, natural or human-caused disasters, accidents, or military combat.

According to the ADAA, symptoms of PTSD include:

  • Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events.
  • Recurrent distressing dreams in which the content or affect (i.e. feeling) of the dream is related to the events.
  • Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring.
  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events.
  • Physiological reactions to reminders of the traumatic events.

Around 3.5% of Americans will experience post-traumatic stress disorder at some point in their lives, and women are twice as likely to suffer from it.

This type of anxiety disorder is characterized by intense fear of social or performance situations. This disorder stems from the embarrassment that others will perceive the symptoms associated with the individual's anxiety and judge the individual harshly for them. This leads to extreme self-consciousness and avoidance of many situations.

Social phobias can be related to general situations like any involving other people. Or they can be more specific, such as with speaking in formal situations or even eating and drinking in front of others.

Following specific phobias, social anxiety disorder is the second most commonly diagnosed anxiety disorder. And according to the ADAA, it affects nearly 15 million American adults.

What’s more, the vast majority of people suffering from social anxiety disorder don’t end up seeking professional help, leading this treatable and sometimes debilitating disease to become normalized.

Co-Occurring Disorders: Anxiety Disorders & Substance Abuse

The phrase “co-occurring disorder” describes a condition where someone suffers from both a substance use disorder and a mental problem like an anxiety disorder.

In many cases, these two mental disorders often feed off of each other. And when it comes to professional treatment, people with co-occurring disorders need to address both conditions at the same time. Otherwise, the condition that’s left untreated can cause a relapse for the other.

Co-occurring disorders are especially common among substance abusers. This is particularly true for people suffering from an anxiety disorder.

In fact, according to the National Institute on Drug Abuse (NIDA), around half of people with a substance use disorder will also experience another mental disorder. And similarly, about half of people with a mental disorder will also suffer from a substance use disorder as well.

To compare this to the rest of the population, mental disorders typically affect just 1 in 5 Americans. That means that the likelihood of a mental disorder is 2 ½ times higher in someone struggling with an addiction.

The most common drugs abused with anxiety disorders are:

It seems intuitive enough that the most common drugs being used in individuals suffering from   anxiety disorders are ones that counteract the symptoms of anxiety.

Central nervous system depressants or “downers” like those above do just that. They affect the individual by essentially “slowing down” the electrical activity in the brain, thus evening things out for someone suffering from an anxiety disorder.

One study even found that among patients dependent on drugs like opioids and sedatives, the rate of co-occurring anxiety disorders (excluding PTSD and OCD) was as high as 60%. That means that 3 out of 5 people suffering from these types of addictions was also likely to be suffering from an anxiety disorder.

Getting the Right Kind of Treatment

In order to treat a co-occurring disorder appropriately, it takes a professional program with a certain type of expertise.

These programs are often called “dual diagnosis” programs.

What makes them different from other professional addiction treatment programs is the fact that they help identify underlying co-occurring disorders and create a recovery plan that focuses on treating both disorders at the same time.

That’s because if only one is treated while the other still persists, the continuing symptoms can often lead to a relapse.

If, for example, someone suffering from an anxiety disorder is treated for, say, opioid abuse, the symptoms of their anxiety will still make life difficult long after treatment. And eventually, they’ll become so frustrated and disillusioned that they’ll likely turn back to using again as a result.

Treating both at the same time, then, is absolutely essential for long-term recovery.  

For more information on treating a co-occurring disorder, have a look at this comprehensive guide to dual diagnosis.

Like any other problem, the very first step to treating a co-occurring disorder like anxiety is actually spotting it in the first place.

And while this may seem like an overly-obvious point, the truth of the matter is that the overwhelming majority of people suffering from an anxiety disorder don't get the treatment they need. Remember, just 36.9% of people with an anxiety disorder actually get help.

When it comes to treating a substance use disorder, it’s vital that a professional program is equipped to actually diagnose an underlying problem like anxiety disorder before treatment begins.

Many times, people entering into treatment are being assaulted by a range of problems caused by their substance abuse. And most simply may not realize that they’re also suffering from an anxiety disorder at the same time since so much is going wrong in their lives.

A proper dual diagnosis program will be able to spot these signs and administer the proper care to treat both the addiction and the underlying anxiety disorder at the same time.

Using certain medications has been shown to be an effective treatment strategy in managing anxiety disorders.

In most cases, SSRIs (or selective serotonin reuptake inhibitors) are the go-to options. Some of the most common for anxiety disorders are:

  • Prozac
  • Zoloft
  • Paxil
  • Lexapro
  • Celexa

Some programs may help treat anxiety disorders with another class of drug called benzodiazepines. This class of drug includes:

However, it should be noted that both SSRIs and benzodiazepines can result in physical dependency which may lead to addiction. SSRIs are typically considered the safer option. But still, both should only be taken under the guidance and direction of a qualified medical expert.

Counseling is an integral part of any recovery program. And it’s especially important when it comes to treating someone with a co-occurring disorder.

These counseling sessions will help the patient get to the root cause of their addiction and help uncover the underlying problems that are fueling their substance abuse. They can also help identify life factors that may be making their anxiety disorder worse.

Counseling is also beneficial because it’s here that most patients will be able to work one-on-one with a psychiatrist and learn about behavioral therapies – an essential form of treatment when it comes to dual diagnosis.

Behavioral therapies are especially effective at treating underlying mental disorders that occur alongside addiction. These therapies are designed to give patients the real-life strategies and tools they need to reorganize their lives and change the way they perceive and react to the world.

One of the best behavioral therapies for anxiety disorders is Cognitive-Behavioral Therapy or CBT. This

There are other behavioral therapies that have been found to be helpful too. According to NIDA, these include: 

  • Dialectical Behavior Therapy (DBT)
  • Assertive Community Treatment (ACT)
  • Therapeutic Communities (TCs)
  • Contingency Management (CM) or Motivational Incentives (MI)
  • Exposure Therapy
  • Integrated Group Therapy (IGT)
  • Seeking Safety (SS)
  • Mobile Medical Application

What to Look for In A Professional Program If You Have An Anxiety Disorder

Finding a facility that meets your specific needs can be tough when you don’t know what to look for. But doing so is also key to getting the absolute best care possible – and to ensuring long-term sobriety and preventing relapse.

Below are just a few things to look for when searching for a professional program. You’ll want to find a facility that offers:

  • Dual diagnosis specialty
  • Proper accreditation from national agencies
  • Evidence-based treatments backed up by real science
  • A high staff-to-patient ratio
  • Staffed by qualified nurses, physicians, and psychiatrists
  • Various treatments that address the full spectrum of addiction and mental disorders
  • Verified insurance acceptance

Northpoint the Evergreen Bellevue: The Premier Option for Co-Occurring Disorders

Suffering from an anxiety disorder alongside an addiction can be devastating if left untreated. And even if you kick your drug habit, this underlying problem can often lead to relapse without professional help.

So when it comes time to partner with a treatment program, finding one with dual diagnosis specialty is absolutely essential.

At the Evergreen at Bellevue, we’ve helped countless patients suffering from an anxiety disorder overcome their addiction and regain their mental health. Our programs are nationally accredited by the Joint Commission, staffed by some of the most qualified professionals in the area, and offer a comprehensive recovery experience.

We know that an anxiety disorder can make living life to its fullest nearly impossible. And we are passionate about helping each of our patients regain control over their lives.

But even if our outpatient program isn’t right for you, we’d love to help you find one that is. Our dedicated addiction support specialists are standing by to answer any questions you may have and point you to the best programs to treat your co-occurring disorders like anxiety.

So, contact us today to get started right now.

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