Dual Diagnosis Treatment: Anxiety and Substance Use Disorder
It is well established that anxiety and substance abuse often co-occur. The fear of losing control can compel people to alleviate those fears and self-medicate with substances like drugs, prescription painkillers, or alcohol, leading to a dual diagnosis or co-occurring disorder.
A successful treatment for this condition includes appropriately integrated medical interventions to treat both the anxiety disorder and the substance use disorder. This supports lasting, holistic recovery.
What is Anxiety Disorder?
An anxiety disorder is more than just the occasional fears and worries that we all have. Some fear is normal; it helps keep us alive. Anxiety disorder is a generalized, future-oriented mood state where the sufferer experiences fear in the present when imagining a future event.
“Fear is an automatic neurophysiological state of alarm characterized by a fight/flight/freeze response to a cognitive appraisal of danger (real or perceived).” This danger could be immediately present or could be imminent (however the sufferer defines “imminent”).
Those experiencing anxiety are experiencing uncontrollable fear. Several different kinds of anxiety disorders include:
- Generalized anxiety disorder
- Panic attacks
- Social anxiety disorder
- Phobia-specific disorders
- Selective mutism
- Separation anxiety disorder
Common Symptoms of Anxiety Disorder
There are cognitive and physiological symptoms of anxiety disorder. Some cognitive symptoms include:
- Fear of losing control
- Fear of pain, injury, or death
- Fear of “going crazy”
- Fear of negative evaluation by others
- Scary thoughts
- Feeling “unreal” or detached from your own body
- Lack of focus
- Worried about non-specific threats
- Poor memory
- Speech disruption
Some physiological symptoms include:
- Heightened heart rate
- Inconsistent breathing (e.g., hiccups)
- Pain or pressure in the chest region
- Constricting throat
- Sweaty, hot flashes, or chills
- Nausea, upset stomach, or diarrhea
- Trembling in the arms and legs
- Numbness or tingling in some or all extremities
- Weakness like you are about to faint
- Tense muscles
- Dry mouth
Anxiety Disorder Statistics
Anxiety disorder is one of the most common psychiatric disorders in the general population. It’s difficult to know for sure how many people suffer because many people who suffer never seek treatment or think their experience with fear is “normal.” This mental health condition can be lifelong or acquired.
- 31.1% of U.S. adults have reported experiencing any anxiety disorder at some point in their lives.
- 19.1% of U.S. adults have reported experiencing any anxiety disorder at some point in the last 12 months.
Women are almost 2 times more likely to report anxiety disorder than men. The split among anxiety disorder sufferers experiencing mild, moderate, or severe impairment is almost equal.
Anxiety and Addiction
Unfortunately, substance addiction and anxiety disorders often occur simultaneously. Anxiety disorder symptoms can compel substance use in an effort to alleviate the severity or frequency. This pattern of substance abuse can evolve into dependence or addiction.
Anxiety feeds into our psychological desire to control a situation from a distance. Even if it’s totally out of our control, our brain can feel better knowing that it “overthought” it. Over time, your brain can even become accustomed to or dependent on overthinking situations, similar to an addiction. This can be a troubling situation when you crave anxiety experiences or uncontrollable fear.
Substance Abuse and Anxiety
Substance abuse is common when the anxiety sufferer attempts to self-medicate in an effort to alleviate their symptoms. Alcohol is a commonly abused substance for anxiety sufferers because alcohol depresses your central nervous system. It slows down your racing thoughts.
Alcohol also stimulates your brain to produce dopamine, a feel-good hormone. When addiction and anxiety go hand-in-hand, the risk potential increases for adverse cardiac events (think heart attacks). The physiological symptoms of anxiety include palpitations and increased heart rate, which can cause damage to the heart over time.
Dual Diagnosis: Anxiety and Substance Use Disorder
One helpful treatment for co-occurring disorders like anxiety and substance abuse is a dedicated dual diagnosis program. This level of treatment identifies each disorder and then applies unique interventions for each.
Co-occurring disorders tend to intensify the effects of the other, leading to a vicious cycle that is hard to overcome. Dual diagnosis treatment will address each disorder as a separate diagnosis in order to build stronger coping skills and secure new habits.
Dual diagnosis treatments for anxiety and substance use disorder may include:
- Cognitive behavioral therapy
- ACT Therapy
- EMDR Therapy
- Family Therapy
Also, levels of care in which treatment for co-occurring substance use disorder and anxiety occurs may include:
- Partial Hospitalization Program
- Intensive Outpatient Program
- Outpatient Care
Cost of Dual Diagnosis Treatment for Anxiety Disorder
The cost of dual diagnosis treatment for anxiety disorder depends on many factors. Your needs, history, and desired lifestyle during treatment play a big part in what the cost will be.
The more intense level of care you need, the more expensive it could be. The length of stay, the intensity of care, and the different kinds of interventions needed will all play a part in determining the cost.
Frequently Asked Questions about Anxiety Disorder
Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for anxiety disorders. Talk to your healthcare provider for their professional opinion on what medication, if any, may be right for you. In most cases, medication alone is not enough to truly resolve anxiety-related concerns. Mental health interventions support the long-term management of anxiety symptoms.
Anxiety may never go away completely, but with the right techniques and treatments, you can overcome the acute, pervasive anxiety that controls your life. With a combination of physiological treatments (like Cognitive Behavioral Therapy – CBT) and pharmacotherapy (like medication), you can learn to manage your anxiety.
During the day, you have plenty of things to distract you. At night, as you are lying in bed trying to go to sleep, you can’t ignore your anxieties as easily. This can lead to more acute symptoms at night.
Sometimes, yes. A recent study on Generalized Anxiety Disorder found a genetic heritability of 31.6%. A twin has an even higher likelihood of getting diagnosed with an anxiety disorder if the other twin has been diagnosed. However, the presence or lack of anxiety disorders is still highly influenced by unique environmental factors, which means genetics alone does not determine heritability.
Anxiety typically has clear, known triggers to the sufferer, while panic attacks are often random, sudden, and unexpected. Panic attacks are generally more intense.
Are you or a loved one struggling with anxiety?
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 U.S. Department of Health and Human Services. (n.d.). Anxiety disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders
 U.S. Department of Health and Human Services. (n.d.-b). Any anxiety disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
 Marceau, K., & Abel, E. A. (2018, September). Mechanisms of cortisol – substance use development associations: Hypothesis generation through gene enrichment analysis. Neuroscience and biobehavioral reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310615/ Gottschalk, M. G., & Domschke, K. (2017, June). Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/