Generalized Anxiety Disorder and Substance Use Disorders

Generalized anxiety disorder (GAD) is known to frequently overlap with other emotional and behavioral problems, including depression, other anxiety disorders, and substance use disorders.

While the exact mechanism by which an individual develops co-occurring generalized anxiety and substance use disorders remains unclear, self-medication is thought to play an important role.

When an individual decides independently to use a substance to soothe or manage a particular symptom, it is referred to as “self-medicating.” Self-medication often provides temporary relief of an uncomfortable sensation or emotion, which reinforces its use. Recent research indicates, however, that the use of alcohol or drugs to cope with symptoms of anxiety can be particularly problematic as it confers additional risk of ultimately developing a substance use disorder.

Relationship Between GAD and Substance Use Disorders

• Though GAD is known to affect women at higher rates, co-occurring GAD and substance use disorders are more likely to affect men.
• According to a recent report from a national survey on substance use disorders, individuals with co-occurring GAD and substance use disorder are more likely to have a family history of an alcohol or drug use disorder than those with GAD alone.
• The presence of a substance use disorder is associated with more severe anxiety symptoms and more overall impairment in day-to-day functioning. Compared to adults with “uncomplicated” GAD, those with GAD and a substance use disorder are more likely to report poor concentration, to describe more conflict with loved ones, and to endorse more difficulty completing their daily responsibilities.

• Though individuals with co-occurring GAD and substance use disorders have higher rates of other co-occurring psychiatric conditions (such as bipolar disorder, panic disorder, or social anxiety disorder) than those without a substance use disorder, rates of seeking treatment are equivalent, and relatively low, across groups.

• Regardless of the presence of a substance use disorder, this large-scale study found that nearly half of those diagnosed with GAD received no treatment. Individuals who did ultimately seek treatment did so, on average, 2 years after the onset of their anxiety symptoms.
• However, there are effective treatments for both GAD and substance use disorders. Depending on which disorder is considered primary and the severity of each condition, treatment of one disorder may be followed by treatment of the second disorder, treatment of both conditions may occur in parallel by different clinicians, or treatment may be integrated such that the disorders are treated (or at least monitored) simultaneously by a single treatment provider.

If you find yourself using drugs or alcohol to manage your anxiety, it is not likely to be the solution to the problem. While some substances may help with anxiety in the short-term, their effects are temporary. And the use of these substances can create a psychological or physiological dependence, which will cause or worsen other life problems and will ultimately exacerbate your anxiety symptoms.

If you (or a loved one) is worried about your use of substances to cope with anxiety, you should learn about the signs of a substance use problem and how to try to change these behaviors.

Consider speaking with a mental health provider or your physician about your particular circumstance; a clinician will be able to help you assess your symptoms and to understand what available treatments might be best suited to your needs. If you are unsure about the resources in your neighborhood, you can find help locally through the Substance Abuse and Mental Health Services Administration (SAMHSA) or the National Alliance on Mental Illness (NAMI) (which also provides some basic information on dual diagnosis).

Sources:

Alegria AA, Hasin DS, Nunes EV, Liu S, Davies C, Grant BF, Blanco C. Comorbidity of generalized anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psych. 2010; 71:1187-1195.

Robinson J, Sareen J, Cox BJ, Bolton JM. Role of self-medication in the development of comorbid anxiety and substance use disorders. Arch Gen Psych 2011; 68:800-807.

Smith JP, Randall CL. Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Res 2012; 34:414-31.