Addiction and Anxiety Disorder

Anxiety is a universal human experience. A natural response that helps us stay alert and safe in threatening situations. While occasional anxiety can be protective, causing sweaty palms before a presentation or racing thoughts during a test, for millions of people, anxiety manifests as something far more severe. When anxiety becomes excessive, unpredictable, and difficult to control, it can develop into a disorder that significantly impacts daily life, relationships, and overall well-being.

Types of Anxiety Disorders

Anxiety disorders come in several distinct forms, each with its own unique characteristics and challenges. While they share common threads of excessive worry and fear, understanding their differences is crucial for proper diagnosis and treatment. Many people experience symptoms of multiple anxiety disorders simultaneously or at different life stages, making it essential to recognize the full spectrum of these conditions.

Here are the primary types of anxiety and anxiety-related disorders that mental health professionals commonly diagnose and treat:

• Generalized Anxiety Disorder (GAD): Generalized anxiety disorder is characterized by persistent and excessive fear and worry. This anxiety is typically not associated with one specific stimulus or event and can instead feel very “generalized”. With GAD, anxiety responses may seemingly come out of nowhere, even during the most mundane daily activities.
• Panic Disorder: Panic disorder involves regular episodes of sudden and intense dread. While most anxiety disorders have associated physical symptoms, the random and intense nature of these panic attacks can make the somatic responses, like shortness of breath, chest tightness, and heart palpitations, feel even more painful. The combination of terror and pain leads many people to feel like they’re dying or having a heart attack. Panic attacks can be self-perpetuating, as the experience of having one can lead an individual to become increasingly anxious about it happening again.
• Social Anxiety Disorder: While generalized anxiety disorder and panic disorder aren’t typically associated with one specific stimulus, social anxiety disorder is more acutely tied to a phobia of social situations, like parties, crowded events, and other public places. This fear may lead people to avoid others, which can lead to strained relationships, isolation, and loneliness.
• Obsessive-Compulsive Disorder (OCD): Obsessive-compulsive disorder is a mental health condition that involves uncontrollable obsessive thoughts and compulsive behaviors. OCD can cause individuals to experience regular and intense anxiety, although there is some debate over whether or not it should be categorized as an anxiety disorder, since it also involves unique behaviors and stimuli. People with obsessive-compulsive disorder are likely to become intensely preoccupied with one or a few very specific anxieties and may unintentionally and uncontrollably respond to these anxieties by doing very specific, often repetitive behaviors.
• Post-Traumatic Stress Disorder (PTSD): PTSD develops after exposure to a traumatic event and is characterized by persistent, intrusive memories, nightmares, or flashbacks of the trauma. Unlike other anxiety disorders that might have unclear origins, PTSD has a direct connection to a specific traumatic experience or series of experiences. People with PTSD often experience hypervigilance (being constantly “on guard”), emotional numbness, and intense psychological distress when reminded of the trauma. They may go to great lengths to avoid situations, places, or people that remind them of the traumatic event. While PTSD was historically associated with combat veterans, it can affect anyone who has experienced or witnessed a traumatic event, including natural disasters, accidents, abuse, or violent crimes.

While these anxiety (and related) disorders tend to be the most common, there are many other anxiety disorders that can impact people very intensely, including specific phobias, agoraphobia, or separation anxiety disorder.

It’s important to be on the lookout for signs of an anxiety disorder in yourself and loved ones so you can seek treatment in a timely manner, rather than living with the anxiety longer than you need.

Common Anxiety Triggers

Understanding what triggers anxiety is crucial for both prevention and treatment. While everyone’s experience with anxiety is unique, certain situations and circumstances consistently emerge as common triggers across different populations. These triggers can range from universal experiences, like public speaking, to deeply personal factors rooted in individual histories and past trauma. By identifying and understanding these triggers, individuals can better manage their anxiety and develop effective coping strategies.

Here are some of the most common triggers that can spark or intensify anxiety symptoms:

• Social situations. Many people claim to be more afraid of speaking in public than they are of death, and even experienced professional speakers can get anxious in front of a crowd. Social settings like parties can increase anxiety and fear that others may be judging you, even when there is no evidence to indicate it. Some people avoid social situations to reduce anxiety, which can lead to long periods of isolation and subsequent worsening of symptoms.
• Work-related pressure. In the current environment, job insecurity is pretty much universal. The fear of losing one’s job can also feed into performance stress. You might wonder if you are ever going to be good enough, which leads to trouble focusing and worsened work quality. Tight deadlines, heavy workloads, and conflicts with coworkers and managers can also cause anxiety. Work can also exacerbate social anxiety by having social components to your job, like presenting on topics in front of more senior team members or having to reach out to strangers to coordinate tasks or make a sale. 
• Health concerns. People with chronic illnesses are often anxious about changes in their health, the unknowns associated with treatment, lifestyle changes they need to make, etc. You might also be anxious about the health of your spouse, parents, children, and even your pets. Many people struggle with hypochondria, or illness anxiety disorder, and worry excessively about the possibility of being ill. 
• Financial issues. It can often seem as if everything is going up except your income. High levels of debt, in particular, can be a major cause of anxiety. Additionally, housing costs are a significant issue in many parts of the U.S., with rents increasing and many people being unable to afford to buy due to high prices and/or shortages. Having a safe place to stay is paramount to mental health stability, and the risk of losing housing is extremely anxiety-inducing. Many also struggle with anxiety about whether they will ever be able to afford retirement. 
• Relationships. It’s understandable that a big life change like a divorce or a breakup can cause anxiety, but all types of relationship conflicts can increase worry. Whether it’s fighting with your teenager, dealing with political differences at family gatherings, or struggling with a friend’s behavior, it’s common to struggle with anxiety when things are rocky with others. 
• Personal triggers. Some people have anxiety triggers that are unique to their own experiences. Anxiety may be more related to one particular stressor over another due to your history. For example, someone who may have grown up with little money may struggle with immense financial anxiety even when there are no current financial concerns. Anxiety can also be tied to previous events that induce anxiety, and any reminder can trigger the same response. Often this is seen with individuals who suffer from posttraumatic stress disorder, or PTSD. An example could be an adult who suffered abuse as a child, and when they hear a door slamming, they think back to their experience and relive the anxiety. Many individuals have specific phobias that increase their anxiety as well, such as fear of heights, fear of flying, and fear of closed spaces. 

Understanding these triggers is often the first step toward managing anxiety effectively. However, when anxiety becomes overwhelming, some people may turn to unhealthy coping mechanisms, including substance use, in an attempt to find relief. This relationship between anxiety and substance use creates a complex cycle that requires careful attention and professional support.

Anxiety and Substance Use Disorders

Many people with anxiety turn to substances like alcohol or opioids for relief, creating what doctors call a “dual diagnosis.” It’s when you have both an anxiety disorder and a substance use disorder. While these substances might temporarily ease anxiety, they often lead to a destructive cycle that worsens both conditions.

Opioids and Anxiety

Using opioids for anxiety relief is particularly risky because:

• The brain quickly builds tolerance, requiring more opioids for the same calming effect
• Opioid withdrawal can intensify symptoms of anxiety 
• Most opioids require prescriptions or are illegal, adding stress about access and legal consequences
• Both anxiety and opioid use change brain chemistry, making recovery more challenging

Alcohol and Anxiety

While alcohol might seem like an easy fix for anxiety, it typically backfires:

• Drinking disrupts brain chemistry, often increasing anxiety once the effects wear off
• About 12% of people experience “hangxiety,” a severe anxiety during hangovers
• Regular use leads to tolerance, requiring more alcohol for the same relief
• People with anxiety are especially vulnerable to developing alcohol dependence

Research consistently shows that individuals with anxiety disorders are more vulnerable to developing substance use disorders, particularly AUD. This increased vulnerability means that people with anxiety disorders need to be especially vigilant about their substance use and should seek professional support for anxiety management rather than turning to alcohol or other substances for relief.

Breaking The Cycle

Managing both anxiety and substance use disorders requires a comprehensive treatment plan that addresses both conditions simultaneously. Here’s how to break free from this challenging cycle:

• Individual therapy: Cognitive Behavioral Therapy (CBT) is particularly effective for treating both anxiety disorders and substance use disorders. This therapeutic approach helps identify triggers, change negative thought patterns, and develop healthier coping strategies for managing anxiety and substance use urges.
• Family therapy: Working with a family therapist can help rebuild damaged relationships and create a stronger support system for recovery. Family therapy sessions provide a safe space to address communication issues, heal past hurts, and help loved ones understand how to best support the recovery process.

• Medication Management: Both anxiety and substance use disorders can be effectively treated with various medications, often used in combination.
  • For anxiety with opioid use disorder (OUD), treatment typically involves medications like methadone or buprenorphine to normalize brain chemistry and reduce cravings, while naltrexone helps maintain abstinence after detoxification. Additional medications like clonidine or lofexidine can help manage both withdrawal symptoms and anxiety.
  • For those with alcohol use disorder (AUD) and anxiety, FDA-approved medications like naltrexone, acamprosate, or disulfiram help reduce cravings, while medications like gabapentin or pregabalin can address both alcohol withdrawal and symptoms of anxiety.
  • Antidepressants, particularly SSRIs like sertraline or fluoxetine, may be prescribed to manage co-occurring anxiety symptoms in both conditions. The specific medication plan should be tailored to each individual’s needs under careful medical supervision.
• Lifestyle Changes: Making positive lifestyle changes is essential for managing both anxiety disorders and substance use disorders. Regular exercise releases natural stress-reducing chemicals while improving overall health. Establishing consistent sleep patterns helps regulate mood and reduce anxiety symptoms. Practicing mindfulness or meditation can calm racing thoughts and reduce cravings. A balanced diet rich in nutrients supports both physical and mental health, while limiting caffeine and sugar can help prevent anxiety spikes. Building a strong support network of friends and family, along with maintaining structured daily routines, provides stability during recovery. Additionally, engaging in enjoyable hobbies and activities can create healthy alternatives to substance use while reducing stress and anxiety naturally.

At Eleanor Health, we believe everyone deserves an extraordinary life, free from substance use challenges. Our comprehensive care approach considers your unique experiences, culture, and values. Through medication-assisted treatment, therapy, psychiatry, peer support services, and other evidence-based services, we’re here to support your journey to lasting wellness. If you need help with mental health conditions and/or substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We are currently located in Louisiana, Massachusetts, North Carolina, New Jersey, Ohio, Texas, and Washington.