Official reports reveal that generalized anxiety disorder is the most common mental health diagnosis in Florida. And that’s just one of many subtypes of anxiety disorders that can severely impact a person’s quality of life.
The good news is that anxiety is very much a treatable condition. Yes, that’s still true even if it’s complicated by a substance use disorder.
In most cases, a thorough assessment followed by an integrated treatment approach can address both conditions effectively.
Read on to learn more about the anxiety/addiction association and the best course of action.
Is It That Common to Have Both Anxiety and an SUD?
Yes, it’s fairly common to see people with both an addiction and a mental health condition.
As for anxiety specifically, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) looked into the prevalence among people suffering from substance use disorders.
The gist of it is that people with generalized anxiety disorders are more likely to have a co-occurring addiction. However, there’s still an association between substance abuse and other subtypes of anxiety, like social phobia and panic disorder.
Here are the study’s highlights in more detail:
| Anxiety Disorders (AD) | With Any Substance Use Disorder (SUD) | With Alcohol Use Disorder | With Drug Use Disorder |
| Any AD | 17.7% | 17% | 25.3% |
| Generalized Anxiety Disorder (GAD) | 4.2% | 3.6% | 8.2% |
| Social Phobia | 4.7% | 4.2% | 7.5% |
| Panic Disorder with Agoraphobia | 1.4% | 1.2% | 2.9% |
| Panic Disorder without Agoraphobia | 2.8% | 2.8% | 4.8% |
Unfortunately, we don’t have the exact figures for Boca Raton. We do, however, have some state-level estimates from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2022–2023 state report.
SAMHSA estimates that 3,551 people in Florida suffered from a mental illness within that timeframe. Out of those, 1,345 suffered from an addiction, along with a serious mental condition.
The report doesn’t break down the estimates based on the diagnosis, though.
Anxiety and Addiction: Which Comes First?
It’s possible that one of the two conditions is causing the other. It’s also possible that they’re both the result of a deeper issue. But defining the exact relationship between the two can be incredibly complex and variable-heavy.
Still, we can explore the common scenarios.
1. Addiction-Induced Anxiety Disorders (AD)
The first scenario is that the substance use disorder came first and caused the anxiety to develop over time. And that’s not really hard to believe when you consider how drugs and alcohol can easily change brain chemistry.
For instance, drugs like cocaine, meth, Ritalin, and Adderall all stimulate the central nervous system. They essentially push your brain into overdrive, which can lead to anxiety.
Even something that people perceive to be relatively harmless, say cannabis, can spark some anxiety. Marijuana can actually cause persecutory delusions, and anxiety happens to be one of the signs of these delusions.
So, it’s possible for someone who has never suffered from anxiety to start experiencing symptoms after they develop a substance abuse habit.
Is this the most likely scenario, though? Studies say “no.”
Insights from the NESARC tell us that substance-induced anxiety has a low prevalence. Think less than 1% of all those diagnosed with both an anxiety disorder and a substance use disorder.
Granted, there are other sources that cite slightly higher estimates. It’s also worth noting that addiction-induced anxiety isn’t as well studied as other substance-induced mood disorders. But the general belief is that only a small portion of ADs are directly caused by addiction.
2. Anxiety Self-Medication That Leads to Addiction
There’s a chance that the anxiety precedes the addiction, and there’s actually greater evidence to support this idea.
One possible explanation here is self-medication that has gone wrong.
Suppose someone starts experiencing nervousness, panic attacks, trembling, intrusive traumatic memories, and a general feeling of doom. All are symptoms of anxiety.
As a result, they start drinking or taking illicit drugs to drown their fears. Maybe they even see a psychiatrist and get a genuine prescription for benzos or barbiturates.
Somewhere along the line, their drinking may get out of hand. Or they might start abusing the prescription drug by taking more than they should. Before they know it, they’ve built physical and psychological dependence and will have trouble quitting on their own.
Side Note: People with social anxiety disorders are more likely to abuse alcohol/drugs compared to people with other subtypes of anxiety.
3. A Shared Root Cause
One study focused on how likely young adults were to develop substance use disorders. The findings showed that those with anxiety disorders were 1.3 to 3.9 times more prone to addiction. You might think this supports the previous scenario. But that’s not the case here.
When the scientists controlled for risk factors like depression, peer pressure, childhood adversity, etc., they found something quite interesting: the association between anxiety and addiction was no longer statistically significant.
This indicates that the two conditions share some risk factors. If someone is prone to anxiety, they might be prone to substance abuse as well. In the “wrong” environment, both conditions can be triggered.
Is Regular Addiction Rehab Enough in This Case?
It is technically possible for the anxiety symptoms to improve when the person starts treating their substance use disorder.
Unfortunately, that’s not always the case, and you can’t really bet on that happening. For one, some experts believe that anxiety disorders can interfere with the rehab program and vice versa.
The best course of action is often dual diagnosis treatment that acknowledges the existence of both a mental health condition and an addiction. In fact, this is the approach that SAMHSA currently recommends.
5 Core Components of Integrated Care
Integrated care is often the recommended treatment option for people with both anxiety and a substance use disorder. Fortunately, the majority (66%) of dual diagnosis patients prefer it as well.
Here’s what makes a successful integrated treatment approach:
1. Individualization
A key consideration of integrated care is personalization. After all, not all anxiety diagnoses are the same. And, of course, not all addictions are equal.
Let’s put things into perspective.
If you were to take all the variable combinations of anxiety disorders and SUDs into consideration, you’d end up with about 50 discrete treatments. The estimate goes even higher when you consider that some people experience a range of ADs throughout their lifetime.
That’s why healthcare professionals have to get to the specifics and tailor the treatment plan to each client’s needs.
2. Simultaneous Treatment
Some addiction treatment professionals may resort to sequential treatment. This means that they’ll tackle the substance use issue first with detox, an inpatient program, and outpatient psychotherapy services before addressing the mental health aspect.
However, dual diagnosis treatment is built on the idea that treating both conditions at the same time improves outcomes. That’s why simultaneous integrated treatment can be the ideal approach.
Together, addiction treatment teams and mental health professionals pick from a number of therapeutic interventions, including (but not limited to):
- Individual therapy
- Prolonged exposure therapy
- Cognitive behavioral therapy (CBT)
- Eye movement desensitization and reprocessing (EMDR)
- Group therapy
- 12-Step programs
- Teletherapy
- Medication management
2. Multi-faceted Teams
Keep in mind that it’s not enough to simply run two treatment plans (one for the SUD, the other for the AD) in parallel. You want the two treatments to intertwine, with the care teams on either side communicating on what’s best for the patient.
For that to happen, you want a dual diagnosis program with an interdisciplinary team that has extensive experience in the physical and psychological aspects of dual diagnosis cases.
Some of the professionals that may be included in the care team are:
- Addiction medicine physicians: Craft tailored treatment plans
- Nurse practitioners: Monitor vitals, administer medications, and track compliance
- Therapists and licensed clinical social workers (LCSWs): Hold therapy sessions
- Psychiatrists: Prescribe drugs needed for medication management when needed
- Case managers: Link team members and anchor the collaborative care approach
3. Shared Location
The early months of recovery can be particularly hard. To make it easier for patients, it helps to combine both the SUD and the anxiety treatment services in one location.
This way, you can boost compliance rates and help people stick to the program.
5. Dual Diagnosis Awareness
We’ve covered how it’s best that everyone on the care team stays informed about the treatment plan. The same applies to the patient and their loved ones.
Staff members can educate the patient on anxiety and addiction, letting them know how the two conditions may interact. As for family members, they can attend therapy sessions to discuss their role and address any concerns they may have.
Dual Diagnosis Treatment at RBHN
Recreate Behavioral Health Network (RBHN) is a Joint Commission-accredited, LegitScript-certified treatment provider headquartered in Boca Raton.
Multi-Faceted, Whole-Person Approach
RBHN adopts a specialized approach. Our experts don’t just treat the anxiety or the substance use issue. They look at the person as a whole, giving each client the best chance for lasting recovery.
Experienced Professionals Working as a Team
We take pride in how our medical and clinical professionals work as one team.
Our team includes social workers, board-certified psychiatrists, emergency medicine physicians, and addiction medicine physicians. And they all come together to form the best treatment plan for every addiction and each subtype of anxiety.
Levels of Care That Cater to Different Recovery Needs
Multiple facilities across the state operate under the Recreate Behavioral Health Network. Each facility offers a range of specialized services. Together, they offer a full continuum of care.
The levels of care offered in our Boca Raton facility include:
- Residential Programs: Ideal for people with intense anxiety or SUDs that require round-the-clock monitoring.
- Partial Hospitalization Programs (PHPs): Offer Structured treatment with a bit more independence than inpatient/residential programs.
- Intensive Outpatient Programs (IOPs): Help clients continue recovery as they practice their newly acquired skills in everyday life.
- Evening IOPs: Work well for patients who have to tend to daytime responsibilities (work, school, childcare, etc.).
- Standard Outpatient Programs: Made for clients who can transition to less rigid structures as they have more control over their anxiety and cravings.
Explore Your Treatment Options in Boca Raton
Dealing with an anxiety disorder alone is hard enough. Adding a substance use problem to the mix can make treatment seem unattainable.
But recovery is possible.
Reaching out for help is the first step. Don’t hesitate to contact our team with any questions or inquiries.
