Anxiety is the most common mental health disorder, impacting 40 million American adults.
While anxiety is entirely treatable, less than 40 percent of people suffering receive treatment. Given how prevalent and treatable anxiety is—and how commonly people with substance use disorder also struggle with anxiety—we’re going to give you an overview of anxiety, how it intersects with addiction, and some of the most popular non-addictive anxiety medications.
What is anxiety?
While you might think anxiety is just feeling apprehensive, there’s actually a range of anxiety disorders with related but distinct symptoms. The Anxiety and Depression Association of America recognize these nine types of anxiety:
- Generalized anxiety disorder: Affects 6.8 million adults of the US population. This disorder has similar symptoms to panic disorder and obsessive-compulsive disorder, including persistent and excessive worry even when there is no apparent reason for concern, restlessness, and difficulty concentrating.
- Panic disorder: Affects 6 million American adults and is characterized by panic attacks
- Social anxiety disorder: Affects social interactions and causes irrational anxiety. Social anxiety disorder affects 15 million adults in the U.S.
- Specific phobias: These can be described as persistent and excessive fear of an object, person, animal, or situation. Phobias affect 19 million adults in the U.S.
- Stress: Everyone experiences stress and anxiety in their lives. The difference between stress and anxiety is that anxiety is a response to stress, whereas stress is in response to a threat. According to the American Psychiatric Association, one-third of Americans live with extreme stress and just over half of the population believe that their stress has increased over the past 5 years.
- Obsessive-compulsive disorder (OCD): Characterized by excessive orderliness, unreasonable thoughts and fears, and compulsive behaviors. OCD affects 7.7 million American adults.
- Post-traumatic stress disorder (PTSD): This disorder is typically characterized by difficulty recovering from a traumatic experience. Symptoms may include flashbacks, nightmares, feeling a sense of threat when there isn’t one, heightened anxiety, or depressed mood. PTSD is more common among women than men, and it impacts 7.7 million Americans.
- Major depressive disorder (MDD): This is the leading cause of disability in the US for people aged 15-43, affecting 16.1 million adults. Symptoms include irritability, trouble sleeping, sadness, anxiety, restlessness, mood swings, changes in appetite, isolation, crying, weight loss or gain, and ruminating.
- Persistent depressive disorder: This chronic form of depression lasts for at least two years. It affects 1.5 percent of the American population.
Do people with addiction also suffer from anxiety?
Yes. As we illustrated above, anxiety disorders affect millions of Americans. They also often co-occur with substance use disorders at a high rate. Each disorder is often a risk factor for the other, meaning those with addiction are at risk of suffering from anxiety, and those with anxiety are at risk of suffering from addiction. According to SAMHSA, people with substance use disorder are more likely to have co-occurring mental disorders, including depressive disorder, anxiety disorders, ADHD, eating disorders, and personality disorders.
Co-occurring disorders can have a significant impact on a person’s life—emotionally, physically, socially, and economically. Unfortunately, there remain treatment gaps in the behavioral health field in treatment approaches for both conditions. This makes it particularly important for addiction treatment professionals (or people in recovery) to expect mental illness at some point within recovery.
For those not in recovery, it’s important to note that certain substances can exacerbate anxiety, including alcohol, benzodiazepines, amphetamines (methamphetamine and Adderall), cocaine, and opioids. It’s not unusual for people to use these substances to self-medicate anxiety or other types of mental illness.
It’s vital that those with substance use disorder seek help for their addiction which will help reduce symptoms of anxiety.
Anxiety symptoms to watch out for
Above, we listed the main symptoms associated with each disorder. However, it’s also helpful to have a short list of symptoms to watch out for on hand:
- Restlessness/feeling on edge
- Excessive worry
- Difficulty concentrating
- Tension in your body
- Changes to sleep patterns
- Lack of tolerance/irritability
If you experience any of these symptoms, you may want to discuss them with your medical provider.
Non-addictive anxiety medications
There’s a range of anxiety medications available, but some of them (like benzodiazepines) can become addictive. It’s particularly important for people with substance use disorders to try to avoid habit-forming medications when possible. Some non-addictive anxiety medications include:
- Hydroxyzine: A non-habit forming antihistamine that has a calming and sedative effect
- SSRIs: Selective Serotonin Reuptake Inhibitors are a common type of medication used for the effective treatment of depression and anxiety. They work by increasing the neurotransmitter serotonin, which is responsible for mood. Examples of this medication include: escitalopram, fluoxetine, paroxetine, and sertraline. SSRIs are non-habit-forming and usually have minimal side effects.
- SNRIs: Serotonin and Norepinephrine Reuptake Inhibitors do the same thing as SSRIs, but also increase the chemical messenger norepinephrine, which increases alertness and arousal affecting a person’s mood and ability to focus. Examples of this medication include: duloxetine, venlafaxine, and desvenlafaxine.
- Beta-Blockers: Although not specifically designed for the treatment of anxiety, beta-blockers are often prescribed off-label to treat anxiety. They work by lowering the heartbeat and feelings of anxiousness. They are particularly helpful for specific situations, like public speaking. The most common beta-blocker available is propranolol.
- Buspirone: This medication influences neurochemical messaging of a serotonin receptor. Unlike SSRIs and SNRIs, buspirone doesn’t have some of the sexual side effects. However, it can take 4-6 weeks to achieve efficacy.
Many people find that the most effective treatment plan for anxiety is a combination of medication and psychotherapy. Your medical provider will be able to address your specific concerns and make recommendations.
Additional resources for anxiety
There are a number of helpful tools and resources available from the following organizations about anxiety disorders: