Discovery Guides Areas


Both Barrels:
The Devastating Comorbidity of Anxiety Disorders and Substance Abuse

(Released May 2012)

podcast link 
  by J. Erick Sinkhorn  


Key Citations




Diagnosis & Treatment


A dual diagnosis is made when an individual is dealing with a mental health problem as well as an addiction. Many people with chemical dependencies also suffer from conditions such as depression or anxiety. Making a dual diagnosis in substance abusers is difficult, as drug abuse itself often induces psychiatric symptoms. This makes it necessary to differentiate between a substance-induced mental illness and a preexisting one.

Physical and mental health evaluations can be performed to diagnose substance-induced anxiety disorder. Doctors will ask about symptoms, about drugs, alcohol, and other substances the patient takes, and the patient’s habits surrounding them. Tests performed on blood and urine can tell the type and quantity of substances in the person’s body, which can help indicate whether or not this is the likely cause of anxiety symptoms.

Substance-induced anxiety disorder should, in theory, be easy to resolve: Remove the substances causing the anxiety and the anxiety disappears. But this condition requires professional, medical treatment. Once the substance causing the anxiety has been identified, it will have to be stopped under controlled circumstances. A careful diagnosis and continued monitoring can help ensure that symptoms related to drug abuse, like intoxication or withdrawal, are not mistaken for a discrete mental disorder.

The frequency with which anxiety disorders and substance abuse co-occur and the symbiotic relationship between the two conditions demonstrate the need for a comprehensive approach to treatment. Patients with a dual diagnosis commonly exhibit more severe symptoms than those who experience either disorder alone. This fact underscores the need for an integrated treatment plan that can disentangle these conditions and evaluate them, both separately and in relation to one another. The most effective plan is one that identifies, evaluates, and addresses the disorders simultaneously ("Comorbid Drug Abuse and Mental Illness," NIDA).
dual diagnosis capability
A map showing the states that depicts the implementation of the Dual Diagnosis Capability in Addiction Treatment (DDCAT) across the U.S.

Yet this approach can be difficult to implement in practice. In part, because the systems in place to treat substance abuse and mental illness are typically disconnected. Individuals with mental illnesses are usually treated by doctors, whereas those with drug abuse problems receive services from a mix of providers with varying backgrounds.

In addition, some substance abuse treatment providers are biased against the use of any medications, including those necessary to treat patients with severe mental disorders. This approach can inhibit effective therapy. Clinicians and researchers generally agree that broad-spectrum diagnosis with concurrent therapy—a combination of pharmacological and behavioral treatment—lead to better outcomes for those with comorbid disorders.

It is important that the patient learn coping strategies and methods by which he or she can manage some anxiety without the use of medications or substances. To this end, the use of nonpharmacologic treatments can be maximized in individuals with substance abuse disorders. Psychotherapy and cognitive behavioral therapy (CBT) can enable patients to understand their motivation to abuse and the underlying problem(s) they are trying to mask with their behavior. CBT in particular has demonstrated efficacy in the treatment of a number of anxiety disorders and can be considered an effective compliment to drug treatment.

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