The Collision of Anxiety and Addiction


Chapter 15: Psychological Disorders

Learning Outcomes

  • Describe the symptoms and diagnostic criteria for anxiety and substance use disorders
  • Identify how comorbidity complicates diagnosis and treatment
  • Evaluate the role of coping mechanisms and risk factors in the development of co-occurring disorders

Key Terms

comorbidity
co-occurrence of two disorders in the same individual
generalized anxiety disorder
characterized by a continuous state of excessive, uncontrollable, and pointless worry and apprehension

The Escape That Became a Trap

Ava, a college senior, had always been a bit anxious. Group presentations made her palms sweat, and crowded events left her drained. But during her junior year, things escalated. She began experiencing panic attacks before exams and avoided social situations entirely.

To cope, Ava started drinking, first just on weekends and then more frequently. "It helps me relax," she told her roommate. "I'm just taking the edge off."

A person looking unsettled and drinking alcohol

But soon, the drinking wasn't just about stress. Ava began using alcohol to sleep, to study, and to get through the day. Her grades slipped, and she withdrew from her extracurriculars. She frequently blacked out on the weekends, but after it made her miss a final, Ava finally visited the student health center.

The counselor conducted a full assessment and diagnosed Ava with generalized anxiety disorder and alcohol use disorder. She explained that these conditions often co-occur, and one can worsen the other. "You're not just dealing with anxiety or addiction," she said. "You're dealing with both, and they're feeding into each other."

Ava began integrated treatment, combining cognitive-behavioral therapy with substance use counseling. She learned to identify her triggers, challenge anxious thoughts, and develop healthier coping strategies.

A group of people in a group therapy session

"I thought I was just stressed," Ava said during a group session. "But I was using alcohol to avoid my anxiety, and it made everything worse."

Recovery wasn't easy. Ava faced setbacks, but with support, she began to rebuild her routine, reconnect with friends, and regain confidence.

Explore the Concept

Check out this video that explains how alcohol affects the brain and how it can actually worsen mood disorders over time.

1. On Your Own

What describes comorbidity in psychological disorders? Select the best answer.

When Disorders Overlap

Two overlapping circles

There is a complex relationship between anxiety and substance use disorders. Individuals with anxiety are more likely to use substances as a form of avoidance coping. Over time, this can lead to dependency and worsen anxiety symptoms.

Key aspects of the relationship between anxiety and substance use disorders include the following:

  • Anxiety often precedes substance use.
  • Substance use can mask or intensify anxiety symptoms.
  • Comorbidity leads to poorer treatment outcomes if not addressed holistically.
  • Integrated treatment improves recovery rates.

Early intervention is key, and clinicians need to assess for multiple disorders, especially when substance use is present.

2. On Your Own

Determine whether the following statement is true or false.

Comorbidity refers to the presence of two or more psychological disorders in the same individual.

From Numbing to Navigating

In therapy, Ava practiced mindfulness and journaling. She learned to sit with discomfort instead of numbing it. She also joined a recovery group on campus, where she met others navigating similar challenges.

One of Ava's journal entries read: "I used to drink to feel normal. Now I'm learning what normal actually feels like." Ava still experienced anxiety, but she no longer relied on alcohol to manage it.

3. On Your Own

What are common challenges in treating comorbid anxiety and substance use disorders? Select the three that apply.

Reflect & Respond

Answer the following questions to reflect on key ideas from the case study. Remember to print your work before leaving this page!

  1. Why might individuals with anxiety turn to substances as a coping mechanism?
  2. What are the risks of treating only one disorder when comorbidity is present?
  3. How can integrated treatment improve outcomes for individuals with a comorbid disorder?
  4. What role can peers and campus resources play in supporting recovery?
  5. Why is it important to treat co-occurring disorders together rather than separately?

References

Hinckley, J. D., Adams, Z. W., Dellucci, T. V., & Berkowitz, S. (2024). Co-occurring trauma- and stressor-related and substance-related disorders in youth: A narrative review. Medical Research Archives, 12(8). https://doi.org/10.18103/mra.v12i8.5688
This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0).

Therapy in a Nutshell. (2022, December 22). The surprising way alcohol makes your brain more anxious [Video]. YouTube. https://youtu.be/sHsBHgwTexM?si=0-v3HWEpSBJwj7_Q

Photo Credits

Pixel-Shot on Adobe Stock. "Young drunk woman in office. Concept of alcoholism."

bernardbodo on Adobe Stock. "Group therapy session of multiracial group of people."

Budi on Adobe Stock. "Two overlapping circles in shades of green against a pastel green background."