Anxiety Disorder and Substance Use: Signs Families Should Know and Treatment Options

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

Worry is a normal emotion that arises when we face uncertainty, problems, or important events. But anxiety disorder differs from ordinary worry in that the fear or worry is excessive, persistent, hard to control, or occurs in situations that are not actually as dangerous as they feel — to the point that it disrupts sleep, school, work, relationships, and daily life.

Some people experience a racing heart, shortness of breath, chest tightness, trembling hands, sweating, dizziness, or a feeling of being about to faint or lose control. Others don’t have severe episodes like these but instead feel continuously anxious, ruminate, anticipate bad outcomes, and find it hard to relax.

When anxiety disorder occurs alongside substance use, the picture becomes more complicated, because certain substances can produce symptoms resembling anxiety or panic. At the same time, some people begin using alcohol, cannabis, sedatives, or other substances to try to reduce their anxiety, help them sleep, or feel brave enough to socialize.

Families should therefore avoid jumping to conclusions such as “they’re just overthinking it” or “it’s only the drugs,” because anxiety symptoms may appear before substance use begins, may result from the drug’s effects or withdrawal, or may involve both problems together. Clarifying these relationships helps a treatment plan target the real problem more precisely.

What Are the Symptoms of Anxiety Disorder, and When Should It Be Assessed?

Anxiety disorder does not take a single form. Some people worry continuously about many things in life, some fear social situations, some fear specific situations, while others experience panic attacks — sudden, intense fear along with physical symptoms.

Symptoms families may notice include:

Excessive worry that is hard to stop thinking about
Ruminating over events that haven’t happened yet and usually expecting the worst outcome
Restlessness, feeling tense, or finding it hard to relax
Being easily irritated
Reduced concentration because of constant worry
Difficulty falling asleep, disrupted sleep, or waking up and overthinking
A racing or pounding heart
Chest tightness or a feeling of not being able to breathe fully
Trembling hands, sweating, or hot flashes
Dizziness, nausea, or a feeling of being about to faint
Fear of losing control when symptoms occur
Avoiding places, people, or situations that cause worry
No longer feeling able to travel, be alone, or socialize as before
Using alcohol, sleep medication, or other substances to calm oneself down

Feeling anxious does not always mean someone has a disorder. What matters is the severity, persistence, ability to control it, and impact on life. If anxiety keeps someone from going to work, prevents them from leaving the house, disrupts sleep continuously, or requires relying on a substance just to get through each day, a professional assessment is warranted.

Can Yaba, Ice, Cannabis, and Withdrawal Cause Symptoms That Look Like Anxiety Disorder?

Yes. Many psychoactive substances can cause anxiety symptoms — while using, after the effects wear off, and during withdrawal.

Stimulants such as yaba, ice, and cocaine can cause a racing heart, heightened alertness, restlessness, trembling hands, insomnia, and feelings of suspicion. When physical symptoms are severe, the person may feel as though they are having a panic attack or facing a serious threat to their own safety.

If stimulant use continues along with prolonged sleep deprivation, anxiety can intensify into paranoia, hearing voices, or other psychotic symptoms.

Cannabis may make some people feel relaxed, but in others it causes a racing heart, anxiety, fear, or panic-like symptoms, especially at higher doses or in people who are sensitive to its effects.

Caffeine and other stimulant-containing drinks can also cause a racing heart, trembling hands, insomnia, and increased anxiety in people who are sensitive to them, even though they are not illegal drugs.

Another factor is withdrawal. Someone who has used alcohol or certain sedatives continuously may experience anxiety, restlessness, trembling hands, a racing heart, and insomnia when they stop or reduce use. With heavy, continuous use, suddenly stopping certain substances can carry medical risk, so severe withdrawal symptoms should never be managed on one’s own.

For this reason, diagnosis must consider when the anxiety symptoms began, whether they occurred before substance use started, whether they occur only after using or during withdrawal, and how symptoms change after stopping use.

Why Do People With Anxiety Sometimes Use Alcohol or Drugs to Self-Medicate?

For someone living with continuous anxiety, discovering that a substance temporarily makes them feel calmer or less afraid can easily lead to repeated use.

For example, someone who fears social situations may find that after drinking alcohol they feel braver about talking to others. Someone who overthinks before bed may start using alcohol or sleep medication to fall asleep more easily. Someone who feels tense all day may use cannabis or another substance to feel more relaxed.

In the short term, the person may feel the substance is “helping” and may not see themselves as having a substance problem at all.

But once the brain learns “when anxious, use the substance,” other ways of coping with anxiety can gradually decline. Some people begin needing to use more often, using before every social situation, or feeling they cannot sleep or do certain activities at all without the substance.

A cycle can develop: feeling anxious leads to using; using brings temporary relief; but once the effect wears off, sleep worsens, anxiety increases, or problems from the substance use arise — leading the person back to using again to relieve those feelings.

Over the long term, what began as an attempt at self-help can become two reinforcing problems: anxiety drives the urge to use, and the effects of substance use make anxiety, sleep, health, and life problems worse.

How Is Anxiety Disorder Treated When It Occurs Together With Addiction?

Treatment should assess both anxiety symptoms and substance use at the same time. There is no need to wait until substance use has fully stopped before starting mental-health care, and anxiety should never be treated without asking about alcohol, sleep medication, cannabis, stimulants, or other substances being used.

The care team will ask when the anxiety began, in what situations it occurs, whether it occurred before substance use started, what substance is used, in what amount and how often, and how symptoms change when the person is not using.

Sometimes symptoms need to be tracked continuously after the drug’s effects wear off or after withdrawal, because assessing someone who has just used or is currently withdrawing may not yet clearly show whether all the symptoms are due to anxiety disorder.

A racing heart or chest tightness should not automatically be assumed to be a panic attack every time, because these symptoms can also come from a physical illness or a substance’s effects. In particular, severe chest pain, loss of consciousness, abnormal breathing, or other unusual physical symptoms call for a medical assessment.

Using Psychotherapy to Learn to Cope With Anxiety Without Relying on Substances

Cognitive behavioral therapy is one of the key approaches to treating anxiety disorder. It helps the person in treatment notice the thoughts that increase their fear, understand their body’s responses, and gradually change how they respond to situations they used to avoid.

For someone with co-occurring substance use, therapy must also help reveal the cycle between anxiety and substance use, such as:

“Before being around a lot of people, I’m afraid I’ll say something wrong, so I have to drink first every time. Once I’ve had a drink I feel braver, which makes me believe even more that I can’t socialize without it.”

“At night I overthink and worry I won’t be able to sleep, so I use medication to force myself to sleep — until eventually I feel I can’t sleep at all without it.”

Treatment therefore does more than simply remove the substance — it helps build new skills so the person can live with anxiety and manage it without relying on a substance as the main coping method.

Using Medication for Anxiety Disorder When Indicated

Certain types of anxiety disorder can be treated with medication. A psychiatrist will consider the nature of the disorder, its severity, substance-use history, current medications, other medical conditions, and each person’s individual risks.

Some classes of medication used to treat anxiety disorder take a period of time before they show an effect, and do not make anxiety disappear immediately after a single dose.

For someone with a history of substance use, medication choice requires special caution, particularly with certain anti-anxiety medications or sleep medications that can lead to dependence if used inappropriately. Medication should never be bought, obtained from someone else, increased in dose, or stopped without medical guidance.

If a medication in a class that can cause withdrawal has been used for a long period, stopping it suddenly may not be safe. A doctor should assess and plan treatment individually.

Restoring Sleep and Reducing the Cycle of Avoidance

People with anxiety often begin avoiding what they fear — not leaving the house, not traveling, not meeting people, not speaking in front of others, or avoiding situations where panic has occurred before. Avoidance can bring immediate relief, but over the long term it can keep the fear in place and let it spread to other situations.

Treatment therefore helps someone gradually return to facing situations at an appropriate pace, rather than forcing them to confront what they fear all at once.

Sleep is another area that needs attention, because anxiety makes it hard to sleep, while insufficient sleep reduces the ability to manage emotions. Setting consistent sleep and wake times, reducing stimulants, and reducing reliance on substances to help with sleep are all part of recovery.

What Should Families Say When Someone With Anxiety and Substance Use Won’t Admit There’s a Problem?

Sometimes it’s clear to the family that the person needs to drink every time before socializing, is using more sleep medication, or uses cannabis almost every time they’re stressed — but the person themselves may feel this is simply what helps them get through life.

Saying things like “just stop overthinking,” “there’s nothing to be scared of,” or “just quit the drug and it’s over” usually doesn’t help, because the person is genuinely experiencing fear or discomfort, even if people around them see the situation as not actually frightening.

Families should start from what they observe, such as, “Lately we’ve noticed you need a drink almost every time before going out to see people — we’re worried that if there’s no alcohol one day, it’ll become even harder for you to go anywhere.”

They might then ask, “What is the anxiety like when you’re not using?” “What does the substance help with in that moment?” and “Has anything started becoming a problem since you’ve needed to use more often?”

Questions like these help the person explore both the short-term benefit they feel and the longer-term harm, without needing to start by forcing them to accept that they have anxiety disorder or an addiction.

If the person is not yet ready for treatment, families can consult a specialist first, to help distinguish ordinary worry from something that needs assessment, and to work out how to set boundaries around substance use.

Outpatient or Residential Treatment: Which Is Right for Anxiety Disorder With Substance Use?

Not everyone with anxiety disorder needs residential treatment. If someone can still function in daily life, is safe, has no withdrawal symptoms requiring close monitoring, and can attend follow-up treatment, outpatient care is usually a suitable starting point.

Anyone with anxiety, panic attacks, insomnia, or co-occurring use of alcohol, cannabis, sleep medication, or other substances can start with an outpatient assessment at Piti Clinic, our mental-health clinic on Pradiphat Road, Saphan Khwai, Bangkok, to assess psychological symptoms, patterns of substance use, sleep, and any co-occurring conditions.

Families can also come in for a consultation first if the person is not yet ready, particularly when it’s unclear whether the anxiety they’re seeing is related to substance use or is a pre-existing mental-health condition.

If there is clear co-occurring addiction, an inability to stop using in the same environment, repeated relapse, using a substance to control anxiety almost every day, significant disruption to sleep and daily life, or multiple co-occurring psychiatric conditions, residential treatment may be an option worth considering.

Treating Anxiety Disorder and Addiction Together at Day One Rehabilitation Center

Someone with anxiety disorder together with addiction should have both problems addressed at the same time, because if substance use stops but the person still cannot manage their anxiety, they may return to using when facing stress or familiar situations again. Conversely, if anxiety is treated but substance use continues, the drug’s effects and withdrawal symptoms can make the psychological symptoms even harder to manage.

At Day One Rehabilitation Center, the care team assesses the type and pattern of substance use, withdrawal symptoms, anxiety, sleep, physical symptoms, psychiatric treatment history, and any co-occurring problems, in order to plan treatment suited to each individual.

Residential treatment reduces access to substances in the early stage and allows symptoms to be monitored continuously after stopping use. A psychiatrist can assess the need for medication when indicated, while individual and group therapy help the person in treatment learn to manage anxiety, cravings, triggers, and avoidance behavior.

Recovery also places importance on sleep, exercise, a consistent daily routine, and preparing a plan for coping before returning to the person’s usual environment.

The goal is not simply to feel calm during treatment at the center, but to help the person in treatment face stress, fear, and uncertainty in life without needing to rely on a substance as the main way of coping.

Frequently Asked Questions About Anxiety Disorder and Substance Use

Do a racing heart, shortness of breath, and chest tightness always mean a panic attack?

Not always. These symptoms can occur in panic attacks, but they can also come from stimulants, caffeine, a physical illness, or other causes. If symptoms are severe, occur for the first time, or come with other unusual physical symptoms, a medical assessment is needed.

Can yaba and ice cause anxiety or panic attacks?

Yes. Stimulants can cause a racing heart, trembling hands, restlessness, insomnia, and feelings of fear or suspicion, which can resemble or trigger panic attacks.

Does cannabis help reduce anxiety?

Cannabis affects people differently. Some may feel temporarily relaxed, while others experience a racing heart, more anxiety, fear, or even panic-like symptoms. Cannabis should not be used as a self-directed treatment for anxiety disorder.

Is drinking alcohol to feel brave enough to socialize a problem?

Occasional drinking does not automatically mean alcohol dependence. But if someone starts feeling they must drink every time before socializing, needs increasing amounts, or cannot face situations without alcohol, both the anxiety and the drinking pattern should be assessed.

Can anti-anxiety medication become addictive?

Certain classes of anti-anxiety medication carry a risk of dependence if used inappropriately, especially with continuous use or self-adjusted dosing. Anyone with a history of substance use should tell their doctor directly, so a safer and more suitable treatment approach can be chosen.

For someone with anxiety disorder and addiction, which should be treated first?

In many cases, both should be addressed at the same time, prioritized according to safety, intoxication or withdrawal symptoms, the severity of the anxiety, and any co-occurring physical or psychiatric conditions.

Can anxiety disorder be treated?

Yes, anxiety disorder can be treated and its symptoms managed. Approaches may include psychotherapy, medication when indicated, adjustments to sleep and daily routine, and reducing or stopping substances that trigger symptoms, all as part of a treatment plan.

Do anxiety disorder and addiction require residential treatment?

Not for everyone. Someone with uncomplicated symptoms can start with outpatient treatment. But if there is co-occurring addiction, an inability to stop using, repeated relapse, withdrawal symptoms that need monitoring, or an environment that makes recovery difficult, residential treatment at Day One Rehabilitation Center may be a suitable option.

Anxiety Disorder and Addiction Can Be Treated Together

When someone feels afraid, anxious, or caught in constant rumination, using a substance to feel calm, fall asleep, or feel brave enough to socialize may seem like the fastest solution at first. But if a person has to rely on a substance every time anxiety arises, the problem can gradually develop into a cycle that makes both their mental health and their substance use more complicated.

Treatment therefore should not stop at telling someone “stop overthinking” or “quit the drug first.” It should instead find out what is driving the anxiety, how it relates to substance use, whether other physical or psychiatric conditions are present, and what need the person is trying to meet by using.

When anxiety and substance use are treated together as connected problems, the person in treatment can gradually build ways of coping with stress, fear, insomnia, and situations they used to avoid, without needing to fall back on a substance every time they feel uncomfortable.

Families do not need to wait until the person accepts that they have anxiety disorder or an addiction before asking for help. Starting from the symptoms that are already disrupting life and inviting the person to get an assessment can be the beginning of a more cooperative course of treatment.