Substance/Medication-Induced Anxiety Disorder

The symptoms of substance-induced anxiety disorder can be challenging to differentiate from other types of anxiety disorders. To qualify, these symptoms must not be present before substance use or continue longer than a month after substance use. 

Common physiological symptoms of substance-induced anxiety disorder include:

• Tightness in the chest, chest pain
• Shortness of breath
• Abdominal pain, nausea
• Heart palpitations
• Sweating
• Trembling
• Faintness

Common psychological or cognitive symptoms of substance-induced anxiety disorder include:

• Difficulty concentrating
• Fear or dread
• Excessive worry that doesn’t fit the situation 
• A sense of being “on edge” or jumpy
• Pacing
• Agitation or irritation

To be classified as a substance-induced anxiety disorder, these symptoms must cause distress,³ as well as interfere with daily function and socialization.

There are various substances, both legal and illegal, that can cause substance-induced anxiety disorder. Certain hallucinogens like MDMA, PCP, LSD, and ketamine can cause anxiety, especially during withdrawal. Stimulants like cocaine commonly cause anxiety during or after use. Alcohol, cannabis, and tobacco may also be contributors. Caffeine in significant amounts may also induce anxiety. 

Certain prescribed medications can also cause symptoms of anxiety. For example, opioids, sedatives, corticosteroids, and barbiturates may have anxiety as a side effect. Non-prescription medication, even used in a responsible manner, can create anxiety symptoms. Decongestants and antihistamines fall into this category.

Finally, volatile chemical substances can cause an anxiety reaction. There are hundreds of industrial compounds that people inhale (huff) for recreational purposes or to which a person may be accidentally exposed. For example, someone painting in an enclosed, unventilated space may find themselves experiencing substance-induced anxiety. 

Risk factors

Some individuals have a higher risk of developing substance-induced anxiety. Risk factors could include the following: 

• Genetic or biological factors: People in families with substance use disorder may be at greater risk of developing a substance-induced disorder (SID) and becoming at risk for substance-induced anxiety. 
• Environment: Individuals who experience trauma in developmental years, such as sexual, physical, or mental abuse, are more likely to develop a substance use disorder (SUD) and may also experience a higher risk of increased anxiety during and after using. 
• Presence of other mental health conditions: This risk factor may be complicated for a diagnosis when trying to untangle conditions that are co-occurring with substance use as opposed to being caused by substance use. 
• Industrial work: People who work around volatile chemicals have a higher risk of exposure and may develop symptoms. 
• Those with pre-existing medical conditions: People who require certain prescription medications can be subject to developing substance-induced anxiety. 

Treatment for substance-induced anxiety includes a combination of medical treatment, therapy, and group support. In some instances, avoiding exposure to the offending substance can be enough to treat the condition, such as cases of accidental chemical exposure or prescribed medication. However, in cases of a substance use disorder, more in-depth treatment may be necessary. 

Medications

A healthcare professional may work with clients on modifying the medication regimen if they find that their current regimen is contributing to substance-induced anxiety. If the anxiety is being caused by substances other than prescribed medications, then treatment for use of those substances is usually indicated. These medications used can vary widely depending on the substance used and the symptoms experienced. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

For individuals who experience substance use disorders, inpatient or outpatient detox programs may be helpful to begin the process of sobriety. Sober houses and group therapy may also be recommended depending on the severity of the disorder. 

Support groups are another standard treatment for substance use disorders. These groups might be found in 12-step programs or community support centers offering peer socialization and activities. 

Self-care

A therapist treating clients with substance-induced disorders may work with them on establishing lifestyle habits that can regulate mood and support a healthy body. These habits may include the following: 

• Establishing a healthy sleep routine
• Avoiding situations and people associated with using substances 
• Eating nutritious, well-balanced meals
• Getting regular, moderate exercise 
• Becoming involved in interesting or enjoyable hobbies  
• Maintaining a strong, healthy social group

In cases of substance-induced anxiety, CBT is often a first-line treatment. A licensed therapist can partner with a client to establish coping mechanisms that shift patterns of thought and behavior into healthier and more positive channels. The therapist may also train their client on healthy lifestyle habits and stress management techniques. 

In some geographical regions, specialization in therapy can be scarce. In some places, there may be no licensed therapists with experience in substance-induced anxiety. In others, options may be limited. Online therapy may address these disparities by offering the potential for therapy sessions to anyone with an internet connection. With online therapy platforms like BetterHelp, an online questionnaire matches you to a licensed therapist who meets your needs. Therapy sessions are conducted via phone, live chat, or video. 

Below are several resources for those who are interested in learning more about substance-induced anxiety and treatment:

• The US Department of Health and Social Services 
• 988 Suicide and Crisis Hotline
• National Institute on Drug Abuse (NIDA) 
• Substance Abuse and Mental Health Services Administration (SAMHSA) 

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Robust research on substance-induced anxiety disorder does not exist. According to a 2020 review of prospective research into substance-induced anxiety and depressive disorders, the causality and correlation between mood disorders and substance use can be unclear. Co-occurring mental health conditions are extremely common in substance use disorders, and pinpointing whether the anxiety is due to self-medication, a common genetic or environmental factor, or caused by the use of a substance itself can be challenging to determine.

Below are several statistics related to substance use disorders and anxiety: 

• While close to 30% of Americans are estimated to experience an anxiety disorder in their lifetime, 20% of those individuals diagnosed with an anxiety disorder also have a substance use disorder.
• Generalized anxiety disorder (GAD) and panic disorder⁵ are the two types of anxiety disorder that have the highest association with SUDs.
• Both anxiety disorders and substance use disorders are among the most common mental health disorders in the US, at 28.8% and 14.6%, respectively.
• In one survey from 2023, 20.9 million adults who have ever had a substance use challenge reported themselves as “recovering” or “in recovery.”