People suffering from anxiety disorders are almost twice as likely to abuse drugs and alcohol than their counterparts.1 Teenagers may be especially vulnerable, as the adolescent brain is still developing, making them more likely to give in to impulses and turn to drugs.1 Learn more about the symptoms of co-occurring anxiety and drug abuse in teens, and how to spot them in your own child. There are evidence-based treatment methods for both disorders, and a variety of treatment program settings that offer such therapies.
Anxiety in Teenagers
According to the National Institute of Mental Health, 25% of teens experience general anxiety, and nearly 6% experience a severe anxiety disorder.2
Anxiety is a normal, natural, and useful emotion that everyone experiences from time to time. It can help people recognize signs of danger or threat so that they can take action accordingly and seek safety. A certain amount of anxiety can also be a great motivator. For example, feeling anxious about an upcoming test or sporting event encourages people to study or practice to improve performance. But, when anxiety occurs on a regular basis and even simple daily activities become a perceived threat, it can have detrimental effects on a person’s life.
For some teens, chronic or severe anxiety is a daily reality. Normal activities such as attending school, going to work, and engaging in social or extracurricular activities can cause feelings of unease or panic. This anxiety can have many negative consequences, from poor academic performance and social difficulties, to more life-threatening problems such as drug and alcohol use, self-harm, and/or suicide attempts.
The pressure to succeed academically and fit in with peers is just one of many reasons a teenager might experience anxiety. Other contributing factors include:
- Major life adjustments: Transitions such as moving, parental divorce, illness, and loss of a loved one can cause situational anxiety in teenagers. Without the appropriate coping skills and emotional support, it can be tough to get through these big life changes. Some teens may develop chronic anxiety in association with life-stressors such as these.
- Social media: Teens are more connected than ever thanks to social media. A significant part of their lives is spent behind a screen, and there are many ways this can contribute to anxiety. A teen who spends all of their time on social media may have anxiety over real social interactions. So, while in some ways it makes people more connected, in other ways it makes people more disconnected, isolated, and lonely. Social media increases the pressure to be liked, creates a fear of missing out (also referred to as “FOMO”), and makes it easier to compare oneself to others.
- Bullying: The way teens bully one another has changed. Social media makes it easy for kids to engage in cyberbullying by giving them the freedom to say hurtful things without even seeing the person’s face, sometimes even doing it completely anonymously. Additionally, teens today can’t necessarily leave the bullies behind the school’s doors.
- Unstable home environment: Children grow up at the mercy of their caregivers with little control of their environment. Teen anxiety is common in situations where there is domestic abuse, substance abuse, and/or poverty at home.
- Genetic predisposition and brain chemistry: Regardless of external circumstances, some people are just more genetically predisposed to anxiety than others. Brain chemistry can determine how well a person responds to stress. A person with little resiliency may develop an anxiety disorder in the face of relatively ordinary life challenges, while someone with more serious problems may bounce back more quickly.3
While anxiety is quite common in teens, it can be hard to spot, as teens don’t typically express their feelings in the same way an adult would.
They’re not likely to just come out and tell you how they feel. Introverted teens may keep to themselves and suffer in silence, while more outgoing teens may act out and be labeled as defiant or oppositional as a result.
Symptoms of anxiety can be severe enough to interfere with day-to-day activities at school and at home, and can include:4
- Difficulty concentrating.
- Elevated heart rate.
- Muscle tension.
- Sleep disturbances.
Anxiety disorders are among the most common mental health disorders in the United States.2 Depression and anxiety are closely related, and they are often co-occurring. Anxiety is lurking underneath many other common mental health issues and may manifest itself in different forms such as phobias, panic attacks, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).2
Co-Occurring Drug Abuse
When 2 mental health disorders occur at the same time, either simultaneously or sequentially, they are referred to as comorbid or dual diagnosis conditions. Having more than one condition impacts the development, prognosis, and management of each disorder.1
Having a dual diagnosis of substance use and a mental health disorder like anxiety or depression can be especially challenging for teenagers. They may begin using drugs or alcohol to self-medicate their mental health symptoms, or to try to forget about the factors in their life that are contributing to those symptoms.
Some teens may abuse medications that are prescribed to treat a mental health condition. Some medications prescribed to manage acute bouts of anxiety, such as benzodiazepines, can themselves contribute to addiction if they are misused in higher and/or more frequent doses than prescribed.
Anxiety and addiction are often intertwined, with the presence of either one being a risk factor for the other disorder. Research has shown that anxiety predates substance abuse in 75% of dual diagnosis cases involving anxiety and substance abuse.5
Teens may be at a higher risk of acting on impulse and making poor decisions, such as using drugs, because the adolescent brain hasn’t fully developed yet. The prefrontal cortex—the area of the brain responsible for making decisions and regulating emotions—is still maturing. Early drug use also increases the risk of later substance abuse and mental health disorders in adulthood. The converse also appears to be true—some childhood or adolescence mental health issues can increase the risk of later drug abuse problems.1
Some signs that a teen might be abusing drugs include:6
- Sudden changes in behavior.
- Unexplained fatigue.
- Withdrawal from social interactions.
- Changes in their group of friends.
- Skipping class.
- Falling grades.
- Changes in sleeping and eating habits.
- Poor hygiene.
- Increased conflict with others.
Treating Both Disorders
As part of a dual diagnosis treatment strategy, it is crucial to address both the teen’s anxiety and their substance abuse, as both disorders can feed off one another.
Anxiety can lead a teen to relapse and use drugs or, on the other hand, using drugs can cause or worsen existing anxiety. To more effectively treat both disorders, treatment must look at the root cause of anxiety and substance abuse and provide alternative coping skills to help manage anxious feelings and triggers to drug use.
There are a variety of evidence-based therapeutic methods used in treating co-occurring teen anxiety and substance abuse. These include:7
- Cognitive behavioral therapy (CBT): Cognitive behavioral therapy is perhaps the most widely used treatment method for any mental health condition. CBT helps people recognize the connection between their thoughts and behaviors, identify distorted thinking, learn how to change maladaptive thought patterns, and develop coping skills to avoid problematic behaviors.
- Exposure therapy: Exposure therapy is a behavioral treatment used primarily in the treatment of anxiety and post-traumatic stress disorder (PTSD). It works by repeatedly exposing patients to a painful memory, traumatic event, feared situation, or object. Exposure is contained within the therapeutic environment and can be real, visualized, or even simulated through virtual reality.1
- Adolescent community reinforcement approach (A-CRA): The A-CRA approach helps adolescents replace influences in their lives that contributed to drug-seeking behavior with positive and healthier alternatives. With this treatment, adolescents learn new coping skills by participating in constructive social and recreational activities.
- Motivational enhancement therapy: This is a therapeutic approach based on the motivational interviewing technique. It works by helping teens resolve any ambivalence about substance abuse and help them find the motivation to participate in treatment. While this treatment can be an effective complementary treatment for adolescent substance abuse, it doesn’t do well as a stand-alone treatment.
- Contingency management: This approach provides adolescents with reinforcement of positive behaviors to combat substance abuse. Rewards are given for participating in treatment and achieving treatment-related goals. Rewards may include movie tickets, gift certificates, personal items, and more.
Teen substance abuse can be treated in either an inpatient or outpatient setting. Inpatient treatment takes place in a residential setting where patients remain at the rehab center 24 hours a day, 7 days a week for a designated period of time ranging from 30 days to up to a year in some cases. Inpatient treatment centers typically provide a combination of individual and family counseling, group therapy, medication (if necessary), and sometimes complementary alternative treatments.
Outpatient treatment is a good option for teens that wish to remain engaged in their daily lives and continue to attend school and other activities. Outpatient treatment is usually 6 hours a week or less, and intensive outpatient treatment is up to 20 hours a week and lasts from a few weeks to a year. Patients attend therapy sessions at the treatment facility, but continue to live at home.
Both inpatient and outpatient programs utilize similar therapeutic approaches to promote abstinence and help patients work through mental health issues. In addition to the therapy models discussed above, your teen may be encouraged to participate in a 12-step program like Alcoholics Anonymous (AA), group therapy with other treatment patients, and family therapy with parents and close siblings.
How Can I Help?
If you have a teen who is struggling with anxiety and drug abuse, there is plenty you can do to help. First, try your best to get your child into professional treatment for both conditions. Treatment can help your child learn to manage anxiety and develop healthy coping skills as an alternative to using drugs.
Other things you can do to help your child on a regular basis include:
- Checking in regularly.
- Encouraging healthy and open communication.
- Asking about their feelings and share yours.
- Closely monitoring any medications.
- Getting involved in your child’s activities.
- Being supportive while giving them appropriate space.
- Working closely with school counselors, teachers, and other adults active in your child’s life.
- Regularly attending family therapy.
- Encouraging your child to channel their feelings into something creative.
Recovering from anxiety and drug abuse is difficult at any age and is perhaps even more so for teenagers. If your teen continues to struggle, remember that there is hope. Fortunately, there are a variety of evidence-based treatment strategies for adolescents struggling with anxiety and substance abuse as well as support groups for teens and their families.
- National Institute on Drug Abuse: Research Report Series. (2010). Comorbidity: Addiction and Other Mental Illnesses.
- National Institute of Mental Health. (N.D.) Any Anxiety Disorder Among Children.
- Donner, J., Pirkola, S., Silander, K., et. al. (2008). An Association Analysis of Murine Anxiety Genes in Humans Implicates Novel Candidate Genes for Anxiety Disorders. Biological Psychiatry, 64(8), 672–680.
- Substance Abuse and Mental Health Services Administration. (2017). Understanding Anxiety Disorders—Young Adult: Get the Facts. HHS Publication No. (SMA) 16-5010: Rockville, MD.
- Smith, J. & Book, S. (2008). Anxiety and Substance Use Review. Psychiatric Times, 20(1): 19–23.
- National Institute on Drug Abuse. (2014). What are Signs of Drug Use in Adolescents, and What Role Can Parents Play in Getting Treatment?
- National Institute on Drug Abuse. (2014). Evidence-Based Approaches to Treating Adolescent Substance Use Disorders.