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.
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
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
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.