Understanding the Link Between Anxiety and Substance Use
This page reflects our understanding of mental health topics as of 2026. If you are reading this at a later date, some details may no longer be current, so please verify anything important against up to date sources. If you notice anything that needs updating, we would welcome you letting us know.
Stopping alcohol or benzodiazepines suddenly after regular heavy use can cause dangerous withdrawal, including seizures. Speak with a doctor before cutting back. Call 911 for signs of overdose or severe withdrawal. If you are having thoughts of suicide, call or text 9-8-8.
Anxiety and substance use are closely connected. People with anxiety disorders are more likely than others to develop problems with alcohol, cannabis, sedatives, or other substances, and people who use substances heavily are more likely to experience anxiety. The relationship often works as a cycle. A substance may bring quick relief from worry, tension, or social discomfort, but as it wears off, anxiety often returns stronger. Over time, this can lead to more use and more anxiety. Understanding the link helps people address both concerns together rather than one at a time.
What the Link Looks Like
- Drinking to feel comfortable at social events or before a date.
- Relying on alcohol to unwind after stressful days.
- Using cannabis to quiet racing thoughts or fall asleep.
- Feeling more anxious, jittery, or low the day after drinking, sometimes called hangxiety.
- Panic attacks during cannabis use or withdrawal.
- Needing more of a substance to get the same calming effect.
- Feeling unable to face certain situations without using first.
Why It Happens
Many substances act on the brain's calming and reward systems. Alcohol and sedatives increase the effect of GABA, a calming chemical messenger, producing relaxation. As they wear off, the brain rebounds in the opposite direction, which can bring increased anxiety, restlessness, and poor sleep. With regular use, the brain adapts, so baseline anxiety may rise and more of the substance is needed to feel calm. Cannabis can reduce anxiety for some people at low doses but increase it at higher doses or with regular use, as described on the page about cannabis and mental health. Stimulants, including high amounts of caffeine, can directly trigger anxiety and panic.
Avoidance plays a role too. When a substance helps someone get through feared situations, they miss the chance to learn they can cope without it. This keeps anxiety in place. People with social anxiety, generalized anxiety, panic disorder, and PTSD are especially likely to use substances in this way. The broader pattern is described on the page about substance use as a coping mechanism.
The order in which the two problems start can vary. For some, anxiety comes first and substances follow as a form of self-medication. For others, heavy use comes first and anxiety develops as a result of withdrawal, sleep disruption, and life stress. Often both factors are at work. A careful history helps clarify the pattern and guide treatment.
What It Is Not
- Not a sign of weak willpower. Using substances to ease anxiety is a very human response to distress.
- Not always a substance use disorder. Coping use can exist without meeting criteria for a disorder, though it may progress.
- Not solved by treating only one issue. Addressing anxiety and substance use together tends to work better.
- Not a reason to avoid anxiety treatment. People can begin therapy while still working on substance use.
How It Is Assessed and Treated
A clinician will ask about anxiety symptoms, substance use patterns, what the substance is helping with, and any signs of dependence or withdrawal. Integrated treatment addresses both concerns at once. Cognitive behavioural therapy helps people manage anxiety, face feared situations gradually, and build new coping skills. Motivational interviewing supports change at a pace that feels manageable. Harm reduction strategies can reduce risks while working toward goals. A physician can help with safe tapering and discuss anxiety treatments that do not carry a risk of dependence. As anxiety becomes more manageable, the pull toward substances often decreases.
Getting Support at Pacific Maple Psych Centre
If you rely on alcohol, cannabis, or other substances to manage anxiety, therapy can help you break the cycle and find calmer ways to cope that last.
Pacific Maple Psych Centre offers individual therapy for anxiety and substance use concerns, in Vancouver and virtually across British Columbia.
Book a SessionCommon Questions About Anxiety and Substance Use
Why do people with anxiety turn to alcohol?
Alcohol quickly reduces tension and self-consciousness, which can feel like relief from anxiety, especially in social situations.
Does drinking make anxiety worse in the long run?
Often, yes. As alcohol wears off, the brain rebounds, raising anxiety and disrupting sleep. Regular use can increase baseline anxiety.
Why do I feel so on edge the morning after a night out?
Next-day anxiety, sometimes called hangxiety, is linked to alcohol withdrawal effects, poor sleep, and worry.
Can cannabis cause panic attacks?
Yes. Higher doses or potent products can trigger panic, paranoia, or racing heart in some people, especially those prone to anxiety.
Which comes first, anxiety or substance use?
It varies. Anxiety can lead to substance use as a way to cope, and heavy substance use can also cause or worsen anxiety.
Is it safe to stop drinking suddenly if I have anxiety?
After regular heavy drinking, stopping suddenly can be dangerous. Speak with a doctor about a safe plan to cut back.
Can treating anxiety help me use less?
Often, yes. As people learn other ways to manage anxiety, the need to use substances to cope tends to decrease.
What is integrated treatment for anxiety and substance use?
Integrated treatment addresses both concerns at the same time, rather than waiting for one to resolve before treating the other.
Are benzodiazepines risky for people who drink?
Yes. Combining benzodiazepines and alcohol increases the risk of dangerous sedation and overdose. Talk with a doctor about safer options.
Should I cut back on coffee if I am prone to panic?
It often helps. High amounts of caffeine can cause jitteriness, racing heart, and panic-like symptoms in people prone to anxiety.