Substance-Induced Anxiety Disorder

What is substance-induced anxiety disorder?

Substance-induced anxiety disorder is anxiety caused by taking a drug or stopping a drug. Many medicines and abused substances can make you feel nervous, worried, or jittery. You may have panic attacks. You may also feel that something terrible is going to happen even when there is no real reason to feel this way.

Medicines or substance use may make an existing anxiety problem worse or cause it to return. This is not substance-induced anxiety. Substance-induced anxiety is directly the result of medicine or substance use.

How does it occur?

Many drugs change the way brain cells communicate with each other. Drugs can also change the amount of chemical messengers, called neurotransmitters, in your nervous system. Having the right balance of these chemical messengers in your nerves and brain is important. Many abused substances and medicines damage parts of the brain that keep anxiety in check.

Frequent use of some substances and medicines can cause anxiety problems. With other substances, withdrawal (stopping use of the drug) can cause anxiety problems for up to 4 weeks after you quit.

Substances and medicines that can cause anxiety problems while you are using them are:

• alcohol (beer, wine, or hard liquor)
• caffeine
• cocaine
• decongestants such as pseudoephedrine (Sudafed)
• marijuana
• hallucinogenic drugs such as PCP and LSD
• amphetamines or uppers such as speed, Ritalin, and Dexedrine
• inhalants (such as gasoline, spray paint, glue, and some insecticides)
• antiseizure medicines like Tegretol and Depakene
• bronchodilators such as those used to treat asthma
• medicines for Parkinson's disease such as amantadine (Symmetrel) and levodopa
• insulin, used to treat diabetes
• birth control pills.

Drugs that can cause anxiety problems for weeks after stopping them are:

• alcohol (beer, wine, or hard liquor)
• cocaine
• marijuana
• sedatives, antianxiety medicines, and sleeping medicines
• painkillers such as codeine and propoxyphene (Darvon)
• steroid medicines
• thyroid medicine.

What are the symptoms?

You may have symptoms while you are taking the substances or medicines, or for a month after you stop. Besides feeling nervous and worried, you may also:

• Think that bad things will happen or that you will never get better.
• Have trouble falling asleep or wake up often during the night.
• Lose weight because you don't feel like eating.
• Fear that you are losing control of yourself and will go crazy or will die.
• Have chills, hot flashes, sweating, shaking, or numbness.
• Feel your heart race or pound.
• Have trouble concentrating or remembering things.
• Have trouble breathing or swallowing due to muscle tightness.
• Feel pain in your chest, stomach, or abdomen.
• Throw up or have nausea or diarrhea.

How is it diagnosed?

If you think a substance or medicine is causing anxiety, see your healthcare provider. Your healthcare provider can tell you if your symptoms are substance-induced anxiety disorder. He or she will ask about your symptoms and your drug or alcohol use. You may have some lab tests to rule out medical problems such as hormone imbalances. Blood and urine tests can check for substance abuse and levels of certain medicines in your system.

How is it treated?

You may have to stop or reduce what is causing the anxiety for up to 4 weeks. Do not reduce or stop taking any prescribed medicine without first consulting your healthcare provider. Follow his or her advice on how to stop or reduce what you are taking. Your provider may prescribe antianxiety or antidepressant medicines to help you get over withdrawal symptoms.

Do not try to overcome the abuse of alcohol, cocaine, or amphetamines all by yourself. Get professional help first. Stopping some substances abruptly can be very dangerous. You can have seizures and heart failure if you stop too quickly.

Psychotherapy

Abuse of substances like alcohol, cocaine, and sedatives can be successfully treated with group or individual psychotherapy. Therapy in a group with others having substance abuse problems is often very helpful. Most towns and cities have chapters of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). In some cases, medicines for anxiety may help you to stop substance abuse. Discuss the options with your healthcare provider or therapist.

Natural and Alternative Treatments

Claims have been made that certain herbal and dietary products help people avoid a return to substance abuse. However, there is no strong research that shows natural treatments can help stop substance abuse.

Some types of alternative treatments to help you avoid future substance abuse are:

• Biofeedback. Through biofeedback you learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration. Biofeedback should be done only in addition to psychotherapy.
• Massage Therapy. Massage therapy may help lower stress, but it does not cure anxiety problems or substance abuse.
• Relaxation Therapies. Learning ways to relax can help with anxiety problems or substance abuse, along with psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy, along with psychotherapy, to be helpful.

How long will the effects last?

Substance-induced anxiety disorder usually lasts as long as you keep taking the medicine or substance causing the anxiety disorder. Symptoms often last up to a month after you stop taking any drug.

What can I do to help myself or my loved one?

Check with your healthcare provider about any drug you think might be causing anxiety.

If you are abusing alcohol, cocaine, or sedatives, a substance abuse program can help you stop and handle any withdrawal symptoms.

Once you have stopped substance abuse, maintaining a healthy lifestyle is crucial. To help prepare you to stop substance abuse and prevent a return to drug use:

• Exercise for at least 20 minutes every day, for example, by taking a brisk walk.
• Talk to your family and friends.
• Eat a healthy diet.
• Avoid caffeine.
• Learn ways to lower stress, such as breathing and muscle relaxation exercises.

When should I seek help

If you feel anxious after starting or changing the amount of any medicine you take, talk with your healthcare provider.

Seek professional help from your healthcare provider or a substance abuse program if you or a loved one abuse substances like alcohol, cocaine, or sedatives.

Get emergency help immediately if you or a loved one have serious thoughts of suicide or harming others. Call for police help if you or a loved one have violent behavior, such as destroying property or threatening others.