Anxiety & Substance Use
A lot of substance use isn't really about the substance. It's about something the substance is making quieter. When you start to take the substance away, the something gets louder — which is exactly when most people give up. We don't.
Anxiety and substance use feed each other. Alcohol takes the edge off social events but rebounds in the 3am wakes. Cannabis blunts the edge of the day and sharpens it in the morning. Stimulants cover for fatigue but spike anxiety further. Benzos quiet panic but build their own dependence. Treating only one half of this loop usually fails.
What this can feel like
- You drink (or smoke, or take) so you can be in a room. Then later, you can't sleep, and you're back in the spiral that started the whole thing.
- You wake at 3am with the same loop running, and by morning you've already lost a fight nobody else heard.
- Sober anxiety feels physically intolerable — chest, throat, hands. The substance is the only thing that has reliably made it stop.
- You've tried to quit substances and found out, three days in, just how much they were doing.
- You've been told by people who love you that you're "anxious" without anyone naming what they actually mean.
- The relief is shorter than it used to be. The next dose comes sooner.
How therapy can help
We treat anxiety and substance use together, not in sequence. Cognitive Behavioral Therapy for anxiety has decades of evidence; Acceptance and Commitment Therapy is particularly helpful for the kind of anxiety that resists being argued with — it teaches you how to do the thing while the anxiety is still loud. We add in relapse-prevention work for the substance side, and group therapy gives weekly grounding while you change a system that's been working (badly) for a long time.
For clients who would benefit from medication, we coordinate with a psychiatrist or prescribing primary care provider, with a clear preference for non-addictive options (SSRIs, SNRIs, buspirone, hydroxyzine) over benzodiazepines for anxiety in the context of substance use.
The first weeks of substance reduction are usually when anxiety is loudest. We expect this, and the early sessions are calibrated for it.
You don't have to figure this out alone
If you've been waiting until the anxiety is "manageable" to deal with the substance, that day rarely arrives on its own.