Skip to main content
SpringerLink
Log in

Substance Use and Anxiety Disorders: A Scoping Review

  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We aimed to evaluate the significance and directionality of the relationship between substance use disorders (SUDs) and anxiety disorders (ADs), as this remains unclear.

Recent Findings

Following PRISMA guidelines and a scoping review methodology, 25 articles met inclusion criteria and were searched using PubMed, Ovid, MEDLINE, and PsychInfo through June 2023. Our results reveal strong associations between substance use and ADs, with alcohol and cannabis exhibiting the most robust relationships. Preliminary evidence points to a potential bidirectional relationship between substance use and ADs, however, more longitudinal and experimental studies are needed to demonstrate causal results. Importantly, individuals with comorbid ADs and SUDs were shown to experience greater symptom severity, have poorer treatment response, and increased rates of relapse compared to those with either disorder alone.

Summary

Our scoping review thus highlights the need for integrated treatment approaches to address comorbid substance use and ADs and improve treatment outcomes for those experiencing dual diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ahmadi M, Ahmadi J. Substance-induced anxiety disorder in opioid dependents. Addict Disord Treat. 2005;4(4):157–9. https://doi.org/10.1097/01.adt.0000163699.83614.25.

    Article  Google Scholar 

  2. Akindipe T, Wilson D, Stein DJ. Psychiatric disorders in individuals with methamphetamine dependence: Prevalence and risk factors. Metab Brain Dis. 2014;29(2):351–7. https://doi.org/10.1007/s11011-014-9496-5.

    Article  CAS  PubMed  Google Scholar 

  3. American Psychiatric Association. What is a substance use disorder? [Internet]. Psychiatry.org. 2023. Available from: https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder.

  4. Back SE, Brady KT. Anxiety disorders with comorbid substance use disorders: Diagnostic and treatment considerations. Psychiatric Ann. 2008;38(11). https://doi.org/10.3928/00485713-20081101-01.

  5. Bahorik AL, Leibowitz A, Sterling SA, Travis A, Weisner C, Satre DD. Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. J Affect Disord. 2017;213:168–71. https://doi.org/10.1016/j.jad.2017.02.016.

    Article  PubMed  PubMed Central  Google Scholar 

  6. ••Bråbäck M, Brantefors A, Franck J, Brådvik L, Isendahl P, Nilsson S, et al. Substance use, hospitalizations, and co-occurring disorders among patients transferred from a needle exchange program to opioid maintenance treatment. Int J Environ Res Public Health. 2022;19(2):697. https://doi.org/10.3390/ijerph19020697. A longitudinal study examining psychiatric comorbidity within opioid users entering opioid maintenance treatment.

  7. Bushnell GA, Gaynes BN, Compton SN, Dusetzina SB, Olfson M, Stürmer T. Incident substance use disorder following anxiety disorder in privately insured youth. J Adolesc Health. 2019;65(4):536–42. https://doi.org/10.1016/j.jadohealth.2019.05.007.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Castaldelli-Maia JM, Bhugra D. Analysis of global prevalence of mental and substance use disorders within countries: Focus on sociodemographic characteristics and income levels. Int Rev Psychiatry. 2022;34(1):6–15. https://doi.org/10.1080/09540261.2022.2040450.

    Article  PubMed  Google Scholar 

  9. Centre for Addiction and Mental Health. Alcohol [Internet]. CAMH. 2023. Available from: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/alcohol.

  10. Cludius B, Stevens S, Bantin T, Gerlach AL, Hermann C. The motive to drink due to social anxiety and its relation to hazardous alcohol use. Psychol Addict Behav. 2013;27(3):806–13. https://doi.org/10.1037/a0032295.

    Article  PubMed  Google Scholar 

  11. Connery HS, McHugh RK, Reilly M, Shin S, Greenfield SF. Substance use disorders in global mental health delivery: Epidemiology, treatment gap, and implementation of evidence-based treatments. Harv Rev Psychiatry. 2020;28(5):316–27. https://doi.org/10.1097/HRP.0000000000000271.

    Article  PubMed  PubMed Central  Google Scholar 

  12. ••Davis JP, Pedersen ER, Tucker JS, Prindle J, Dunbar MS, Rodriguez A, et al. Directional associations between cannabis use and anxiety symptoms from late adolescence through young adulthood. Drug Alcohol Depend. 2022;241:109704. https://doi.org/10.1016/j.drugalcdep.2022.109704. A longitudinal study examining the bidirectional relationship between cannabis use and anxiety disorders.

  13. Fabricius V, Langa M, Wilson K. An exploratory investigation of CO-occurring substance-related and psychiatric disorders. J Subst Use. 2008;13(2):99–114. https://doi.org/10.1080/14659890701680877.

    Article  Google Scholar 

  14. •George TP, Welsh L, Franchuk SL, Vaccarino FJ. Why integrating medications and psychosocial interventions is important to successfully address the opioid crisis in Canada. Can J Psychiatry. 2022;67(3):176–8. Highlights the need for more robust psychosocial interventions for dual diagnosis.

  15. Gilder DA, Lau P, Gross A, Ehlers CL. A co-morbidity of alcohol dependence with other psychiatric disorders in young adult Mexican Americans. J Addict Dis. 2007;26(4):31–40. https://doi.org/10.1300/j069v26n04_05.

    Article  PubMed  Google Scholar 

  16. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Arch Gen Psychiatry. 2006;61(8):807. https://doi.org/10.1001/archpsyc.61.8.807.

    Article  Google Scholar 

  17. Herrero MJ, Domingo-Salvany A, Torrens M, Brugal MT. Psychiatric comorbidity in young cocaine users: Induced versus independent disorders. Addiction. 2008;103(2):284–93. https://doi.org/10.1111/j.1360-0443.2007.02076.x.

    Article  PubMed  Google Scholar 

  18. Javaid SF, Hashim IJ, Hashim MJ, Stip E, Samad MA, Ahbabi AA. Epidemiology of anxiety disorders: Global burden and sociodemographic associations. Middle East Curr Psychiatry. 2023;30(1). https://doi.org/10.1186/s43045-023-00315-3.

  19. Karpyak VM, Biernacka JM, Geske JR, Abulseoud OA, Brunner MD, Chauhan M, et al. Gender-specific effects of comorbid depression and anxiety on the propensity to drink in negative emotional states. Addiction. 2016;111(8):1366–75. https://doi.org/10.1111/add.13386.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Karpyak VM, Geske JR, Hall-Flavin DK, Loukianova LL, Schneekloth TD, Skime MK, et al. Sex-specific association of depressive disorder and transient emotional states with alcohol consumption in male and female alcoholics. Drug Alcohol Depend. 2019;196:31–9. https://doi.org/10.1016/j.drugalcdep.2018.12.010.

    Article  PubMed  Google Scholar 

  21. Keung MY, Leach E, Kreuser K, Emmerich BW, Ilko S, Singh M, et al. Cannabis-induced anxiety disorder in the emergency department. Cureus. 2023;15(4):e38158. https://doi.org/10.7759/cureus.38158.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kivlichan AE, Praecht A, George TP. Substance-induced mood disorders: a scoping review. Curr Addict Rep. 2024.

  23. Koob GF, Volkow ND. Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry. 2016;3(8):760–73.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mackesy-Amiti ME, Donenberg GR, Ouellet LJ. Prevalence of psychiatric disorders among young injection drug users. Drug Alcohol Depend. 2012;124(1–2):70–8. https://doi.org/10.1016/j.drugalcdep.2011.12.012.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Munir S, Takov V. Generalized anxiety disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/.

  26. National Institute of Mental Health. Anxiety disorders [Internet]. National Institute of Mental Health. U.S. Department of Health and Human Services. 2023. Available from: https://www.nimh.nih.gov/health/topics/anxiety-disorders.

  27. Nel C, Augustyn L, Bartman N, Koen M, Liebenberg M, Naudé J, et al. Anxiety disorders: Psychiatric comorbidities and psychosocial stressors among adult outpatients. S Afr J Psychiatry. 2018;24(0). https://doi.org/10.4102/sajpsychiatry.v24i0.1138.

  28. Pires AJ, Casanova CC, de Quevedo L, Jansen K, Silva RA. Panic disorder and psychoactive substance use in primary care. Trends Psychiatry Psychother. 2014;36(2):113–8. https://doi.org/10.1590/2237-6089-2013-0042.

    Article  PubMed  Google Scholar 

  29. Quello S, Brady K, Sonne S. Mood disorders and substance use disorder: A complex comorbidity. Sci Pract Perspect. 2005;3(1):13–21. https://doi.org/10.1151/spp053113.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Salo R, Flower K, Kielstein A, Leamon MH, Nordahl TE, Galloway GP. Psychiatric comorbidity in methamphetamine dependence. Psychiatry Res. 2011;186(2–3):356–61. https://doi.org/10.1016/j.psychres.2010.09.014.

    Article  PubMed  Google Scholar 

  31. Shafe S, Gilder DA, Montane-Jaime LK, Josephs R, Moore S, Crooks H, et al. Comorbidity of alcohol dependence and select affective and anxiety disorders among individuals of East Indian and African ancestry in Trinidad and Tobago. West Indian Med J. 2009;58(2):164–72.

    CAS  PubMed  Google Scholar 

  32. Smith JP, Book SW. Anxiety and substance use disorders: A review. Psychiatr Times. 2008;25(10):19–23.

    PubMed  PubMed Central  Google Scholar 

  33. Strike CJ, Urbanoski KA, Rush BR. Who seeks treatment for cannabis-related problems? Can J Public Health. 2003;94(5):351–4. https://doi.org/10.1007/BF03403559.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sumnall HR, Wagstaff GF, Cole JC. Self-reported psychopathology in polydrug users. J Psychopharmacol. 2004;18(1):75–82. https://doi.org/10.1177/0269881104040239.

    Article  PubMed  Google Scholar 

  35. Srivastava M, Jain S, Patel A. Substance use among outdoor treatment-seeking patients with mental illness: a case-control study from a tertiary care hospital of northern India. J Educ Health Promot. 2018;7:75. https://doi.org/10.4103/jehp.jehp_97_17.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Thomasius R, Sack P-M, Petersen K. DSM-IV axis-I comorbidity among illicit drug users seeking treatment for substance use disorders: results from the multi-centre study of psychiatric comorbidity in drug addicts (MUPCDA). Ment Health Subst Use. 2010;3:182–92. https://doi.org/10.1007/s00406-018-0916-5.

    Article  Google Scholar 

  37. Tilli V, Suominen K, Karlsson H. Panic disorder in primary care: Comorbid psychiatric disorders and their persistence. Scand J Prim Health Care. 2012;30(4):247–53. https://doi.org/10.3109/02813432.2012.732471.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Tournier M, Sorbara F, Gindre C, Swendsen JD, Verdoux H. Cannabis use and anxiety in daily life: a naturalistic investigation in a non-clinical population. Psychiatry Res. 2003;118(1):1–8. https://doi.org/10.1016/s0165-1781(03)00052-0.

    Article  PubMed  Google Scholar 

  39. •Ummels SA, Seldenrijk A, Bos EH, de Graaf R, Batelaan NM, ten Have M. The bidirectional relationship between anxiety disorders and alcohol use disorders in adults: Findings from a longitudinal population-based study. J Affect Disord. 2022;314, 126–132. https://doi.org/10.1016/j.jad.2022.06.091. A longitudinal study exploring the bidirectional relationship between alcohol use and anxiety disorders.

Download references

Funding

NIDA and CIHR funding to Dr. George.

Author information

Authors and Affiliations

  1. Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, 60 White Squirrel Way, Room 312, Toronto, ON, M6J 1H4, Canada

    Diana Goldfield, Molly Zhang & Tony P. George

  2. Institute for Medical Sciences and the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M6J 1H4, Canada

    Diana Goldfield, Molly Zhang & Tony P. George

Authors
  1. Diana Goldfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Molly Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tony P. George
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

D.G. wrote the main manuscript text and M.Z. helped screen studies and formulate results. All authors reviewed the manuscript.

Corresponding author

Correspondence to Tony P. George.

Ethics declarations

The Section Editors for the topical collection Dual Diagnosis are Tony George and Victor Tang. Please note that Section Editor Tony George was not involved in the editorial process of this article as he is a co-author.

Competing Interests

The authors declare no competing interests.

Conflict of Interest

Dr. George reports that he has been a consultant to Aelis, Frutarom, Roche and Sanford Burnham Prebys in the past three years, and Co-Principal Editor, Neuropsychopharmacology (NPP).

Human and Animal Rights and Informed Consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldfield, D., Zhang, M. & George, T.P. Substance Use and Anxiety Disorders: A Scoping Review. Curr Addict Rep 11, 352–370 (2024). https://doi.org/10.1007/s40429-024-00541-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-024-00541-7

Keywords

Search

Navigation