Substance/Medication-Induced Anxiety Disorder

Why Alcohol, Drugs, or Medications Increase Stress and Panic

Substance/Medication-Induced Anxiety Disorder

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Substance or medication-induced anxiety disorder is the diagnostic name for severe anxiety or panic which is caused by alcohol, drugs, or medications.

While it is normal to have some feelings of anxiety in stressful situations, and even the transient feelings of anxiety, paranoia or panic that can happen spontaneously during intoxication or withdrawal from alcohol or drugs, substance-induced anxiety feels much worse and goes on a lot longer. For some people, it can significantly upset their enjoyment in life.

Unfortunately, the same drugs that many people use to try and boost their confidence, help them relax, and lower their inhibitions are the ones most prone to causing substance-induced anxiety disorder or panic attacks. In some cases, people don't even realize that it is alcohol, drugs or medications that are causing the anxiety because they only associate those substances with feeling good.

When physicians or psychologists give a diagnosis of substance/medication-induced anxiety disorder, they check to make sure that the anxiety wasn't there before the use of alcohol, drugs or medications thought to be responsible.

This is because there are several different types of anxiety disorders, and if the symptoms were there before the substance use, it isn't diagnosed as substance/medication-induced anxiety.

In some cases, anxiety or panic can occur straight away. There is even a category “with onset during intoxication,” which means that the anxiety episode actually started when the individual was drunk or high on the drug. It can also occur during withdrawal, during which symptoms of anxiety are common.

However, with anxiety which is simply a symptom of withdrawal, the person's symptoms will generally resolve within a few days of discontinuing alcohol or drug use, while with substance-induced anxiety disorder, it can start during withdrawal, and continue or get worse as the person moves through the detox process.

Generally, the diagnosis isn't given if the person has a history of anxiety without substance use, or if the symptoms continue for more than a month after the person becomes abstinent from the alcohol, drugs or medication.

For the diagnosis of Substance/Medication-Induced Anxiety Disorder to be given, the symptoms have to be causing a great deal of emotional upset or significantly affecting the person's life, including their work or social life, or another part of their life that is important.

A wide variety of psychoactive substances can cause substance-induced anxiety, including:

  • Alcohol-induced anxiety disorder
  • Caffeine-induced anxiety disorder
  • Cannabis-induced anxiety disorder
  • Phencyclidine-induced anxiety disorder
  • Other hallucinogen-induced anxiety disorder
  • Inhalant-induced anxiety disorder
  • Amphetamine-induced anxiety disorder
  • Other stimulant-induced anxiety disorder
  • Cocaine-induced anxiety disorder
  • Other substance-induced anxiety disorder
  • Unknown substance-induced anxiety disorder

Medications known to cause substance-induced anxiety include:

  • Anesthetic-induced anxiety disorder
  • Analgesic-induced anxiety disorder
  • Sympathomimetic or other bronchodilator-induced anxiety disorder
  • Anticholinergic-induced anxiety disorder
  • Insulin-induced anxiety disorder
  • Thyroid preparation-induced anxiety disorder
  • Oral contraceptive-induced anxiety disorder
  • Antihistamine-induced anxiety disorder
  • Antiparkinsonian-induced anxiety disorder
  • Corticosteroid-induced anxiety disorder
  • Antihypertensive and cardiovascular medication-induced anxiety disorder
  • Anticonvulsant-induced anxiety disorder
  • Lithium carbonate-induced anxiety disorder
  • Antipsychotic-induced anxiety disorder
  • Antidepressant-induced anxiety disorder

Specific heavy metals and toxins that can cause panic or anxiety symptoms include organophosphate insecticide, nerve gases, carbon monoxide, carbon dioxide, and volatile substances such as gasoline and paint.

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  1. Brady KT, Haynes LF, Hartwell KJ, Killeen TK. Substance use disorders and anxiety: a treatment challenge for social workers. Soc Work Public Health. 2013;28(3-4):407-23. doi:10.1080/19371918.2013.774675

  2. Mchugh RK. Treatment of co-occurring anxiety disorders and substance use disorders. Harv Rev Psychiatry. 2015;23(2):99-111.

  3. Kaplan K, Kurtz F, Serafini K. Substance-induced anxiety disorder after one dose of 3,4-methylenedioxymethamphetamine: a case report. J Med Case Rep. 2018;12(1):142. doi:10.1186/s13256-018-1670-7

  4. Smith JP, Book SW. Anxiety and Substance Use Disorders: A Review. Psychiatr Times. 2008;25(10):19-23.

  5. Anker JJ, Kushner MG. Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Res. 2019;40(1) doi:10.35946/arcr.v40.1.03

Additional Reading

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.


Substance Abuse and Anxiety Disorders/Panic Attacks

Substance/Medication-Induced Anxiety Disorder

One class of medications that has received support for its role in treating comorbid anxiety and alcohol abuse is selective serotonin reuptake inhibitors (SSRIs).

More specifically, both paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft) have been explored among samples of individuals who have been diagnosed with alcohol abuse and anxiety.[6] [7]

Findings from these studies, however, remain mixed with some finding support for reduced symptoms of both anxiety and alcohol dependence, while others do not. As such, more work is needed to explore the role of selective serotonin reuptake inhibitors on symptoms of comorbid substance abuse and anxiety.

One anti-anxiety medication, buspirone (brand name: BuSpar) has received support for its role in treating both alcohol abuse and symptoms of anxiety.[8] Further, the anticonvulsant medication topiramate (brand name: Topamax) has demonstrated potentially positive results in treating individuals with cocaine dependence and symptoms of anxiety.[9]

How Anti-Anxiety Medications Work: SSRIs block the reabsorption of serotonin in the brain, boosting your mood.

The use of behavioral therapy, either alone or in conjunction with medication, is a critical component of the treatment for dually diagnosed substance abuse and anxiety problems.

In fact, behavioral therapy is often the preferred method of treatment, given that prescribing medication—particularly the benzodiazepine anti-anxiety medications, with their high propensity for dependency and abuse—is a major concern for many substance abuse professionals.

Cognitive Behavioral Therapy

The most commonly referred behavioral approach for individuals suffering from comorbid substance abuse problems and anxiety is cognitive behavioral therapy (CBT). The goal of this approach is to change an individual’s maladaptive beliefs and unhelpful behaviors.

Individuals who undergo cognitive behavioral therapy are taught:

  • To recognize their thoughts, feelings and physiological responses to certain situations.
  • Skills in relaxation practice that they then use during graded exposure exercises.

Exposure exercises:

  • Are clinician-guided.
  • Encourage individuals to face feared situations in a stepwise fashion.
  • Allow the individual to experience success and mastery, in order to face increasingly challenging situations.

Cognitive Behavioral Therapy: CBT works by changing negative and unhelpful thoughts, behaviors, and emotions.

CBT, in particular, has received empirical support for its role in treating substance abuse, both among adult and pediatric populations, as well as anxiety problems.

CBT has received much support for its role in treating substance abuse and anxiety problems.

While most studies have supported the use of CBT for individuals with substance abuse and anxiety,[10] other studies have actually shown that exposure—a specific intervention component of cognitive behavioral therapy—can have detrimental impacts on the individual’s progress with regard to their substance abuse problems.[11]

Targeting Treatment for Co-occurring Conditions

The treatment of individuals with dually diagnosed, or co-occurring, substance abuse problems and anxiety brings about important considerations.

In most cases, professionals will attempt to treat both co-occurring conditions simultaneously; however, this may not actually be the most beneficial for individuals with substance abuse problems and anxiety. For instance, some individuals may be more ready to make changes with regard to one disorder over the other.

As such, it may actually be beneficial for these individuals to target treatment accordingly, rather than attempting to focus treatment on both.

Further, individuals undergoing behavioral treatment for anxiety may impede their progress by using alcohol to cope with feelings of distress that may come up as the result of undergoing treatment.

Thus, it is important for professionals treating these conditions to be mindful of the course of symptoms of the comorbid condition and to engage in continual monitoring of the individual’s progress in treatment.

Indeed, there is very little information regarding outcomes from treatment approached in this way. Thus, more work is necessary in order to clearly identify the ideal approach to targeting symptoms of co-occurring substance abuse problems and anxiety.


Diagnostic criteria for Substance-Induced Anxiety Disorder

Substance/Medication-Induced Anxiety Disorder

A. Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture. 

B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): 
 (1) the symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal
 (2) medication use is etiologically related to the disturbance 

C. The disturbance is not better accounted for by an Anxiety Disorder that is not substance induced. Evidence that the symptoms are better accounted for by an Anxiety Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g.

, about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence suggesting the existence of an independent non-substance-induced Anxiety Disorder (e.g.

, a history of recurrent non-substance-related episodes). 

D. The disturbance does not occur exclusively during the course of a Delirium. 

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the anxiety symptoms are sufficiently severe to warrant independent clinical attention. 

Code [Specific Substance]-Induced Anxiety Disorder 

(291.8 (new code as of 10/01/96: 291.89) Alcohol; 292.89 Amphetamine (or Amphetamine- Substance); 292.89 Caffeine; 292.89 Cannabis; 292.89 Cocaine; 292.89 Hallucinogen; 292.89 Inhalant; 292.89 Phencyclidine (or Phencyclidine- Substance); 292.89 Sedative, Hypnotic, or Anxiolytic; 292.89 Other [or Unknown] Substance) 

Specify if: 

With Generalized Anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation 
With Panic Attacks: if Panic Attacks predominate in the clinical presentation
With Obsessive-Compulsive Symptoms: if obsessions or compulsions predominate in the clinical presentation 
With Phobic Symptoms: if phobic symptoms predominate in the clinical presentation  Specify if: 

With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome 

With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association


Substance Use Disorders

Substance/Medication-Induced Anxiety Disorder

Moderate alcohol consumption—a glass of wine with dinner or a few drinks at a party—is no cause for concern for many people.

However those with anxiety disorders may find that alcohol or other substances can make their anxiety symptoms worse. And they are two to three times more ly to have an alcohol or other substance abuse disorder at some point in their lives than the general population.

About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.

Anxiety or Substance Use Disorder: Which Comes First?

Most people with alcohol or substance use and anxiety disorders experience them independently, but having both can be a vicious cycle.

The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms.

Social Anxiety Disorder
The co-occurrence of substance abuse, particularly alcohol abuse, is common among people who have social anxiety disorder. People with this disorder report that alcohol helps lessen their social anxiety, although it often makes it worse. Alcohol abuse usually develops after the onset of this disorder.

Read more about social anxiety disorder and alcohol abuse.

Posttraumatic Stress Disorder (PTSD)
PTSD and substance abuse commonly occur together. People suffering from this disorder often use alcohol or drugs to try to ease their anxiety, but substance abuse can exacerbate PTSD symptoms.

Many mental health professionals treat PTSD and substance abuse together because symptoms of PTSD (intrusive thoughts and sleep disturbance) can cause a substance abuse relapse.

Panic Disorder
Alcohol or drugs often cause panic attacks, and having panic disorder is a risk factor for a relapse among people with a substance abuse disorder. Alcohol abuse commonly begins before or at the same time as panic disorder symptoms.

Learn more about comorbidity, or when two or more disorders or illnesses occur in the same person, either at the same time or one after the other.


Treating substance abuse will not eliminate an anxiety disorder, so it’s usually necessary to treat both together, particularly to lessen the chance of relapse.

People with anxiety and substance abuse disorders are at an increased risk for abuse as well as potentially dangerous interactions when they use prescription medication. Doctors prescribe medications with low abuse potential that are considered safe should a relapse occur. The choice of medication always depends on a person’s individual circumstances.

Many therapists will use therapy for people with both anxiety and substance abuse disorders.

A well-established, highly effective, and lasting treatment is cognitive-behavioral therapy, or CBT, which focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12 to 16 weeks, depending on the individual. Joining a support group may be a good additional treatment option.

Mental Disorders, Substance Abuse Linked to Increase in ER Visits

A report from the Agency for Healthcare Research and Quality (AHRQ) finds that almost one in eight of the 95 million visits to hospital emergency departments made by adults in the United States in 2007 were due to a mental health and/or substance abuse problem.

The most common reason for these visits was a mood disorder (42.7%), followed by anxiety disorders (26.1%), alcohol-related problems (22.9%), and drug disorders (17.6%).  (AHRQ-HCUP Statistical Brief 92. Mental Health and Substance Abuse-Related Emergency Department Visits Among Adults, 2007.

Released July 2010) Read more.

Getting Help

ADAA Find a Therapist 
American Society of Addiction Medicine
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Substance Abuse Treatment Facility Locator (SAMHSA)


Substance-Induced Anxiety Disorder

Substance/Medication-Induced Anxiety Disorder

Anxiety disorders are some of the most common mental health problems. According to the Substance Abuse and Mental Health Services Administration: “Nearly 40 million people in the United States (18%) experience an anxiety disorder in any given year.”1

Anxiety disorders can begin at any age. They can stem from short-term concerns or lifelong issues. They are influenced by genetics, environment, and biology. They can be caused by substance use and abuse.

When Is Anxiety a Problem?

Everyone experiences anxiety at some point in their life. For some, these feelings become a more serious concern. Worry, fear and nervousness get in the way of everyday life. They keep someone from fully enjoying and participating in life. They impact physical health and disrupt relationships. They may contribute to substance abuse or other mental health issues.

Substance-induced anxiety disorders are no less serious than any other form of anxiety. Mental health and addiction problems commonly co-occur. This makes treatment more complex but certainly still more than possible. When substances are causing anxiety, ending drug use can end anxiety symptoms.

If anxiety issues existed before addicted or developed along with addiction, integrated treatment can be the solution.

Anxiety and Addiction

Many drugs cause anxiety symptoms. Prescription medications, alcohol, marijuana and more can create or worsen feelings of worry or paranoia. This is more ly to happen for people with a personal or family history of mental illness. It may simply be a symptom of substance abuse, or it may reveal an underlying concern.

Either way, unwanted mental health symptoms can lead to self-medication, increased drug use and then increased anxiety symptoms. As the Anxiety and Depression Association of America (ADAA) explains, “The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms.

”2 This cycle of using the substances that worsen a problem to mask a problem is common. The ADAA goes further: “About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.

” Anxiety and substance use are closely linked. Escalating mental health issues and drug use result in addiction.

What Can You Do About Anxiety and Addiction?

Treatment for co-occurring mental health and addiction issues exists. It exists, and it is effective. Getting a professional assessment leads to getting the right treatment.

When anxiety issues and addiction occur at the same time, integrated treatment is typically the best choice.

Social Work in Public Health explains, “Integrated treatment refers to the focus of treatment on two or more conditions and to the use of multiple treatments such as the combination of psychotherapy and pharmacotherapy.

Integrated treatment for comorbidity has been found to be consistently superior compared to treatment of individual disorders with separate treatment plans.”3 Integrated treatment addresses immediate, pressing health concerns and their underlying causes and consequences. It leads to long-term healing rather than short-term relief followed by relapse.

Finding Treatment

At Black Bear Lodge, we assess offer comprehensive assessments from the very start. We get to know you, your situation and the specific, personalized care you need. We offer integrated treatment programs that address substance use and mental health issues at the same time.

We adjust plans as your recovery progresses and your needs change. We are here for you from the very beginning to long after treatment ends. Call 706-914-2327 today to learn more about what we offer.

Learn how we can help you or a loved one find physical, psychological and emotional health.

1 “Mental Disorders.” Substance Abuse and Mental Health Services Administration. 27 Oct. 2015. Accessed 6 Oct. 2017.

2 “Substance Use Disorders.” The Anxiety and Depression Association of America. Accessed 6 Oct. 2017.

3 Kelly, Thomas, and Daley, Dennis. “Integrated Treatment of Substance Use and Psychiatric Disorders.” Social Work in Public Health. 2013. Accessed 6 Oct. 2017.


What is Substance-Induced Anxiety Disorder?

Substance/Medication-Induced Anxiety Disorder

In the U.S., the most common mental illness is anxiety, with more than 40 million people diagnosed with an anxiety disorder.

From obsessive-compulsive disorder and panic disorder to generalized anxiety and posttraumatic stress disorder, anxiety disorders these are conditions that can develop because of biological, genetic, and environmental factors. While millions of people live with anxiety disorders caused by one of these factors, there are many more who experience anxiety as a result of the mind-altering substances they abuse.

Nearly half of those who have a substance use disorder, such as a heroin addiction or alcoholism, also have a mental illness. Mental illnesses and the disease of addiction tend to go hand-in-hand for many, as each condition can trigger the other. When treatment is not obtained for either condition, a person’s mental health can suffer dramatically.

When someone with an anxiety disorder and a substance use disorder reaches out for help, they will ly receive comprehensive treatment that focuses on treating both conditions.

With treatment, professionals can better determine how and why these issues are co-occurring with each other.

In many cases, therapists and counselors find that the anxiety a client experiences is directly related to his or her substance abuse. This is referred to as substance-induced anxiety.

What is Substance-Induced Anxiety?

Substance-induced anxiety is anxiety that develops because of a certain substance of abuse. Without the abuse of the substance, the anxiety would not be occurring.

Symptoms of substance-induced anxiety are often shared with symptoms associated with other anxiety disorders, though some symptoms are specific to the fact that a substance is triggering the anxiety. These symptoms include:

  • Constantly thinking that bad things are going to happen
  • Problems breathing
  • Chest pain and pounding heartbeat
  • Chills and sweats
  • Shaking and tremors
  • Being afraid of losing control (“going crazy”)
  • Problems with memory and concentration
  • Stomach problems such as diarrhea or nausea
  • Difficulty sleeping

Those experiencing substance-induced anxiety can experience some or all of these symptoms, plus many others, for as long as he or she continues using. When the substance use causing the anxiety ends, the anxiety and additional repercussions caused by the use can continue, which is why seeking professional treatment can be the best thing a person with this issue can do.

How is Substance-Induced Anxiety Treated?

When someone is presenting with substance-induced anxiety, the first thing he or she should do is quit the substance abuse.

Depending on the type of substance being abused, professional detox services may be necessary to support this transition.

If this is the case, an individual will detox under the care of professionals who can help them manage their period of withdrawal with emotional support and medications, if necessary.

Therapy, such as that offered throughindividualand group therapy sessions, can help individuals being treated for substance-induced anxiety address the root causes of the anxiety, the effects it caused within his or her life, and how to move forward now that the substance abuse is no longer occurring.

Attending local support groups such as those offered through Alcoholics Anonymous(AA) and Narcotics Anonymous(NA) can also help those recovering from substance-induced anxiety. The support that can be obtained through others with similar experiences can aid in the healing process.

Other resourcesthat can be utilized include yoga and meditation, along with natural supplements that can help in one’s physical and psychological health and recovery.

Which Substances Induce Anxiety?

Substances that are known for triggering the onset of anxiety include:

  • This stimulant substance that is comprised of several chemicals found in pharmacies and home improvement stores often causes anxiety in those who abuse. This is because, when meth is abused, the user experiences two extremes within a short period of time. He or she goes from extreme euphoria and excitement to depression and sadness. The shift from one end of the spectrum to the other often produces feelings of panic and paranoia, both of which are trademarks of anxiety. As the use of meth continues, so does the anxiety.
  • Similar to meth because of its stimulant properties, cocaine is one of the most common substances that causes anxiety. When under the influence of cocaine, individuals experience a massive jolt of energy and happiness, but when they lose that high, they can feel jittery and anxious because the stimulant effect of the drug is wearing off. As the brain works to re-balance itself, symptoms associated with anxiety can occur.
  • Alcohol abuse is often linked to symptoms of depression because this substance is a depressant in itself. But alcohol can also trigger the onset of anxiety because of how it interacts with the brain. When alcohol is in the body, it alters serotonin levels. Serotonin is responsible for helping to regulate mood, among other things. The consistent alteration of serotonin levels is what produces feelings panic, lack of control, obsessive thoughts, etc.

Other substances, ranging from LSD to dextromethorphan, have also been linked to substance-induced anxiety.

Get Help at JourneyPure Bowling Green

We know just how difficult it can be to experience a substance-induced anxiety disorder, which is why we approach each and every client with compassion and understanding. If you are experiencing this condition, know that there is help available. At JourneyPure Bowling Green, you can get that help.

Michelle Rosenker is a content writer for JourneyPure where she gets to exercise her journalistic skills by working with different addiction treatment centers nationwide.

She has 10 years of experience in the field of addiction treatment and mental health and has written content for some of the country’s most prominent treatment centers and behavioral hospitals.

Through her writing, Michelle is proud to continually raise awareness about the disease of addiction and share hope for the future. She lives next to the ocean in Massachusetts with her husband, two young children, and faithful dog. 


Substance-induced anxiety disorder

Substance/Medication-Induced Anxiety Disorder

Photo by: Alexander Trinitatov

Prominent anxiety symptoms (i.e.

, generalized anxiety, panic attacks, obsessive-compulsive symptoms, or phobia symptoms) determined to be caused by the effects of a psychoactive substance is the primary feature of a substance-induced psychotic disorder .

A substance may induce psychotic symptoms during intoxication (i.e., while the individual is under the influence of the drug) or during withdrawal (i.e., after an individual stops using the drug).

A substance-induced anxiety disorder is subtyped or categorized whether the prominent feature is generalized anxiety, panic attacks, obsessive-compulsive symptoms, or phobia symptoms.

In addition, the disorder is subtyped whether it began during intoxication on a substance or during withdrawal from a substance. A substance-induced anxiety disorder that begins during substance use can last as long as the drug is used.

A substance-induced anxiety disorder that begins during withdrawal may first manifest up to four weeks after an individual stops using the substance.

Causes and symptoms

A substance-induced anxiety disorder, by definition, is directly caused by the effects of drugs—including alcohol, medications, and toxins. Anxiety symptoms can result from intoxication on alcohol, amphetamines (and related substances), caffeine, cannabis (marijuana), cocaine, hallucinogens, inhalants, phencyclidine (PCP) and related substances, and other or unknown substances.

Anxiety symptoms can also result from withdrawal from alcohol, sedatives, hypnotics, and anxiolytics, cocaine, and other or unknown substances.

Some of the medications which may induce anxiety symptoms include anesthetics and analgesics, sympathomimetics (epinephrine or norepinephrine, for example) or other bronchodilators, anticholinergic agents, anticonvulsants, antihistamines, insulin, thyroid preparations, oral contraceptives, antihypertensive and cardiovascular medications, antiparkinsonian medications, corticosteroids, antidepressant medications, lithium carbonate , and antipsychotic medications. Heavy metals and toxins, such as volatile substances fuel and paint, organophosphate insecticides, nerve gases, carbon monoxide, and carbon dioxide may also induce anxiety.

The Diagnostic and Statistical Manual of Mental Disorders , ( DSM-IV-TR )—produced by the American Psychiatric Association and used by most mental health professionals in North America and Europe to diagnose mental disorders—notes that a diagnosis is made only when the anxiety symptoms are above and beyond what would be expected during intoxication or withdrawal and when severe. The following list is the criteria necessary for the diagnosis of a substance-induced anxiety disorder as listed in the DSM-IV-TR :

  • Prominent anxiety, panic attacks, or obsessions or compulsions.
  • Symptoms develop during, or within one month, of intoxication or withdrawal from a substance or medication known to cause anxiety symptoms.
  • Symptoms are not actually part of another anxiety disorder (such as generalized anxiety disorder , phobias, panic disorder , or obsessive-compulsive personality disorder ) that is not substance induced. For instance, if the anxiety symptoms began prior to substance or medication use, then another anxiety disorder is ly.
  • Symptoms do not occur only during delirium .
  • Symptoms cause significant distress or impairment in functioning.

Little is known regarding the demographics of substance-induced anxiety disorders. However, it is clear that they occur more commonly in individuals who abuse alcohol or other drugs.

Diagnosis of a substance-induced anxiety disorder must be differentiated from an anxiety disorder due to a general medical condition.

There are some medical conditions (such as hyperthyroidism, hypothyroidism, or hypoglycemia) that can produce anxiety symptoms, and since individuals are ly to be taking medications for these conditions, it can be difficult to determine the cause of the anxiety symptoms.

If the symptoms are determined to be due to the medical condition, then a diagnosis of an anxiety disorder due to a general medical condition is warranted. Substance-induced anxiety disorders also need to be distinguished from delirium, dementia , primary psychotic disorders, and substance intoxication and withdrawal.

Clinical history and physical examination are the best methods to help diagnose anxiety disorders in general; however, appropriate laboratory testing will most ly be necessary to specifically identify substance-induced anxiety disorder. Lab tests may include:

  • complete blood count (CBC)
  • chemistry panels
  • serum and/or urine screens for drugs

The underlying cause of the anxiety symptoms, as well as the specific type of symptoms, determine course of treatment and is often similar to treatment for a primary anxiety disorder such as generalized anxiety disorder, phobias, panic disorder, or obsessive-compulsive disorder . Appropriate treatment usually includes medication (antianxiety or antidepressant medication, for example).

Anxiety symptoms induced by substance intoxication usually subside once the substance responsible is eliminated. Symptoms persist depending on the half-life of the substances (i.e., how long it takes the before the substance is no longer present in an individual's system).

Symptoms, therefore, can persist for hours, days, or weeks after a substance is last used. Obsessive-compulsive symptoms induced by substances sometimes do not disappear, even although the substance inducing them has been eliminated.

More intensive treatment for the obsessive-compulsive symptoms would be necessary and should include a combination of medication and behavioral therapy.

Little is documented regarding the prevention of substance-induced anxiety disorder. However, abstaining from drugs and alcohol, or using these substances only in moderation, would clearly reduce the risk of developing this disorder.

In addition, taking medication under the supervision of an appropriately trained physician should reduce the lihood of a medication-induced anxiety disorder.

Finally, reducing one's exposure to toxins and heavy metals would reduce the risk of toxin-induced anxiety disorder.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Kaplan, Harold I.,M.D., and Benjamin J. Sadock, M.D. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th edition. Baltimore: Williams and Wilkins.

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Substance/Medication-Induced Anxiety Disorder

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