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.

What is the cause?

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)
• 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
• 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. 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 the substance that is causing the anxiety. 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. It may take up to 4 weeks for the anxiety to get better. 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 might have seizures and heart failure if you stop too quickly.

Psychotherapy

Abuse of substances like alcohol, cocaine, and sedatives can be 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.

Claims have been made that certain herbal and dietary products help people avoid a return to substance abuse. No herb or dietary supplement has been proven to consistently or completely stop substance abuse. Supplements are not tested or standardized and may vary in strength and effects. They may have side effects and are not always safe.

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and psychotherapy.

How long will the effects last?

This disorder usually lasts as long as you keep taking the substance causing the anxiety. Symptoms often last up to a month after you stop taking it.

How can I take care of myself?

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:

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Don’t use alcohol or drugs. Exercise according to your healthcare provider's instructions.
• Avoid situations where people are likely to use alcohol or drugs.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

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 if you or a loved one abuses substances like alcohol, cocaine, or sedatives.

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