The Link Between Teen Anxiety and Substance Abuse

Teens with untreated anxiety disorders tend to worry about anything and everything. Anxiety is often described by youth as a relentless, invisible pressure that weighs on their mind and body. Anxiety can impact teens’ ability to function, manage relationships, keep up in school, and increase the risk of substance abuse—with many teens turning to drugs or alcohol to numb symptoms of anxiety and emotional pain. 

According to the National Institute of Health, nearly 48% of teens in substance abuse treatment struggle with a co-occurring anxiety disorder. Teen anxiety and substance abuse create a negative feedback loop, meaning one condition often worsens symptoms of the other [1].

Comprehensive treatment for teen anxiety and substance abuse includes dual diagnosis, which addresses both addiction and mental health disorders. Read on to understand more about the link between teen anxiety and substance abuse, and effective treatments that support long-term recovery. 

How Does Anxiety Increase The Risk of Substance Abuse? 

According to the Journal of Adolescent Health, unresolved anxiety can increase the risk of substance abuse in youth by nearly 33%. Some of the reasons teens with anxiety may turn to drugs or alcohol include [2]: 

• Ease racing thoughts: Some teens turn to depressants such as marijuana or sedatives to slow down racing thoughts and promote feelings of relaxation. 

• Increase self-esteem: Teens with anxiety often have low self-esteem and struggle in group events or interacting with peers. They might turn to substances such as alcohol (especially in social settings) to increase their confidence and sociability. 

• Numb physiological symptoms: Anxiety can cause distressing physical symptoms such as headaches, nausea, vomiting, inability to sleep, and muscle pain. Teens may cope with these by abusing substances such as marijuana or pain pills to increase feelings of relaxation or euphoria.

• Decrease restlessness: Teens with anxiety are more likely to experience restlessness and may fidget or struggle to concentrate. Some teens have reported that using nicotine products such as vapes helps them manage these symptoms (although no evidence currently supports this).  

• Coping with life challenges: Anxious teens may lack protective or resilience factors to face life stressors such as academic pressure, peer conflict, and transitions. Without the coping tools to overcome these challenges, they may feel overwhelmed and are more likely to turn to substance abuse.  

Addiction and Mental Health: How Drugs and Alcohol Make Anxiety Worse 

Although many teens find short-term relief from drugs and alcohol, studies have shown that over time, substance use only worsens the cycle of anxiety. Some of the ways substance abuse worsens symptoms of anxiety in teens include [3] [4]: 

• Changes in CNS Activity: The central nervous system (CNS) plays a key role in the body’s stress response, contributing to anxiety when overstimulated. Drugs and alcohol often interfere with regular functioning of the CNS. For example, stimulants increase CNS activity, contributing to symptoms of anxiety such as racing thoughts, increased heart rate, and trouble sleeping.  

• Changes in Brain Structure: Substance abuse can cause structural changes in regions of the brain, such as the prefrontal cortex (PFC), amygdala, and basal ganglia. These play a role in cognitive functions such as emotional regulation, habits, and stress response. Notably, the amygdala is associated with feelings of anxiety in relation to substance abuse. Studies show that during withdrawal from drugs or alcohol, the amygdala is activated, causing symptoms of anxiety that are common during detox. 

• Disrupted Sleep Patterns: Experts recommend growing teens get 9 to 9 1/2 hours of sleep each night for good mental and physical health. Both anxiety and substance abuse can disrupt sleep patterns and cause insomnia, further worsening symptoms of anxiety.  

• Altered Neurotransmitters: Drugs and alcohol alter neurotransmitters in the brain that regulate functions such as stress levels, fear response, and emotional regulation. For example, alcohol increases the neurotransmitter GABA, leading to feelings of relaxation and euphoria. However, when these initial effects wear off, it triggers adverse effects to the nervous system, causing anxiety. 

Signs To Watch For In Your Teen 

Sometimes anxiety and symptoms of substance abuse can mimic one another, such as mood swings, restlessness, and changes in mood or personality. Other signs to watch for that could indicate your teen is struggling with anxiety and substance abuse include: 

• Acting visibly drunk or high
• Finding drugs, alcohol, or paraphernalia (e.g., lighters, pipes, empty pill or liquor bottles) in their room or belongings 
• Trouble focusing, staying organized, or paying attention in school 
• Irritability, or aggression 
• Isolation, lack of motivation, or participation in activities they once enjoyed 
• Problems with communication or social skills 
• Physiological symptoms such as nausea, vomiting, headache, muscle and joint pain, or other flu-like symptoms 

Helping Teens Heal from Anxiety and Substance Abuse With Dual Diagnosis 

Teens who struggle with anxiety and substance abuse require dual diagnosis treatment that focuses on combining a variety of interventions to address both addiction and co-occurring mental health disorders. 

Substance abuse may be treated with detox, relapse prevention strategies, 12-step, and medication-assisted treatment. Anxiety treatment may include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and creative arts therapies.

Detox and Addiction Treatment 

The first step in any substance abuse treatment program is making sure that drugs, alcohol, and any other toxins have been removed from the teens’ bodies. Detox in dual diagnosis programs offers around-the-clock care with medical supervision to ensure teens are stabilized, their vitals are monitored, and if necessary, medications are prescribed to alleviate withdrawal pain. 

Teens may also participate in addiction counseling that focuses on behavioral interventions to avoid triggers, temptations, and coping skills to manage cravings. Peer support and group therapy are also key components of addiction treatment. They help teens connect with others in similar situations and foster a space for mutual understanding to decrease feelings of shame, guilt, or isolation. 

Evidence-Based Mental Health Therapies 

Teens with co-occurring mental health disorders, such as anxiety, often require targeted interventions and evidence-based therapies to address the underlying mental health challenges and thinking patterns that drive their substance abuse. Two commonly used mental health therapies include: 

• Cognitive Behavioral Therapy is considered the gold standard therapy for anxiety, depression, and substance abuse. It focuses on the interconnection between thoughts, emotions, and behaviors and by reframing maladaptive thinking patterns to help reduce emotional distress and anxiety. 

Through collaboration with a licensed CBT therapist, teens learn to identify, analyze, and modify distorted or unhelpful beliefs. Treatment is also goal-oriented and emphasizes the importance of skills training. 

• Dialectical Behavior Therapy was initially created to treat borderline personality disorder (BPD) and complex trauma, but has shown to be beneficial helping teens recover from substance abuse and co-occurring anxiety. It balances acceptance and change strategies to help teens regulate intense emotions, improve social functioning, and reduce self-destructive behaviors. 

DBT helps teens develop awareness of the present moment, respond to crisis situations in a helpful way, understand and regulate their emotional responses, and develop strong boundaries and healthy relationships.  

Creative Art Therapies 

Creative art therapies, such as art, music, dance, and writing or journaling help teens process distressing emotions, triggers, and experiences that often contribute to their anxiety.  These therapies create a safe space for teens to explore and communicate complex feelings that they struggle to articulate verbally. 

Art therapies support teens in recovery by helping them:

• Externalize their inner thoughts and develop insights around their emotions
• Increase self-awareness of the present moment
• Powerful way for storytelling to process distressing emotions ,especially related to trauma, which can drive anxiety and substance abuse 
• Fosters a sense of accomplishment and boosts self-esteem 

Dual Diagnosis Treatment for Teens in Texas 

Clearfork Academy is a network of behavioral health treatment facilities helping teens recover from substance abuse and co-occurring mental health disorders. We offer several levels of care, including dual diagnosis treatment to address both addiction and anxiety. 

We offer evidence-based treatments such as CBT, DBT, and EMDR, as well as creative art and recreational therapies, and strive to educate parents about mental health. Contact our admissions team today to see how we can support your family.

Sources

[1] Fishman, M.J.Et al.(2012). Adolescent Substance Abuse and Mental Health: Problem Co-Occurrence and Access to Services. Journal of child & adolescent substance abuse, 21(4), 310–322.

[2] McCauley Ohannessian C. (2014). Anxiety and substance use during adolescence. Substance abuse, 35(4), 418–425.

[3] National Institute on Drug Abuse. 2020. Drugs, Brains, and Behavior: The Science of Addiction. 

[4] Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General. 2016. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. CHAPTER 2, THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION.