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Co-occurring substance use disorder and anxiety-related disorders in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Sudie E Back, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Substance use disorder (SUD) commonly co-occurs in anxiety-related disorders (in DSM-5 these include the anxiety disorders, trauma- and stressor-related disorders, and obsessive-compulsive and related disorders) [1-4]. The association between these disorders is multifaceted. Anxiety-related disorders may increase the risk for the development of SUDs, and may alter the presentation and treatment outcome of SUDs. SUDs may alter the presentation and outcome of treatment for anxiety-related disorders.

The complexity of these comorbidities highlights the importance of a comprehensive understanding of the symptoms of each disorder, proper diagnosis, and use of effective treatments as well as consideration of potentially toxic drug-drug interactions, medication abuse liability, and patient adherence.

In the revision of DSM-IV to DSM-5, PTSD was reclassified from an anxiety disorder to a “trauma and stressor-related” disorder and OCD was reclassified as an “obsessive-compulsive and related disorder” [5]. Diagnoses of substance abuse and substance dependence in DSM-IV were replaced by the single diagnosis, substance use disorder in DSM-5 [5].

This topic reviews the epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of co-occurring substance use disorder and anxiety-related disorders. The treatment of co-occurring substance use disorder and anxiety-related disorders is described separately. Individual anxiety-related disorders and SUDs are described separately. (See "Treatment of co-occurring substance use disorder and anxiety-related disorders in adults" and "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Social anxiety disorder in adults: Epidemiology, clinical manifestations, and diagnosis" and "Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis" and "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis".)


Substance use disorders (SUDs) have been found to co-occur at an increased rate in individuals with posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder (SAD) compared to rates in the general population. Obsessive-compulsive disorder (OCD) and SUDs have not been found to co-occur at a higher rate than each disorder individually.

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Literature review current through: Oct 2017. | This topic last updated: Jul 19, 2017.
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