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Treatment of co-occurring substance use disorder and anxiety-related disorders in adults

Sudie Back, PhD
Megan M Moran-Santa Maria, 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  

This topic reviews treatment of co-occurring substance use disorder and anxiety-related disorders. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of co-occurring substance use disorder and anxiety-related disorders are described separately. Treatment of individual, noncomorbid anxiety-related disorders are described separately. Treatment of individual, noncomorbid substance use disorders are described separately. (See "Co-occurring substance use disorder and anxiety-related disorders in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Psychotherapy for obsessive-compulsive disorder in adults" and "Pharmacotherapy for panic disorder in adults" and "Psychotherapy for panic disorder in adults" and "Pharmacotherapy for generalized anxiety disorder in adults" and "Pharmacotherapy for social anxiety disorder in adults" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults" and "Pharmacotherapy for opioid use disorder" and "Cannabis use disorder: Treatment, prognosis, and long-term medical effects" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Brief intervention for unhealthy alcohol and other drug use" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis".)


Clinical trials have identified medications and psychotherapies that effectively treat individual, noncomorbid anxiety-related disorders as well as individual, noncomorbid substance use disorders (SUDs). However, evidence from clinical trials, described below, is generally inadequate to determine the effectiveness of these interventions in treating co-occurring anxiety-related disorders and SUDs.


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Literature review current through: Sep 2016. | This topic last updated: Nov 7, 2014.
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