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

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


Substance use disorders (SUDs) are common in patients with anxiety-related disorders (in DSM-5, these include the anxiety disorders as well as posttraumatic stress disorder and obsessive-compulsive disorder) [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 recognizing the symptoms of each disorder and diagnosing them accurately. Effective treatment requires consideration of potentially toxic drug-drug interactions, medication abuse liability, and patient adherence. Evidence from clinical trials of treatments for the disorders when presenting individually is generally inadequate to determine treatment effectiveness for anxiety disorders and SUDs when presenting concurrently.

This topic reviews treatment of co-occurring substance use disorders and anxiety-related disorders. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of co-occurring substance use disorders and anxiety-related disorders, as well as individual substance use disorders and anxiety-related disorders, are described separately. (See "Co-occurring substance use disorder and anxiety-related disorders in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)

Treatment of individual, noncomorbid anxiety-related disorders are described separately. (See "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Psychotherapy for obsessive-compulsive disorder in adults" and "Pharmacotherapy for panic disorder with or without agoraphobia in adults" and "Psychotherapy for panic disorder with or without agoraphobia in adults" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults" and "Approach to treating social anxiety disorder in adults" and "Approach to treating generalized anxiety disorder in adults".)

Treatment of individual, noncomorbid substance use disorders are described separately. (See "Treatment of cannabis use disorder" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Brief intervention for unhealthy alcohol and other drug use" and "Approach to treatment of stimulant use disorder in adults".)

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Literature review current through: Nov 2017. | This topic last updated: May 26, 2017.
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