Substance-Induced Anxiety Disorder: How Drug Use Can Cause Panic Attacks

Anxiety disorders are the most common mental health conditions. About 30% of people have one at some point during their lifetimes.

For most people, a combination of genetic and environmental factors cause these disorders. Other people find that using certain substances trigger their diagnoses.

Keep reading to learn more about substance-induced anxiety disorder and what you can do to avoid or cope with it.

What is substance-induced anxiety disorder?

Substance-induced anxiety disorder is a condition that is similar to other anxiety disorders. You could find yourself feeling very worried, nervous, and shaky. The difference is that this condition develops as a direct result of substance use. 

Perhaps you normally find yourself feeling calm with very low anxiety symptoms. Then, you use a certain drug or drink alcohol and feel extremely anxious. The anxiety could come during intoxication or when the substance is leaving your body. After the effects wear off, you feel calm again. This is an example of substance-induced anxiety disorder.

Substance-induced anxiety disorder is an officially recognized condition. Mental health experts and researchers may refer to it by different names, like:

• Drug-induced anxiety disorder

• Medication-induced anxiety disorder

• Toxin-induced anxiety disorder

Substance-induced anxiety disorder isn’t diagnosed very often. Only a very small number of people with anxiety symptoms — about 0.002% — will receive this diagnosis during a given year. Experts believe that there could be many more people with the condition who never receive a diagnosis and treatment.

What’s an anxiety disorder?

Anxiety disorders are a broad group of mental health conditions. The exact symptoms of each anxiety disorder vary. But they share the similar features of worry, fear, and physical tension.

Everyone feels anxious at times. But people with these conditions experience anxiety that is more intense than the situation calls for. These high levels of anxiety can keep them from functioning well at home, work, or school.

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Some of the most common anxiety disorders include:

• Phobias: intense and irrational fears of certain situations or things

• Social anxiety disorder: extreme anxiety and discomfort when around other people

• Panic disorder: experiencing panic attacks that repeat, often without warning, and extreme fear of having a panic attack in the future

• Generalized anxiety disorder: an overall feeling of worry and nervousness  

Many people with anxiety disorders try to control it by avoiding the things that make them anxious. Fortunately, anxiety disorders can be treated with therapy and medications.

Symptoms of substance-induced anxiety disorder

You might struggle to separate substance-induced anxiety disorder from another anxiety disorder. Feeding into the confusion is the idea that these conditions share many symptoms.

Anxiety disorders tend to produce physical and mental symptoms. Some common physical symptoms of substance-induced anxiety disorder are:

• Fast heart rate or pounding heartbeat

• Excessive sweating

• Shakiness

• Shortness of breath

• Pain or tightness in the chest

• Feeling dizzy or lightheaded

• Feeling very hot or very cold

• Low energy and fatigue

• Muscle tension

Some common mental symptoms of substance-induced anxiety disorder are:

• Significant worry and nervousness

• Trouble concentrating or paying attention

• Irritability

• Fear of going crazy or losing control of yourself

• Fear that you are dying

Depending on various factors, your anxiety may be more mild, or it could build over time. Some people experience full panic attacks related to their substance-induced anxiety disorder.

One way to identify an anxiety disorder from a substance-induced anxiety disorder is timing. If these symptoms were present before the substance use or persist for more than a month, then you probably have a different anxiety disorder. If the symptoms begin after you use a substance or while you are coming off of a substance, then you likely have substance-induced anxiety disorder. 

What are the signs of someone with drug-induced anxiety?

A loved one with substance-induced anxiety could present in a number of different ways. They could be very active and energetic. Or they could be panicky and reserved.

A person with substance-induced anxiety could be:

• Sweaty and shaky

• Struggling to get good sleep

• Having difficulty catching their breath and calming down

• Unable to eat

• Talking very quickly

• Complaining of pains in their chest or stomach

At this point, you may not know if their symptoms are due to anxiety, other medical concerns, or a substance-induced problem. Often, it’s best to be safe and contact emergency professionals, especially if they complain of chest pain.

What drugs can cause substance-induced anxiety disorder?

Alcohol and other drugs disrupt the normal flow of chemicals in the brain. This imbalance can cause anxiety.

Nearly every type of substance can produce anxiety, either during intoxication or withdrawal. Substances that can produce anxiety during intoxication include:

• Alcohol

• Cannabis (marijuana)

• Hallucinogens like LSD and psilocybin (mushrooms)

• Inhalants like gasoline and paint

• Stimulants like cocaine and methamphetamine

Substances that can produce anxiety when leaving the body include:

• Alcohol

• Stimulants

• Opioids like heroin and prescription painkillers

• Sedatives like benzodiazepines and sleeping medications

Alcohol and stimulants contribute to anxiety twice: once during intoxication and again during withdrawal. This can create a very uncomfortable rollercoaster effect.

Do any other substances create anxiety symptoms?

It’s not only the above drugs that can trigger substance-induced anxiety disorder. Other triggers include caffeine, toxins like carbon dioxide, and medications such as:

• Decongestants

• Corticosteroids

• Asthma medications

• Thyroid medications

• Anesthesia medications

If you or a loved one has a history of anxiety or substance-induced anxiety, be sure to talk to your healthcare provider before starting any new medications. They could trigger an intense period of anxiety.

How long does substance-induced anxiety disorder last?

Substance-induced anxiety disorder usually lasts less than a month. How long the symptoms last will depend on the substance, the dose, and the duration of use.

For example, opioids can trigger anxiety during withdrawal. A person goes through withdrawal much quicker for heroin than for buprenorphine. So the substance-induced anxiety disorder symptoms will likely last less time than for someone using heroin. Someone using other opioids could expect even longer durations. 

As with other conditions, substance-induced anxiety disorder is unique to each person. The intensity and duration of symptoms will depend on the individual. 

How do you treat drug-induced anxiety disorder?

Since the symptoms of drug-induced anxiety tend not to last long, you may simply wait for them to improve naturally. If symptoms are especially intense or frequent, consider contacting a healthcare provider. 

Working with mental health professionals will help you directly address your condition and manage your symptoms. Healthcare providers may offer sedatives, like lorazepam (Ativan). Or they may offer antidepressant medications, like sertraline (Zoloft). These medications can help minimize your symptoms until the condition resolves.

Therapists can teach you new ways of thinking, relaxation techniques, and other coping skills to add to your treatment plan. Not using any anxiety-inducing substance is an essential part of recovery from substance-induced anxiety. 

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Written by:

Eric Patterson, LPC

Eric Patterson, LPC, has been a professional counselor in school and outpatient settings for over 15 years. Patterson has been cited as a mental health expert in publications such as Today.com, Good Housekeeping, and InStyle.

Reviewed by:

Emily Guarnotta, PsyD

Emily Guarnotta, PsyD, is a licensed clinical psychologist and certified perinatal mental health professional with over 10 years of clinical experience.

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If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.