Anxiety and addiction: which comes first, and why they often exist together

Quick takeaway

Anxiety and addiction often exist together because each one exacerbates the other. For many people anxiety comes first, with drinking, drugs, gambling or another compulsive habit developing as a way to calm it. For others, the substance or behaviour creates anxiety of its own through withdrawal, hangovers, debt and secrecy. Which came first matters less than treating both at the same time, because easing one while ignoring the other tends to bring both back. I’m Peter J Davies of Addiction Care, and I offer confidential one-to-one therapy for anxiety and addiction in Guildford, Surrey.

If you’ve been feeling anxious, you may have noticed that a drink, a pill or a late-night bet settles your nerves for an hour or two, but the worry comes back stronger the next morning. Over time it becomes hard to tell whether you’re dealing with anxiety, an addiction, or both at once.

I’m Peter J Davies, and I’ve worked as an addiction specialist in Guildford for more than 20 years. Anxiety and addiction often present together, and in my experience they rarely untangle unless they’re worked on side by side.

Here, I’ll share how to tell the two apart, which one tends to come first, why they keep each other going, and how to find one-to-one help near you.

Do I have an addiction or anxiety?

You can have anxiety without an addiction, an addiction without an anxiety disorder, or both at once. Anxiety becomes a disorder when worry is persistent and out of proportion, often with a racing heart, poor sleep and restlessness. Generalised anxiety disorder now affects around one in 12 adults in England, according to the NHS Adult Psychiatric Morbidity Survey 2023/4.

Addiction describes your relationship with a substance or behaviour: you’ve lost some control over it, you carry on despite the harm, and you feel unsettled without it. That can apply to alcohol, drugs and prescribed medication, and to behaviours such as gambling.

The two overlap when the substance or behaviour has become your main way of managing your nerves. One honest test is to notice what happens when you go without for a few days. If your anxiety rises sharply and using is how you deal with it, the two have become linked. If you drink heavily every day or take benzodiazepines, speak to your GP before cutting down, because stopping suddenly can be dangerous.

Which comes first, anxiety or addiction?

In many people who have both, the anxiety came first. A 2018 review of the research on self-medication found that among people who use alcohol or drugs to ease anxiety or low mood, the anxiety usually started first, and using substances to cope later developed into dependence.

The link runs the other way too. A 2015 review in Current Psychiatry Reports found that sedating substances such as alcohol, benzodiazepines, cannabis and opioids can both soothe anxiety and cause it, while stimulants such as cocaine and amphetamines are more likely to bring anxiety on directly. Withdrawal, hangovers, debt and the strain of keeping a secret then add anxiety of their own.

Whichever started first, by the time you’re struggling with both, each one is fanning the flames of the other.

Why anxiety and addiction often exist together

The pattern I see most often follows a loop:

1. You feel anxious, and a drink, a pill, a bet or an hour on your phone brings short-term relief
2. Your brain learns that this is the fastest route to calm
3. As the effect wears off, withdrawal or regret pushes your anxiety higher than before
4. You reach for the same relief again, usually in larger amounts

Over time, the thing that once eased your anxiety becomes one of its main causes.

Prescribed medication can become part of this cycle too. Benzodiazepines are sometimes prescribed for anxiety, and prescription drug addiction can develop even when you’ve followed your doctor’s advice. Family history, trauma and long periods of stress can also leave some people vulnerable to both.

Signs your anxiety and addiction are feeding each other

These are the signs I listen for:

• You drink, use or gamble before situations that make you nervous, such as work events or social gatherings
• Your anxiety is worst the morning after, or as the effect wears off
• You feel panicky or on edge when you can’t get hold of your usual substance or activity
• You need more than you used to for the same sense of calm
• You’ve stopped seeing friends or doing things you enjoy, because of worry or because of your habit
• You hide how much you use from the people close to you, and the secrecy itself keeps you anxious

If you recognise two or three of these, it’s worth speaking to a counsellor who understands both conditions.

Why anxiety and addiction need treating together

Treating one in isolation tends to leave the other in place. If you stop drinking without learning other ways to manage anxiety, the anxiety returns and so does the pull to drink. If you work on the anxiety while the drinking carries on, the alcohol keeps undoing that work. The above mentioned 2018 review concluded that treating both at the same time is the current gold standard of care.

In my sessions, that means looking honestly at what your substance or behaviour has been doing for you, finding other ways to manage anxious feelings, and planning for the moments when the urge is strongest.

Most of my clients do this work while carrying on with their jobs and family lives. If you are worried that residential treatment is your only option, there are good alternatives to residential rehab worth knowing about.

Finding one-to-one therapy for anxiety and addiction in Guildford

I see clients face to face in central Guildford, a short walk from the town centre and the station. We begin with a confidential assessment, an honest conversation about what you’re using and how anxious you’ve been feeling.

Support	What it offers	How to access
Addiction Care, Guildford	One-to-one addiction therapy in Surrey that works on the anxiety alongside the addictive behaviours	Call 01483 533808
Your GP	Medical advice on withdrawal and medication, and referral to local services	Book an appointment
Samaritans	Free, confidential listening support	Call 116 123

If you’re reading this because you’re worried about someone else, I also run a Family Programme for partners, parents and adult children affected by a loved one’s addiction.

Taking the first step

Anxiety and addiction keep each other going, and both ease more reliably when they’re treated together by someone who understands the link. You don’t need to work out which came first before you ask for help, because that’s part of what we can untangle together.

Call me now to book a confidential assessment so we can talk it through. If you would like to talk, either for yourself or for a loved one, please call 01483 533808 or get in touch online.

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