How Do You Approach Treatment for Clients with Anxiety and Substance Use Disorders
At The Recovery Hub, we recognize that the intersection of anxiety disorders and substance use disorders presents unique diagnostic and clinical challenges. Research indicates that nearly 20% of individuals with an SUD also have an anxiety disorder, with comorbidity often resulting in poorer treatment outcomes when not addressed concurrently (Grant et al., 2004). Our treatment model is rooted in an integrated, co-occurring framework that ensures both conditions are evaluated and treated in a synergistic, evidence-based manner.
Integrated, Co-Occurring Treatment Model
We utilize an integrated model of care, aligning with SAMHSA’s recommendation for simultaneous treatment of co-occurring disorders within the same service delivery context. This model diverges from sequential approaches, which have been associated with fragmented care and increased client dropout (Drake et al., 2001). At The Recovery Hub, licensed alcohol and drug counselors, mental health professionals, and psychiatric providers work collaboratively from assessment through aftercare planning.
Initial diagnostic assessments incorporate screening tools for generalized anxiety and substance use disorders. We also utilize ASAM Criteria for level-of-care placement, ensuring services are appropriately matched to the client’s functional capacity, acuity, and readiness for change.
Biopsychosocial Formulation and Treatment Planning
Clients with co-occurring anxiety and SUD typically present with intricate biopsychosocial histories, where substance use may serve as a maladaptive coping mechanism for unmanaged anxiety symptoms. In our treatment planning process, we apply a multidimensional approach that considers neurobiological vulnerabilities, trauma history, social determinants of health, and environmental triggers.
Treatment plans are individualized and structured around the integration of:
Evidence-based psychotherapies such as Cognitive Behavioral Therapy (CBT) are empirically supported for treating anxiety and SUD concurrently (McHugh et al., 2010).
Medication-Assisted Treatment (MAT), including Suboxone for opioid use disorder, with psychiatric oversight for co-prescribing SSRIs or other anxiolytics as clinically appropriate.
Psychoeducation and skill-building focused on emotion regulation, cognitive restructuring, relapse prevention, and healthy coping mechanisms.
Multidisciplinary Collaboration and Clinical Supervision
Our staff engage in weekly case consultations facilitated by licensed supervisors with co-occurring expertise. These meetings ensure ongoing alignment between therapeutic interventions and diagnostic clarity, particularly in complex cases where symptom overlap (e.g., substance-induced anxiety vs. primary anxiety disorder) may obscure clinical presentation.
We also maintain active coordination with outside providers, such as primary care physicians, when needed to ensure continuity and safety, particularly during medication transitions or higher acuity periods.
Closing Thoughts
Integrated treatment for co-occurring anxiety and substance use disorders requires more than parallel services, it requires true clinical integration, shared decision-making, and continuous outcome monitoring. At The Recovery Hub, our team is committed to treating the whole person, addressing root causes, and fostering long-term recovery through collaborative, compassionate, and evidence-based care.
References:
Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24(4), 589–608.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., … & Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Archives of General Psychiatry, 61(8), 807-816.
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–525.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2002). Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. U.S. Department of Health and Human Services.
