Written by Keunshea Fleming, CSW-I
Anxiety and substance use feed each other because the relief is real and the rebound is bigger. A drink, a pill, or a hit genuinely lowers anxiety for a few hours, and then the nervous system compensates by running hotter than before, so the next day's baseline is worse than the day you started from. Over time you are no longer using to feel good — you are using to get back to neutral. Treating either problem alone usually fails, because each one keeps rebuilding the other.
The loop, step by step
It is worth seeing the mechanics laid out, because most people are living inside them without ever having watched them run.
- Anxiety rises. It might be a specific situation or it might be a body that has been humming since Tuesday.
- You use. Relief arrives fast — often in minutes, which is faster than anything else available to you.
- Your system adapts. It reduces its own calming capacity to compensate for the outside help.
- The substance wears off. Now the reduced capacity is exposed, and anxiety rebounds above where it was.
- The rebound gets read as evidence of how bad your anxiety is, rather than as an effect of step three.
- You use earlier next time.
Nothing in that sequence requires a character defect. It requires a working nervous system and something that reliably quiets it.
Why the thing that worked stops working
Early on, the math is good. The relief is large, the cost is small, and you can point to a real improvement in how you function.
Then the ratio shifts. The same amount produces less relief, the window before rebound shortens, and the hours you are not using start feeling worse than the hours before you ever began. People often describe an exact point where it flipped from making life better to defending against how bad the gaps feel.
That flip is also where the shame usually starts, because it arrives with the recognition that you are no longer choosing this in the way you were.
Which came first matters less than you think
Almost everyone in this loop has an opinion about the order. The anxiety came first and I was self-medicating, or I never had anxiety until I started drinking.
Both are frequently true, and in the moment neither one changes the plan much. The loop is self-sustaining once it is running. You can have started with a serious anxiety condition or with none at all and end up in an identical place.
Where the order does matter is later, once use has stopped long enough for a baseline to emerge. That is when it becomes possible to see what the anxiety is doing on its own, and what it needs. Before then, any assessment is measuring the loop rather than the person.
Withdrawal anxiety is not the same as your anxiety
This is the single most useful distinction for anyone in the first weeks of cutting back.
Withdrawal and early abstinence produce anxiety that is chemical and time-limited — racing heart, dread with no content, jumpiness, sleep that will not hold, a sense of impending disaster that attaches itself to whatever is nearby. It is often worse than the anxiety that started the whole thing, and it convinces a lot of people that they cannot live without using.
They are not wrong that it is unbearable. They are wrong about what they are measuring. That state is a nervous system recalibrating, not a forecast of your life.
Coming off some substances — alcohol and benzodiazepines in particular — can be medically dangerous, and that is not a stop to attempt alone based on willpower. Talk to a physician about how to do it safely.
The social piece nobody accounts for
A quiet part of this loop is that the substance was doing social work.
For many people it was the only way conversation felt possible, the only way a party was tolerable, the only way to be around family. Remove it and you are left with the original social anxiety, undressed, in exactly the settings where it is most exposed.
People who do not plan for this get blindsided. They handle the physical piece well, then stand in a kitchen at a gathering with nothing in their hands and nothing to do with their face, and the strength of the pull surprises them.
That gap is workable, but it has to be treated as its own project rather than assumed to resolve on its own.
Treating one without the other
Treating the anxiety while use continues tends to stall. Skills do not get a fair test, medication is hard to evaluate, and the substance keeps resetting the baseline.
Treating the use while ignoring the anxiety is equally unstable. The anxiety was doing something, and if nothing replaces the function it served, the pressure builds in the same direction it always did.
What works better is holding both at once: a plan for the substance, and real work on what the anxiety is about, with the understanding that the second only becomes legible after some distance from the first. In practice this often looks like individual therapy running alongside whatever recovery support you are using — a group, a program, a prescriber, or all three.
Where to start when it all seems like too much
Start with the substance, with medical guidance, because everything else is hard to see through it.
Then get honest with one person about the loop rather than about a single piece of it. People tend to disclose the drinking to one friend and the anxiety to another, which keeps anyone from seeing the whole shape.
And if the anxiety has ever gotten to the point where you did not want to be here, treat that as the priority it is. 988 is available by call or text, any hour, and it is not only for emergencies.
Common questions
Is one drink to take the edge off really a problem?
Not necessarily, and this is not a question that answers itself by quantity. The more informative question is what happens when it is not available — whether the evening reorganizes itself around getting it, and whether the anxiety on nights without it is worse than it used to be.
Will my anxiety get worse if I stop?
Usually yes, for a period, and then it typically settles below where it was while using. Knowing that in advance is protective, because the temporary spike is exactly when most people conclude that stopping was a mistake.
Can I be in therapy if I am still using?
Yes. Waiting until you have it handled is a common reason people never start. Come as you are and be honest about the use, because a therapist working from an edited version cannot help you with the actual problem.
Does anxiety medication work if I am also drinking?
That is a question for your prescriber, and it needs a truthful answer about how much and how often. Combining some medications with alcohol carries real risk, and your prescriber cannot manage that without accurate information.
If you recognize the loop in your own week, that recognition is worth something — most of the difficulty in this is how long it stays unnamed. When you want a plan that addresses both halves instead of one, you can find an appointment here. You can also read about my work with trauma and substance use first.