Self-Medicating Anxiety? Options for Changing Substance Use

Establish goals for change, because anxiety and substance use don't mix well.

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Though substance use is a common “coping” strategy used by individuals struggling with Generalized Anxiety Disorder and other anxiety disorders, self-medicating symptoms in this manner is not the best route to recovery. Why not? Well to start, substance use carries a fair amount of risk. According to The Anxiety and Depression Association of America, people with anxiety disorders are two to three times more likely to struggle with substance abuse in their lifetime as compared to the general population.

In addition, using substances to cope with anxiety is actually counterproductive – that is to say, it typically makes anxiety worse in the long-term.

Like other entrenched routines, a particular pattern of substance use can be difficult to change. To do so is likely to require thoughtful consideration of reasons for change, awareness of cues that may trigger the problematic chain of behavior, identification of a clear intention or goal for change, as well as planning. It is also like to require some support – from a mental health professional, a physician, family and friends, and/or a support group of other people with similar struggles.

Motivation for Change and Goal-Setting

Review the pros and cons of making any change at all (versus no change) to remind yourself of your reasons for working on your use of substances to deal with anxiety in the first place.


               Immediate Effects

   Advantages        Disadvantages

                Long-term Effects

    Advantages        Disadvantages

Drink more safely



Drink less alcohol



Quit drinking



Goals for change related to substance use commonly fall into one of three categories: safer use, reduced use, and abstinence. To hone in on your desired goal with regards to alcohol use for example, perhaps try jotting down a list of advantages and disadvantages to each on a grid like the one pictured above.

Prepare by Learning Strategies​ for Change

If your goal is harm reduction with alcohol use, there are several strategies that might help:

  • Eat well and hydrate throughout the day
  • Choose your drink carefully
  • Plan transportation home from your evening out
  • Use a buddy system

If your aim is to reduce your overall alcohol intake, consider the following means to that end:

  • Monitor your current intake, in real time
  • Set a limit
  • Avoid drinking games
  • Experiment with “abstinence days”
  • Limit your cash when you go out
  • Start later in the day
  • Alternate an alcoholic drink with a non-alcoholic drink
  • Eat something that makes alcohol taste bad (such as breath mints)
  • Use meditation, breathing exercises, or a prescribed sleep aid for sleep

Trying to abstain altogether from drinking?

  • Get support from family, friends, or like-minded individuals
  • Anticipate cravings and plan distracting or alternative pleasurable activities to ride out the sensation
  • Minimize, to the extent possible, contact with people/places/things that enhance risk of relapse
  • Take it one day at a time

If you are using marijuana or other substances to manage anxiety, strategies similar to those listed above are likely to apply. If you notice that you sometimes experience symptoms of withdrawal when your usual pattern of substance use is disrupted, or if you are unsure of where to start implementing these tips, ask a physician or mental health professional to help guide you through the process.

Make a Change Plan

If, in reading over the list of strategies for behavior change provided, you find yourself thinking that this is going to require some work – well, you’re right! Behavior change requires more than good intentions (though those will, of course, help you to get started and keep at it). Simply put, you are going to need to plan, on a variety of levels.

  • Plan daily and weekly goals that move you towards larger goal
  • Identify impending high risk situations and create a clear plan (and backup plan) to manage the risk
  • Anticipate social pressure and think ahead about how you will respond to others’ requests that you join them for a drink, a cigarette, etc. Generate a couple of drink refusal ideas, for example “Thanks, but I’m on vacation from booze” or “My stomach is actually feeling a little queasy, so I’ll pass,” and test them out.
  • Personalize your plans. Tailor them to the function of your substance use – if it’s to relax, distract, reward, ease shyness – then your plan should include alternative strategies to achieve those goals.
  • Consider how outside issues might relate your use of substances to manage anxiety. How might you directly address the source of the problem?

Remember, the last part of any plan is to evaluate the outcome so that you can repeat or modify your approach to change as needed.

For more information on substance abuse and anxiety, including resources for treatment, contact the following organizations:

Additional reading on these and related options for changing substance use include:

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