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Substance Abuse and Phobias

Understanding the Connection Between Substance Abuse and Phobias


Updated July 10, 2008

Anxiety disorders including phobias are often linked to other disorders. According to the National Institute of Mental Health, the most common concurrent disorders are a second anxiety disorder, depression and substance abuse.

Differential Diagnosis

Deciding whether a client with a substance abuse problem has a phobia can be difficult. Many substances can cause phobic symptoms, particularly while the user is actively under the influence. Long-term use of substances can also lead to social phobia and agoraphobia.

Substances as a Coping Mechanism

Some people who have untreated social phobia or agoraphobia use substances as a coping mechanism. Alcohol and recreational drugs appear to have a bit of an anti-anxiety effect on phobias, and users feel that they have more confidence when they are under the influence. The combination of anti-anxiety properties with the placebo effect can be very powerful, eventually leading to a substance abuse problem.

Specific phobias are only rarely associated with substance abuse. This may be because it is relatively easy to simply avoid the object of a specific phobia.

Gender Differences

Although substance abuse occurs concurrently with phobias in both men and women, men appear to be at higher risk. However, it appears that in the majority of cases, women develop the phobia prior to the drug addiction. In men, the addiction generally precedes the phobia.

Treatment Concerns

Some medications that are prescribed for phobias, such as benzodiazepines, can be addictive and are sometimes abused. It is important that clients with a history of substance abuse be carefully monitored if these medications are prescribed.

New Research

A tuberculosis medicine known as D-cycloserine is currently in clinical trials for use in treating phobias. Some research shows that D-cycloserine may also be effective in treating substance abuse. It is possible that this medication will be particularly useful in treating clients who have both a substance abuse problem and a phobia, although it is too soon to tell.


Swan, Neil. “Gender Affects Relationships Between Drug Abuse and Psychiatric Disorders.” National Institute on Drug Abuse: Notes. July/August 1997. 12:4. March 14, 2008.

The Numbers Count: Mental Disorders in America. National Institute of Mental Health. March 14, 2008. http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml

Science Daily. “Antibiotic that appears to control phobias may also be useful in treating addiction.” Science Daily. November 7, 2007. March 14, 2008. http://www.sciencedaily.com/releases/2007/11/071106141554.htm

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