Anxiety & Addiction: Co-Occurring Treatment on Long Island, for When the Thing That Calms You Down Is Keeping You Stuck
For adults across Garden City, Rockville Centre, and the rest of Nassau County, anxiety and drinking (or using, gambling, or scrolling at 2 a.m.) often turn out to be two halves of the same problem. Our co-occurring anxiety and addiction treatment addresses them as one.
It usually starts sensibly enough. A glass of wine takes the edge off after the kids are down. A gummy makes the Sunday-night dread about Monday tolerable. A Xanax, prescribed years ago for a flight, turns into something you keep in the car. For a while, the arrangement works, and that is exactly why it’s so hard to question.
Then the math changes. The anxiety comes back sharper the next morning, so the evening dose moves earlier. You start planning around the substance: which parties will have an open bar, how many are left in the bottle, whether anyone noticed. Now there are two problems where there used to be one, and each one keeps feeding the other.
If that sounds familiar, you are describing one of the most common patterns we see in addiction therapy and anxiety therapy alike. It is also one of the most treatable, once both sides get addressed in the same room; that’s what co-occurring anxiety and addiction treatment on Long Island is built to do.
Contact Long Island Psychology for a confidential conversation about whether our approach is a good fit.
What Co-Occurring Anxiety and Addiction Treatment Addresses
Clinically, “co-occurring” (you may also hear “dual diagnosis”) means a person meets criteria for an anxiety condition and a substance use or behavioral addiction at the same time. That could be generalized anxiety with alcohol, social anxiety with cannabis, panic with a benzodiazepine that was supposed to be temporary, or anxiety paired with gambling, pornography, or compulsive eating.
The label matters less than the relationship between the two. In our practice at Long Island Psychology, we think about that relationship in terms of reality: what a person can tolerate about their life as it actually is, and what they do when it feels intolerable.
Anxiety, at its core, grows out of a mismatch between how things are and how a person needs them to be. The anxious mind locks onto the worst outcome and rehearses it, hoping to get ahead of it. Worry feels like preparation; it can even feel responsible. What it really provides is an illusion of control over things that were never controllable in the first place, like whether a boss is annoyed, whether a biopsy comes back clean, or whether a partner will stay. Because that control is imaginary, it never delivers the calm it promises, so the worrying escalates.
Addiction grows from a closely related place. At its root is the desire to escape from our existing reality, and the type of addiction (drugs, alcohol, gambling, sex, food) matters less than that desire. A substance or behavior offers a way out for an hour or an evening. Sometimes the draw is escape from something painful. Other times it’s the pursuit of a high, a relief, or a sense of aliveness the person has come to believe ordinary life can’t provide on its own. (Our page on pleasure versus happiness gets into that distinction.)
Put the two side by side and the overlap becomes clear. Both are strategies for managing a reality that feels unacceptable. Anxiety tries to control it; addiction tries to leave it. When a person has both, the substance often becomes the tool they reach for once the worrying stops working. That is why treating only one half so rarely holds.
Signs Your Anxiety and Your Drinking or Using Are Connected
- You drink, use, or gamble most on the days your anxiety runs highest, and you can predict those days in advance.
- Social plans feel manageable only if you know alcohol will be there.
- The morning after brings a spike of dread or shakiness that a drink (or another pill) would quiet.
- A prescription meant for occasional use has become daily, or you’ve started running short before the refill.
- You have tried cutting back, and the anxiety that surfaced felt worse than whatever you were originally treating.
- Friends or a spouse have mentioned your drinking, and your first reaction was panic about losing your way of coping.
- Periods of sobriety have been white-knuckled: you stopped the substance, but nothing replaced it.
- Most of your free time now goes to recovering from the substance, planning around it, or worrying about it.
How Anxiety and Addiction Feed Each Other
The connection runs in more than one direction, and figuring out which direction dominates for a particular person shapes the whole treatment plan.
Self-Medication: Anxiety First, Substance Second
This is the most familiar version. Someone with long-standing worry or panic (or a dread of being judged) discovers that a substance quiets it, and the relief teaches the brain a very efficient lesson. Over time the relief shortens while the anxiety between doses grows. Our page on self-medicating anxiety with alcohol or substances describes how this pattern starts and why it’s so hard to see from the inside.
Substance-Induced Anxiety: The Cure Becomes the Cause
Some substances produce anxiety directly. High-potency cannabis, stimulants, and heavy caffeine are frequent culprits; so is withdrawal from alcohol or sedatives, where the nervous system rebounds into overdrive each time the substance wears off. People in this situation often believe their anxiety is getting worse on its own, when a meaningful part of it is chemical. Our page on managing anxiety in early recovery explains what happens to that rebound once the substance is gone.
Shared Roots: Same Soil, Two Plants
For many people, neither condition came first. Both grew from a common source: a temperament that feels threat intensely, a childhood home where emotions weren’t safe to feel, trauma, or a family history in which a parent drank to cope. In those cases, what we treat is the underlying intolerance of distress that both conditions express.
The Worry-and-Sedation Cycle
People with chronic worry often land in a particular loop involving alcohol, sedative prescriptions, or both. The worry supplies the reason; the sedative supplies the relief; the rebound supplies the next round of worry. When the sedative is a prescription, the picture gets more delicate; our page on anxiety medication misuse and benzodiazepine dependence covers it.
What This Looks Like in a Session
A composite drawn from many patients, with details changed. A project manager in his early forties, living in Merrick and commuting to an office near Roosevelt Field, comes in because his wife gave him an ultimatum about the drinking. He’s prepared to talk about alcohol. He is not prepared to talk about anxiety, because he doesn’t think he has any; he thinks he’s “just wired.”
Twenty minutes in, he’s describing the hour between 4 and 5 p.m., when the day’s unanswered emails start stacking up in his head and he begins to mentally draft the defense for every decision he made. By the time he pulls into the driveway, he’s been arguing with imaginary critics for forty minutes. The first beer happens before his jacket comes off. “It’s the only way I can stop the committee from meeting,” he says.
Nothing about that is a willpower problem. His drinking is a very effective (and very expensive) sedative for a worry pattern nobody ever named. In the months that follow, both halves get work: motivational work around the drinking itself, which he remains ambivalent about for a while, and direct work on the 4 p.m. committee. As the worry loosens, the case for the beer gets weaker, and he’s the one who notices.
What Changes
Before
- The substance is the only reliable way to turn the worry down
- Cutting back feels impossible because the anxiety underneath rushes in
- Uncertainty feels like an emergency you have to solve tonight
- Your evenings organize themselves around the substance
After
- You have several ways to tolerate anxiety, and none of them require recovering the next day
- The anxiety underneath has been treated directly, so sobriety stops feeling like white-knuckling
- Uncertainty is uncomfortable but livable, and it doesn’t need a drink to get through
- Your evenings organize themselves around what you value
Co-Occurring Anxiety and Addiction Treatment: How We Work
At Long Island Psychology, both conditions are treated together, by the same clinician, in one coordinated plan. We don’t send people off to “get sober first” before the anxiety can be addressed, and we don’t treat anxiety while quietly ignoring the drinking. The specific mix depends on the person, but it typically draws from the following.
Acceptance as the Common Thread
Because anxiety and addiction are both ways of refusing reality, the work that ties everything together is helping a person come into alignment with their actual life. Acceptance, as we use the word, means being able to stand in a situation you don’t like, whether that’s uncertainty, grief, boredom, or a craving, without needing to control it or escape it; people sometimes hear resignation in the word, and that’s a misreading. Our article on acceptance and mental health expands on this idea.
Cognitive Behavioral Therapy (CBT)
CBT helps with both halves of the problem. On the anxiety side, it targets catastrophic predictions and the belief that worry keeps you safe. On the addiction side, it maps the situations (and the thoughts running underneath them) that lead to use. For people whose anxiety includes panic attacks, phobias, or obsessive-compulsive patterns, our CBT includes exposure and response prevention: gradually facing feared sensations or situations while resisting the escape response, so the nervous system learns firsthand that the feared outcome doesn’t arrive. For someone who has used a substance to escape those sensations, that learning is often the turning point.
Motivational Interviewing and Motivational Enhancement Therapy
Ambivalence about changing a drinking or drug habit is normal, especially when the substance is doing a job. Motivational interviewing, along with its more structured form, motivational enhancement therapy, helps a person look at what the substance gives them and what it costs them without anyone arguing either side. People tend to believe their own reasons for change far more than anyone else’s.
Relapse Prevention
Relapse prevention identifies high-risk situations (a Friday happy hour, a family holiday, a sleepless night) and builds a specific plan for each. For people with co-occurring anxiety, the plan pays special attention to anxiety spikes as relapse triggers, since that is where most slips begin.
Acceptance and Commitment Therapy (ACT) and Mindfulness
Mindfulness is built into ACT rather than added on. Learning to notice a craving or an anxious thought as something passing through, instead of a command that has to be obeyed, is a core ACT skill. It gives people room to make a values-based choice in the exact moment they used to reach for a drink.
Psychodynamic Therapy
Psychodynamic work asks what the substance and the worry have been doing for a person emotionally, and where those patterns started. Many people discover that their anxiety has a specific origin, and that their drinking protected them from feelings they never had permission to experience.
Dynamic Experiential Learning (DEL)
Developed here at Long Island Psychology by Dr. Shulman, DEL works experientially, helping a person register at an emotional level (and not only an intellectual one) that the distress they have been escaping is survivable.
Positive Psychology
Recovery that consists only of subtracting a substance tends to feel empty, and emptiness is a relapse risk. Positive psychology helps people build what the substance was standing in for: meaning, engagement, connection, and real enjoyment that doesn’t come with a hangover. Our Resilience Training Program draws on the same principles.
Involving a Partner When It Helps
What About Behavioral Addictions?
The same reality-avoidance pattern shows up with behaviors as often as with substances. Gambling, compulsive pornography use, and binge eating can all serve as anxiety relief. Our understanding of compulsive sexual behavior as an addictive process builds on the foundational work of Dr. Patrick Carnes, and we treat it with the same integrated approach. See our pages on gambling addiction and sex addiction for more.
What to Expect in Your First Session
The first session is a conversation, not an interrogation. We’ll map how your anxiety and your use relate: which came first, what each one does for you, and when each one gets worse. We’ll also ask about safety, since stopping alcohol or sedatives abruptly can be medically dangerous, and when that’s a risk we coordinate with your physician or a medical detox program before anything changes. From there we build a plan that fits you. Some people walk in certain they want to stop entirely; others aren’t sure yet. Both are reasonable places to start.
Contact us to set up that first conversation.
Frequently Asked Questions
Do I have to stop drinking or using before I can start therapy for anxiety?
No. Waiting for sobriety before addressing anxiety tends to backfire, because untreated anxiety is one of the strongest drivers of relapse. We work on both at once, starting wherever you are.
How do I know whether my anxiety is caused by the substance or was there first?
Often it’s some of each. We look at timing (whether the anxiety predates the use), at how symptoms behave during periods of lower use, and at your family and personal history. That picture usually becomes clearer within the first several sessions.
Is outpatient therapy enough, or do I need rehab?
For many people, outpatient therapy is the right level of care. When use is heavy, or when withdrawal could be dangerous, we help arrange detox, an intensive outpatient program, or inpatient care first, then continue therapy afterward.
Is it safe to stop drinking on my own?
Not always. Alcohol and benzodiazepine withdrawal can cause seizures in heavy, long-term users. If you’ve been drinking daily or taking sedatives regularly, talk with a physician before stopping.
Will you tell me I have to quit completely?
We won’t hand you a verdict. Some people conclude that abstinence is the only thing that works for them; others work toward a different goal. Motivational interviewing is designed to help you reach your own conclusion.
Can you prescribe medication?
Our psychologists don’t prescribe, but we coordinate closely with psychiatrists and primary care physicians across Nassau County when medication is part of the plan.
What if my anxiety medication is part of the problem?
That’s a common and delicate situation. We never recommend stopping a prescription on your own; we work alongside your prescriber so any change happens safely and gradually.
Can my spouse or partner be involved?
Yes, when it helps. Partners often carry a lot of their own anxiety about the drinking, and a few joint sessions can change the tone at home considerably.
Is telehealth an option?
Yes. We offer virtual therapy throughout New York State, which many patients use for privacy or to fit sessions around a commute on the Long Island Rail Road.
Is this confidential?
Yes. Therapy is confidential under New York law and HIPAA, with the standard limited exceptions around imminent safety that we review at the start. Because we don’t bill insurance directly, no diagnosis goes to an insurer unless you submit for reimbursement yourself.
How does payment work?
Long Island Psychology is a self-pay practice. We provide a superbill that many out-of-network plans reimburse against; our page on checking your out-of-network benefits walks you through it.
Where are you located?
Our offices are in Garden City, a short drive from the Meadowbrook Parkway and Roosevelt Field, and in Rockville Centre, just off Sunrise Highway near Mercy Hospital and Molloy University. We also see patients from Long Beach, Oceanside, and the North Shore by telehealth.
Treating Both Halves in Nassau County
Anxiety and addiction are not character flaws, and you don’t have to pick which one to fix first. They are two responses to the same underlying difficulty, and they respond best when treated together by someone who understands both.
Contact us to talk with a member of our team. Long Island Psychology sees patients in Garden City and Rockville Centre, and offers telehealth throughout New York, including Merrick, Oceanside, Long Beach, Levittown, Great Neck, and Manhasset. Many of the people we see for this work are busy professionals in Mineola, Westbury, and East Meadow whose drinking looks perfectly normal by Nassau County standards, which is often what let it grow unnoticed. See our full list of Nassau County locations served.
