Why high-functioning anxiety often leads to hidden substance use

Many successful people battle anxiety behind closed doors and turn to alcohol, tobacco or medication to cope-experts explain the signs, risks and solutions

They might appear calm, capable and driven, but beneath the surface, many high-functioning individuals are silently battling anxiety—and often rely on substances to keep going. From alcohol and nicotine to prescription pills, these coping tools help them manage the invisible pressure they carry each day.

 

According to Dr Gorav Gupta, CEO and senior psychiatrist at Tulasi Healthcare, Gurgaon, high-functioning anxiety is a hidden struggle where people look outwardly successful but constantly battle chronic worry, perfectionism and self-doubt.

 

What does high-functioning anxiety look like in real life?

 

Dr Gupta explained that high-functioning anxiety often shows up in professionals, students and caregivers as:

 

• Overachievement
• Relentless busyness
• Fear of underperformance
• Burnout masked as dedication

 

These individuals may be excelling at work or in academics while silently fighting an intense mental battle they rarely disclose.

 

Why are high-functioning individuals prone to substance use?

 

The pressure to maintain control, appear perfect and never show weakness can push people toward unhealthy coping mechanisms. Dr Gupta explained that substances often become a disguised ‘crutch’:

 

• Alcohol: to unwind, socialise or fall asleep
• Nicotine: to calm nerves or stay alert
• Prescription medications: benzodiazepines for anxiety, stimulants for focus
• Cannabis: for emotional escape

 

These habits often pass as casual routines—an evening drink, a post-meeting cigarette, or a pill during crunch times—but they signal dependence.

 

Are there differences in substance use by gender and age?

 

Yes, patterns vary, said Dr Gupta:

 

• Women often turn to alcohol or sedatives for relief
• Men may lean on stimulants or tobacco to remain focused
• Young adults (of any gender) commonly misuse cannabis or ADHD drugs for quick relief

 

People tend to choose what feels socially acceptable or easily accessible—but the risks remain the same across groups.

 

What are the signs someone may be silently struggling?

 

People with high-functioning anxiety are skilled at masking their distress. Still, some red flags can signal underlying problems:

 

• Mood swings or unexplained irritability
• Reliance on daily ‘de-stress’ habits (like drinking or smoking)
• Insomnia or erratic sleep patterns
• Intense periods of productivity followed by burnout

 

If someone’s ability to function appears dependent on their next smoke, drink or pill, it could be a sign of self-medication.

 

What are healthier ways to manage high-functioning anxiety?

 

There are effective and sustainable alternatives to substance use. Dr Gupta recommended:

 

• Therapy: Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy (ACT)
• Mindfulness practices: including meditation and breathwork
• Exercise: to regulate mood and manage stress
• Consistent sleep routines
• Emotional openness: with trusted friends, family or therapists
• Short-term supervised medication: when prescribed by a mental health professional

 

These strategies help build resilience and promote long-term emotional wellbeing.

 

Why early intervention and support are critical

 

The sooner anxiety and substance use are identified, the easier it is to intervene without major life consequences. Compassion—not judgment—is key.

 

“These are people who already hold themselves to impossible standards,” said Dr Gupta. “What they need most is empathy, understanding, and safe spaces to ask for help.” 

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This content is for informational purposes only and is not a substitute for professional medical advice.