Purpose of Review <p>The relationship between anxiety and stimulant use disorder is complex and multifaceted, involving genetic predispositions, neurochemical changes, and environmental factors. While correlations are evident, the causal mechanisms underlying their bidirectional association remain incompletely understood and require rigorous methodological approaches to elucidate correlation. Significant research gaps persist regarding stimulant-specific manifestations and tailored interventions. Future interdisciplinary research focusing on these mechanisms is essential for developing effective, personalized therapeutic strategies that can address both comorbid conditions.</p> Recent Findings <p>Current evidence reveals complex neurobiological pathways linking anxiety and stimulant use disorder through shared limbic system circuits. Studies have demonstrated that individuals with stimulant use disorder exhibit distinct anxiety sensitivity levels, with chronic users often developing anxiety symptoms even without prior history. Genetic correlations, neurochemical alterations in dopaminergic and serotonergic systems, and psychosocial stressors contribute to this relationship. Research indicates variability in causal pathways depending on specific stimulants and individual demographics, suggesting multiple directional influences where anxiety may precede or result from chronic stimulant use, though the precise mechanisms require further investigation.</p> Summary <p>This review examines the proposed bidirectional relationship between anxiety and stimulant use disorder, explores the distinction between causality and correlation in these co-occurring conditions, and highlights fundamental mechanisms that may regulate these interactions.</p>