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Alcohol and Anxiety: What You Should Know

By Manjari Bansal
Alcoholism and anxiety are two separate disorders that can occur simultaneously. Here's what you should know about a dual diagnosis.

Having a glass of wine to unwind may feel like a great way to end a long day, but how do you know when you're alcohol dependent? And if you have anxiety, does alcohol alleviate or aggravate your symptoms?

If you find that you're reaching for alcohol to cope with anxiety, it could be a sign of a larger problem. Read on for more details about the connections between alcohol and anxiety.

Alcohol and Anxiety

According to the National Alliance on Mental Illness, anxiety disorders are the most common and prevalent mental disorders found among US adults, with around 48 million people experiencing one in a given year.  

You may drink to uplift your mood: to feel more relaxed, energized, and happier. Alcohol may act as your coping mechanism for dealing with stress, anxiety and other mental conditions, the Mental Health Foundation notes. However, this is a temporary solution and as the effect of alcohol wears off, you may feel worse due to withdrawal symptoms. Using alcohol as a method to manage mental well being can become a problem in itself.  

“Many people who suffer from anxiety disorders turn to alcohol as a way to self-medicate,” Clare Waismann, RAS, SUDCC, Founder and Director of Waismann Method® and Domus Retreat in California, tells WebMD Connect to Care.

“While alcohol may initially help reduce anxiety symptoms, it is a central nervous system depressant that can eventually worsen anxiety. For people with anxiety disorders, alcohol can cause drowsiness, decreased inhibitions, and impaired judgment, leading to dangerous situations. Additionally, alcohol use can lead to dehydration and electrolyte imbalances, which can further contribute to anxiety symptoms,” Waismann says. 

“The problem is this becomes a crux,” Lea McMahon, LPC, EdD, Chief Clinical Officer at Symetria Recovery in Texas, tells WebMD Connect to Care. “They aren’t actually dealing with their anxiety, but masking it. They can become anxious when not drinking. If they feel alcohol helped them with social conversations, they may start drinking to help with conversations at work or other inappropriate times.”

“Having an anxiety disorder puts the individual at a higher risk of developing an alcohol use disorder like alcoholism,” James Pratty, MD, a Psychiatrist and Medical Director at Behavioral Health for Brand New Day, tells WebMD Connect to Care.

“Statistics show that out of every 5 people with anxiety, at least one person reports using alcohol to cope with anxiety symptoms. The effects of alcohol can relieve feelings of stress and anxiousness. But over time, it may become tempting to use alcohol as a crutch to avoid anxiety symptoms, which can ultimately lead to an alcohol use disorder or depending on more and more alcohol to function normally. Suddenly stopping drinking can cause alcohol withdrawal, which can cause severe symptoms like aggression, seizures, hallucinations, palpitations, panic, and anxiety, making an existing anxiety disorder worse,” Pratty explains. 

 “It is common that individuals prone to anxiety develop an addiction,” Paulo Negro, PhD, MD, Medical and Addiction Advisor at All Sober, tells WebMD Connect to Care. “For example, someone with social anxiety may drink in social gatherings. Over time, the use of alcohol may lead to addiction in those vulnerable to the problem.”

“After a while, the addiction runs in parallel with the anxiety disorder. For example, the same individuals addicted to alcohol and with social anxiety will need treatment for both conditions. It will not be enough to treat the alcohol use disorder because they will relapse due to the anxiety whereas the opposite is also true,” Negro explains.

Anxiety and Alcohol Dependence

According to a 2018 study published in the journal Depression and Anxiety, the comorbidity (i.e., the simultaneous presence of two or more diseases) is commonly seen between mood/anxiety disorders and substance use disorders. The reason behind these co-occurring conditions is the self-medication hypothesis, which means people suffering from mental disorders commonly misuse substances to relieve the symptoms of mental health conditions. Over time, this practice of self-medication may turn into an independent condition or addiction. 

AUD and anxiety disorders do commonly co-occur,” Aaron Sternlicht, LMHC, CASAC, a therapist and co-founder of Family Addiction Specialist in New York, tells WebMD Connect to Care.

“AUD and anxiety disorders are akin to the chicken or the egg dilemma as to which came first. Some individuals with an anxiety disorder may turn to alcohol as a coping mechanism only to develop a dependence on alcohol while others with alcohol dependence may develop anxiety as a result of their alcohol use,” Sternlicht says. 

“In either scenario, AUD and anxiety disorders are always treated concurrently,” Sternlicht says. “While the first immediate focus of treatment is on mitigating withdrawal symptoms of alcohol which can be fatal, treatment thereafter will commonly include a combination of developing relapse prevention techniques in conjunction with Cognitive Behavioral Therapy (CBT) which will help challenge and change unhealthy or unhelpful thoughts and feelings that can lead to anxiety and/or cravings for alcohol. CBT serves to help improve behaviors, emotional regulation, and coping skills. Therapeutic treatments may also be used in conjunction with medication such as Medication-Assisted Treatments for alcohol and/or anti-anxiety medications.”

Does Alcohol Cause Anxiety?

The majority of people who are addicted to alcohol also experience strong anxiety and mood issues, according to a 2019 study published in Alcohol Research: Current Reviews. Also, studies have shown that up to 50% of individuals receiving treatment for alcohol use disorder usually meet the diagnostic criteria for one or more anxiety disorders

“Alcohol use can cause anxiety for some individuals, and may also exacerbate anxiety for individuals who already have an underlying issue with anxiety,” Sternlicht says. 

Alcohol use disrupts the balance of chemicals in the brain and impedes the brain's ability to function properly, including the natural processes in the brain that help to regulate stress and anxiety. When an individual consumes alcohol they have an unnatural influx of pleasurable brain chemicals, after which anxiety can follow when the effects of alcohol subside. This is why anxiety is a common withdrawal symptom of alcohol. Alcohol use also impedes proper sleep which can then serve to trigger anxiety,” Sternlicht adds. 

“After a night of drinking, people often feel guilty or ashamed of their drinking,”  Waismann says. “These feelings lead to more anxiety and distress, making it difficult to concentrate, sleep, or relax. Fortunately, anxiety related to a hangover is usually only temporary and usually goes away within 10 to 14 hours. However, if anxiety symptoms linger for much longer, it could signify a more serious problem, such as alcohol withdrawal or an anxiety disorder. If you are concerned about your anxiety level, it is best to speak with a doctor or mental health professional.”

When Does Anxiety Go Away After Quitting Drinking?

“This really depends on a lot of factors, but generally if you are getting appropriate treatment, which includes therapy and medication management, the anxiety can go away within a few months of quitting drinking,” Julian Lagoy, MD, a psychiatrist at Mindpath Health, tells WebMD Connect to Care.

 “However, there are cases where the anxiety can take years to treat.” 

“If anxiety is caused due to alcohol withdrawal then treating withdrawals can treat anxiety,” Hassaan Tohid MBBS, SUDCC, CCATP, Board Certified Addiction Counselor and Founder of California Institute of Behavioral Neurosciences and Psychology, tells WebMD Connect to Care.

“But for the anxiety caused by chronic alcohol use, it is natural to assume that it can be treated once there is complete abstinence from alcohol for a long period of time. But of course, more research is needed to answer this question about how long it may take to resolve anxiety symptoms caused by chronic alcohol use,” Tohid adds. 

Hangover Anxiety

Hangovers are very common in people who are heavy drinkers, Cleveland Clinic notes. Research has shown that around 75% of people who consume too much alcohol, experience the symptoms of a hangover the next day. 

Hangover anxiety, often called “hangxiety,” is when anxiety is felt after the effects of alcohol wear off,” Sternlicht says. “While alcohol can help curb feelings of anxiety in the short-term, alcohol can serve to cause or exacerbate feelings of anxiety after drinking.”

“While the exact causes of hangover anxiety are not fully understood, it is believed to be the result of a combination of factors, including dehydration, electrolyte imbalance, and withdrawal from alcohol,” Waismann says.

“The symptoms can include fatigue, severe headache, poor coordination, difficulties concentrating, and generalized malaise,” Pratty says. 

“All of these symptoms occur well after all of the alcohol is out of someone’s system. As far as how long hangxiety last is determined by how much alcohol was consumed the day before. Typically, the symptoms can last 24 to 48 hours. There are no long-term physical or psychological effects although certainly, someone that is regularly drinking alcohol to excess can develop a level of dependency where they are feeling driven to regularly consume alcohol,” Pratty adds. 

“This anxiety is caused after heavy drinking, a small amount of drink does not usually cause it,” Tohid says. “However, every human being’s tolerance to alcohol is different. Everyone may respond to alcohol differently.”

How to Treat Hangover Anxiety

Waismann tells WebMD Connect to Care, that there are a few things you can do to help your body recover and ease your hangover anxiety, like:

  • Rehydrating by drinking plenty of water. You may also try drinks available in the market with high levels of electrolytes. 
  • Eating a light meal of mild foods to help settle your stomach. If you're experiencing nausea, broth, soda crackers, bananas, or dry toast can help.
  • Getting some sleep will also be crucial in helping your body recover. If you're having trouble sleeping, try taking a shower, listening to relaxing music, or diffusing some essential oil for aromatherapy. 
  • Over-the-counter pain medicines can be used for headaches or muscle aches. 

“The best way to prevent this is to not have a hangover or drink too much in the first place. If you are drinking a lot you should try to avoid drinking on an empty stomach, drink sufficient water in between drinks, and do not drink too fast,” Lagoy says. 

However, If your alcohol intake is higher and you are often experiencing severe hangover anxiety, then you should seek professional treatment for both AUD as well as anxiety disorders.

Get Help Now

If you are diagnosed with alcoholism and anxiety as co-occuring disorders, you don't want them to go untreated. It's important to treat both disorders.

The good news is that there are plenty of treatment options available for people struggling with a dual diagnosis, whether it's consulting a physician, joining a support group like Alcoholics Anonymous (AA), enrolling in a treatment/detox center, or seeking help from a counselor or therapist.

WebMD Connect to Care Advisors are standing by to help find the option that's right for you.

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