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Addiction and emotional distress often go hand-in-hand. Indeed, Alcohol Use Disorder—or AUD, the current preferred term for an unhealthy relationship with alcohol—often occurs in the same people and at the same time as anxiety disorders, characterized by excessive unease and worry. This combination can become disabling. People who are alcohol-dependent are twice as likely to have anxiety. Because it and AUD often occur simultaneously, you might wonder whether one produces the other, and whether treatment of one can solve the other.
Does Anxiety Cause Alcohol Abuse, Or the Other Way Around?
The answer: both are possible.
A 2008 review of several studies found that 75 percent of people with both anxiety and AUD developed the former first. This indicates that the former may lead to alcohol dependence or abuse, more often than the other way around.
AUD might also cause anxiety. In a couple of smaller-scale studies, patients reported drastically decreased anxiety levels after treatment for AUD. That doesn’t necessarily mean that alcohol was the cause, but it does indicate that alcohol was a major contributing factor to its severity. In another study that followed a group of college students for seven years, anxiety disorders increased fourfold among those with alcohol dependence.
How Drinking Can Alter Brain Chemistry
Many people who fit into the first category—anxiety first, then AUD—use alcohol to self-medicate because they think it will help them deal with their stress. Ironically, though, drinking can actually lead to more anxiety. Not only can excessive drinking undermine your relationships, your job, or your finances, but it can also alter your brain chemistry. Chronic alcohol abuse can make your brain deficient in a chemical called GABA (short for Gamma-Aminobutyric acid) an anti-stress mood elevator. The more frequently and excessively you drink, the less GABA you have, and the more tense and anxious you feel.
What’s more, people with AUD often go through periods of excessive alcohol consumption followed by withdrawal. Those withdrawal periods can cause changes in the brain that may induce panic attacks, or at least make you more susceptible to stress. The more withdrawals you go through, the worse and more stressed you feel, making it more likely you’ll relapse. Other studies have confirmed that consistent alcohol use can make you less able to cope with stress.
Mind Over Matter
To further the irony, the relief that many people feel when they drink may turn out to be a placebo effect. In one 2004 study, participants were ranked based on how much they thought alcohol could improve their anxiety. Then many of them were given a non-alcoholic beverage that they were told contained alcohol. The male participants who thought alcohol was really good at lowering anxiety and who took the placebo experienced greater stress reduction. They experienced more than the participants who didn’t think alcohol could reduce their anxiety.
Essentially, their stress relief wasn’t linked to how much alcohol they drank—since they didn’t drink any—but to how much they thought alcohol would help them. So alcohol’s ability to actually, physiologically reduce anxiety may just be “in your head.”
Anxiety and Alcohol: A Vicious Cycle
Whether anxiety causes alcohol misuse or the other way around, the research has largely settled on one thing: When the two disorders come together, they can form a vicious cycle. Not only does each condition makes the other one worse, but they also make each other harder to treat. You might start drinking to cope with anxiety, but find the effects of your drinking—poor job performance, strained personal relationships, or even just alcohol withdrawal—cause even more anxiety. Then you might drink even more than before to cope with these new stressors. And on and on it goes, until you’ve lost control.
How We Can Help
Do you want to stop drinking too much and feel less stressed, but you don’t know where to begin? Research indicates that you need to treat both. You can’t expect your drinking patterns to automatically improve once you start treating your anxiety. You also can’t rely on all of your anxiety to disappear when you start drinking less. Without treating the second disorder, you’re at a higher risk of relapsing.
There are FDA-approved medications like naltrexone that can help reduce alcohol cravings. Also, behavioral psychotherapy approaches can help you cope with anxiety in a way that won’t run the risk of conflicting with your alcohol treatment. At Ria Health, we know the importance of effective, confidential, one-on-one treatment. No one needs the added stress of having to get to a doctor’s office. Our medical team is passionate about helping you achieve a less stressful and more rewarding life.
Do you find this interesting? Want to learn about another alcohol-related topic? Feel free to leave a comment below.
And it goes without saying, if you’re having difficulties managing your drinking, we’re here to help you.
John E. Mendelson, MD is the co-founder and chief medical officer of Ria Health