Last Updated on March 23, 2021
Does Anxiety Cause Alcohol Abuse? | Drinking and Your Brain | Alcohol and Anxiety Relief | The Vicious Cycle | Solutions
Addiction and emotional distress often go hand-in-hand. In fact, alcohol use disorder (AUD) often occurs in the same people, and at the same time as anxiety disorders—a pattern of excessive unease and worry.
The combination of the two can become disabling. People who are alcohol-dependent are twice as likely1 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?
Can alcohol cause anxiety? Or does anxiety lead to excessive drinking? The answer: both are possible.
A 2008 review of several studies2 found that 75 percent of people with both anxiety and AUD developed the former first. This indicates that anxiety may lead to excessive drinking or addiction, more often than the other way around.
But alcohol use disorder might also create anxiety where there wasn’t much before. In a couple of smaller-scale studies3 4, patients reported drastically decreased anxiety levels after treatment for AUD. That doesn’t necessarily mean that alcohol was the cause, but it does suggest that alcohol might make anxiety worse.
Drinking and Your Brain Chemistry
Many people who fit into the first category—anxiety first, then AUD—use alcohol to help them manage feelings of stress. This is often called self-medication.
Ironically, however, too much alcohol can actually increase anxiety6. 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 drinking followed by withdrawal. Those withdrawal periods can cause changes in the brain that may induce panic attacks7, or at least make you more susceptible to stress8. The more withdrawals you go through, the worse and more stressed you feel, making it more likely you’ll relapse.
Other studies9 have confirmed that consistent alcohol use can make you less able to cope with stress. In other words, it’s possible that alcohol can increase anxiety attacks, and that drinking often—especially every day—may help cause anxiety.
Alcohol and Anxiety Relief
If all of this is true, why does alcohol reduce anxiety—or at least feel like it does? Can alcohol help anxiety?
Alcohol is a central nervous system depressant, and as such can temporarily calm your system down. However, this can often have the opposite effect the next day as the alcohol wears off. And on top of this, the relief many people feel when they drink may turn out to be a placebo effect.
In one 2004 study10, participants were ranked based on how much they thought drinking could improve their anxiety. Then many of them were given a non-alcoholic beverage that they were told contained booze. The male participants who thought alcohol was good at lowering anxiety and who took the placebo experienced greater stress reduction. They experienced more than the participants who didn’t think drinking could help.
In other words, stress relief from alcohol may have a lot to do with the belief that it works, vs it’s real effects. And the real impacts of alcohol on your system will likely make you more anxious long-term.
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 reinforce each other11. Not only does each condition make the other one worse, but they also make each other harder to treat. In other words, alcohol is often bad for someone with anxiety.
For example, a person might start drinking to cope with feelings of stress, but find the effects of their drinking—poor job performance, strained personal relationships, or even just alcohol withdrawal—cause them even more anxiety. Then they might drink even more than before to cope with these new stressors. And behind the scenes, changes in their brain chemistry from excessive drinking might make it even harder to break the cycle.
Solutions for Alcohol and Anxiety
If you struggle with anxiety disorder, it’s best to avoid alcohol, or at least limit your drinking. If you drink occasionally, the impacts may be manageable. But if you find that you often have panic attacks, or generally feel worse the day after having some alcohol, it may simply improve your quality of life to skip the booze. And you should definitely avoid self-medicating with alcohol, as it can lead to a negative cycle.
If you’re already struggling with your drinking habits, and looking for alcohol-induced anxiety treatment, it can be hard to know where to start. But research suggests that since the two problems are often so entwined, you’ll need to treat both. It can be harder to treat your anxiety if you are still consuming large amounts of alcohol. And if you quit drinking, but don’t treat your anxiety, it may put you at a higher risk for relapse12.
Fortunately, there are solutions. Some medications, such as gabapentin, can actually help treat both problems at once. And newer, more modern forms of alcohol treatment now often include mental health care. A counselor or medical professional may be able to help you find a balanced approach that helps you overcome your alcohol-related anxiety at the same time.
One especially easy way to do this is via telemedicine. Ria Health’s program is one option that gives you expert medical support, coaching, prescription medications, and more—all through an app on your smartphone.
John E. Mendelson, MD is the co-founder and chief medical officer of Ria Health