Alcohol and Anxiety

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We know that some people rely on alcohol to take the edge off when they are feeling anxious. But could it be that they are feeling anxious as a result of drinking, and alcohol’s impact on their nervous system?

While alcohol may be calming at first, anxiety is a common consequence of long-term heavy drinking—and a major symptom of withdrawal and hangovers. By drinking heavily, many people actually worsen the very problem they are trying to “fix”!

An estimated 40 million Americans1 suffer from an anxiety disorder at any given time. Alcohol dependence doubles the risk that a person will struggle with this issue, and makes the likelihood of diagnosis with a generalized anxiety disorder four times greater2. And in many cases, it’s hard to tell which problem came first.

In other words, there seems to be a “chicken and egg” relationship between anxiety and alcohol use disorder (AUD). Here’s what you need to know about this common problem, and how to find solutions that work for you.

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What Is Anxiety?

Anxiety is part of being human. We all experience it from time to time, such as when faced with a job loss, an important exam, or a relationship issue. However, anxiety disorders are different. They represent a serious level of anxiety—a constant, overwhelming fear—that interferes with daily functioning.

Anxiety disorders include panic disorder, social anxiety disorder, specific phobias, obsessive-compulsive disorder, agoraphobia, and generalized anxiety disorder. Many researchers believe that these disorders may be due to problems in brain circuit functioning that regulate fear and other emotions.

Excessive worry, nervousness, obsessing, and being overly self-conscious in public settings are some of the hallmarks of anxiety.

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What Is the Connection Between Alcohol and Anxiety?

Can alcohol cause anxiety? The answer appears to be yes, and the problem works both ways. In a nutshell, anxiety can cause people to drink, and heavy drinking can cause changes in brain chemistry that create anxiety.

While it is usually harmless to have a single drink after a stressful day, someone with an anxiety disorder may self-medicate with several drinks in an effort to quiet their mind.

On the flip side, it is common for someone who is alcohol dependent to develop symptoms of anxiety when they cannot drink, or during the initial period of recovery. This is a result of the effects that alcohol abuse can have on the nervous system.

It can sometimes be difficult for people who struggle with both alcohol and anxiety to recall which came first. In one 2008 review, 75 percent3 of participants suffered from anxiety before developing AUD. But a significant number of people experience things the other way around, and the two are often intertwined.

Why Alcohol Might Seem to Make Anxiety Better

Does alcohol help anxiety? Alcohol is a depressant and sedative that affects the central nervous system. It can therefore improve symptoms of anxiety short-term. But long-term, it tends to have the opposite effect.

The relaxed feeling that you experience when you drink is linked to the impact of alcohol on your brain chemistry. Alcohol increases the effects of neurochemicals that calm your system down, while reducing the levels of chemicals that ramp things up. This can make you feel less anxious while your blood alcohol concentration (BAC) is still high.

As your BAC levels fall, however, you may actually feel more anxious than you were prior to drinking. This is why the effects of alcohol on anxiety are rather deceptive. Overall, heavy alcohol use can actually cause anxiety.

Why Alcohol Can Actually Make Anxiety Worse

Why does alcohol cause anxiety? It turns out that long-term heavy drinking actually rewires your brain.

The more often you consume large amounts of alcohol, the more your nervous system begins to compensate for its sedative effects. This can leave you increasingly anxious when you don’t drink, and lead to dependence on alcohol to regulate your nervous system.

People with AUD often also go through periods of excessive drinking followed by withdrawal. Those withdrawal periods can cause changes in the brain that may induce panic attacks4, or at least make you more susceptible to stress5.

On top of all this, alcohol abuse also undermines your self-control and judgment. You may make more dangerous choices, or have worse interactions with those around you, making your daily life more anxiety-producing.

For those with social anxiety, this can be an especially difficult cycle. The Anxiety and Depression Association of America (ADAA) reports that about 7 percent of Americans have social anxiety6. Approximately 20 percent of people with social anxiety disorder also struggle with alcohol dependence.

Why Many People Struggle with Anxiety in Recovery

To begin with, it makes sense that a person who used alcohol as a coping mechanism for anxiety would feel quite anxious during recovery. They are forced to face this condition in daily life without the help of alcohol.

But even for those who didn’t struggle with this issue to begin with, quitting alcohol can cause significant anxiety as your brain chemistry rebalances itself.

The withdrawal symptoms many people experience in the first week or two of quitting alcohol often include severe anxiety, irritability, and panic attacks. And, long-term, it’s common for people in recovery to feel more anxious for months or even years after quitting.

Essentially, heavy drinking over an extended period forces your nervous system to compensate—becoming more “active” to counteract the presence of alcohol. Removing alcohol leaves your nervous system without its counter-weight, causing it to over-activate. Until things rebalance again, anxiety is a very common symptom.

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Treatment for Anxiety and Alcohol

If you are struggling with co-occurring alcohol use disorder and anxiety, it can feel overwhelming. While addiction may seem like the more imminent danger, it’s also critical to treat the underlying anxiety to prevent relapse, or other negative life-consequences.

If you’ve been using alcohol to cope with anxiety, some healthy alternatives need to be put in place. Here, coaching or counseling can help. A skilled recovery coach can help you identify new strategies to manage anxiety in daily life, while a therapist can help you get to the root cause.

When psychotherapy alone isn’t sufficient, medication may be added to the treatment plan. Certain medications such as benzodiazepines may be effective for treating anxiety, but do not mix well with alcohol. An alternative medication is gabapentin, which can be used for treating combined anxiety and AUD.

Read more: Treating Anxiety and Alcohol—A Psychiatrist’s Perspective

Getting Help for Anxiety and Alcohol

Alcohol use disorder and anxiety each bring their own unique set of challenges, and often co-occur. But the good news is that both conditions are treatable.

If you or a loved one struggles with both alcohol and anxiety, reach out to your physician or mental health provider about your concerns.

Professional support for AUD—including medications that treat both anxiety and alcohol addiction—is also now available online. Ria Health offers expert medical advice and weekly coaching support from an app on your smartphone. We’ll stick with you through every step of the recovery process, and help you face the challenges of daily life without excessive drinking.

Get in touch with us today, or get started on your journey.

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