Anxiety disorder and alcohol use disorder are common co-occurring disorders that can cause severe distress and impair your daily functioning. Alcohol use disorder can exacerbate an existing anxiety disorder or may lead to new anxiety symptoms and vice versa, meaning that a pre-existing anxiety disorder can contribute to an alcohol use disorder (as many individuals use alcohol as an unhealthy coping mechanism).
What is Anxiety Disorder?
Most people experience anxiety at some point in their lives. Anxiety is a normal (and very human) response to a fearful situation or a stressor, such as the way you might feel before a doctor’s appointment or before an exam. In a perfect world, feelings of anxiety would generally subside after an upsetting situation or stressor has been resolved. However, when feelings of anxiety persist, you may experience excessive fear or worry that doesn’t go away and doesn’t always seem to be influenced by stressful external factors. For example, feelings of anxiety may be present in the absence of fear or a stressor. When these symptoms interfere with your ability to function in daily life as a healthy adult, it may be a sign that you have an anxiety disorder.
Symptoms and Types of Anxiety
Several types of anxiety disorders may manifest in different ways, depending on the individual, but all of them share symptoms of excessive worry and fear. Common types of anxiety disorders that co-occur with substance use disorders, including alcohol use disorders, include:
Generalized anxiety disorder (GAD). The main symptoms are chronic, excessive worry and fear about general, everyday things that interfere with your ability to function. The feelings must occur most days and last at least six months to qualify for this diagnosis.
Panic disorder. It is characterized by recurrent, unexpected panic attacks, which are sudden, intense episodes of fear and dread that are often debilitating and can feel life-threatening. Some people feel like they are having a heart attack. Symptoms can include chest pain, difficulty breathing, feelings of impending doom, heart palpitations, and feeling like you’re out of control.
Social anxiety disorder (SAD). Previously referred to as social phobia, this involves intense fear of social or performance situations such as public speaking. You may worry that others will judge your feelings and behaviors negatively or have an intense fear.
Can Alcohol Cause Anxiety or Make it Worse?
Alcohol use can cause new-onset anxiety and worsen pre-existing anxiety symptoms. Many individuals will use alcohol as an unhealthy coping tool to reduce symptoms of anxiety.
Alcohol may be a temporary, unhealthy way to relieve anxiety and forget about your underlying stressors; however, using alcohol does not erase these underlying triggers. Whether your anxiety is related to past trauma, financial stress, or untreated depression, alcohol is merely a temporary Band-Aid, and the longer one depends on alcohol to help treat their anxiety, the more at risk they are for developing an alcohol use disorder. Additionally, symptoms of anxiety will still be lurking around the corner as the underlying triggers have not been adequately addressed and treated.
Chronic alcohol use affects your ability to respond to stress in healthy and effective ways, which can lead to anxiety. This may be due to alcohol’s effect on the amygdala, the area of your brain that regulates negative emotions. Brain imaging studies have found abnormalities in amygdala functioning in individuals with alcohol use disorder.
Understanding Alcohol Use and Misuse
Alcohol is one of the most commonly used (and misused) substances in the United States. In 2021, 78.3% of individuals aged 12 or older reported drinking alcohol at some point in their lives, 23.3% of people aged 18 and older reported binge drinking in the past month, and 10.6% of individuals aged 12 or older had an alcohol use disorder (AUD), the clinical term for alcohol addiction, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Alcohol misuse means that you use alcohol in unhealthy ways that impact your life. It involves drinking more than the Centers for Disease Control and Prevention’s (CDC) Dietary Guidelines for alcohol, which states that people who choose to drink should do so in moderation.
According to the NIAAA, alcohol misuse is characterized by compulsive drinking, an inability to control your alcohol use, and negative feelings when you don’t drink.
A large proportion of people who misuse alcohol also have co-occurring anxiety disorders. Having either an alcohol use disorder or an anxiety disorder can substantially elevate your risk of developing the other.
Risk Factors for Anxiety
Research suggests that both genetic and environmental factors contribute to an individual’s risk of developing an anxiety disorder, producing anxiety symptoms, or aggravating them.
These may include:
Caffeine; stimulant substance use, such as cocaine and amphetamines; and certain medications.
Trauma or exposure to other stress.
Some physical health problems, such as thyroid problems or heart arrhythmia.
Other mental health disorders, such as depression or a family history of mental health disorders.
Being shy or nervous.
Coping Mechanisms for Anxiety
On the other hand, certain factors and self-care measures may help to improve anxiety, including:
Practicing mindfulness is the psychological practice of actively paying attention to the present moment.
Keeping a journal.
Participating in relaxation techniques, such as deep breathing or visualization.
Seeking support from people you trust.
Exercising and eating regular, healthy meals.
Getting plenty of sleep.
Identifying and challenging your negative, unhelpful thoughts.
Participating in mutual-help groups.
Alcohol and Panic Attacks
One study reported that 25% of people who sought treatment for panic disorder had a history of alcohol dependence. Alcohol has an effect on many chemicals in the brain, including GABA (Gamma-aminobutyric acid), serotonin, and dopamine. When these brain chemicals are altered, it can throw off how the body reacts in everyday situations. Alcohol can induce panic because of its effects on GABA, a chemical that usually has a relaxing effect. Mild amounts of alcohol can stimulate GABA and cause feelings of relaxation, but heavy drinking can deplete GABA, causing increased tension and feelings of panic.
Individuals with panic disorder and many other types of anxiety disorders may try to self-medicate with alcohol in hopes of reducing their anxiety levels. However, heavy alcohol use, over time, can potentially make them dependent on alcohol. As a result, when they stop drinking, they are at risk of alcohol withdrawal, which can result in severe anxiety.
Is Anxiety Associated with Alcohol Tolerance and Dependence?
Alcohol tolerance occurs when you need more alcohol over time to induce the same feelings of euphoria. This can become a vicious cycle because you may initially use alcohol as an unhealthy coping mechanism to help relieve your underlying anxiety. Still, over time, you will need more alcohol to produce the same effects (tolerance).
Dependence, different from tolerance, develops when the body adapts to regular alcohol use. A telltale sign of dependence is the presence of alcohol cravings or alcohol withdrawal symptoms when you reduce your alcohol use or stop drinking altogether. Alcohol withdrawal can worsen a pre-existing anxiety condition, or it can create new symptoms of anxiety, potentially resulting in the need to drink again.
How to Get Help for Anxiety and Alcohol Use Disorders
The first and most important step you can take to get help for your addiction and anxiety disorder or other mental health conditions is to seek a thorough evaluation from your primary care physician or mental healthcare professional, who can assess both conditions and provide referrals for treatment.
The standard of care for treating co-occurring substance use and mental health disorders takes an integrated approach, meaning anxiety and addiction are treated at the same time rather than separately. Integrated treatment, which is still individualized to meet your specific needs, may utilize a variety of behavioral interventions, medications, or both.
Behavioral therapies that have proven to be effective for individuals with alcohol use disorders and different co-occurring mental disorders include:
Cognitive-behavioral therapy helps you make positive changes to unhealthy thoughts and behaviors that contribute to your anxiety and addiction.
Dialectical-behavior therapy teaches you skills to help you change unhelpful thoughts and behaviors that impact your anxiety and alcohol misuse.
Contingency management provides tangible rewards for positive behaviors, such as remaining sober.
These interventions may occur in an inpatient or outpatient setting after detox.
If you or someone you love has an alcohol use problem and are concerned about the impact it might be having on family and friends, talk to your healthcare provider. Effective treatments are available, and they can recommend treatment programs that may help with detox and recovery.
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Another Solution-The Missing Link to Long-term Sobriety
Resource: Stacy Mosel, L.M.S.W.
Reviewed by: Kristen Fuller, MD
Updated Sep 22, 2023