Anxiety: Before, During, and After Alcohol Use

People who misuse alcohol may also experience symptoms of anxiety and anxiety disorders. Research has found a strong correlation between anxiety and alcohol use.1

In this article:

What Is Anxiety?

Anxiety is a challenging feeling that can come in many forms, but generally presents under two categories: situational or temporary anxiety and clinical anxiety disorders.

Both types of anxiety are overwhelming and can feel outside your control. Several healthy coping skills, such as exercise and meditation, can help manage anxiety symptoms, but sometimes those coping skills alone are not adequate, and the person suffering from anxiety begins searching for other ways to manage such an uncomfortable feeling.2

The difference between the two types of anxiety can be subtle, as anxiety represents a common feeling that most people experience during their lives. Many situations provoke anxious feelings, including stressful life circumstances and stages of life, such as:

  • Exams or performance evaluations
  • Presentations or high-value assignments
  • Job and education transitions
  • Interpersonal transitions, such as marriage or cohabitating
  • Interpersonal issues, such as estrangement from a family member
  • Birth or adoption of a child
  • Moving
  • Application processes, including jobs, government benefits, scholarships, and so on

Both positive and negative experiences can create feelings of anxiety and stress. Although these life events are frequently overwhelming and stressful, these are examples of temporary stressors linked to specific situations. Typically, the anxiety related to these stressors passes after you give the presentation, are awarded a foster child placement, or come to a sense of closure about an argument with a family member even if the relationship isn’t fully mended.3

Learned coping skills can usually help you get through this type of anxiety, even when you experience heightened symptoms.

Unlike situational and temporary anxiety, an anxiety disorder is marked by the following symptoms: 3

  • Prolonged anxiety
  • Impaired ability to function in daily life
  • Physical symptoms such as heart palpitations, difficulty breathing, and feeling shaky
  • Excessive worry about a specific situation, problem, or potential outcome that does not match reality

Anxiety disorders can decrease your quality of life and may require professional treatment, such as therapy and antianxiety medication.

How Is Alcohol Used as a Coping Mechanism for Anxiety?

Learned coping skills are part of how everyone processes anxiety, both situational and clinical. Some of these coping skills, such as mindful movement and breathing exercises, may provide more meaningful relief with little to no negative side effects on your mental or physical health in the future.

However, while you can learn new coping skills, the coping skills you already have likely come from repeating what has helped you manage similar situations in the past. Studies show that one of the most common potentially harmful—also referred to as “maladaptive”—coping skills used to manage anxiety symptoms is alcohol use.1

Despite this, the relationship between alcohol and anxiety is complex. Research does not show a definitive correlation between the diagnosis of an anxiety disorder and moderate or excessive alcohol use. Some researchers speculate that this data cannot be quantified because individuals with temporary and situational anxiety symptoms are as likely to use alcohol as a coping mechanism as individuals with a clinical anxiety disorder.1

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Medical professionals report that their patients who use alcohol to manage anxiety symptoms do so primarily because of the sedative effects of alcohol. With this sedative effect, alcohol can temporarily calm the anxious thoughts, feelings, and fears.4

How Does Alcohol Cause and Influence Anxiety?

While alcohol use is a commonly observed coping mechanism for anxiety symptoms, alcohol can actually increase anxiety due to its stimulant and depressant properties, therefore creating the opposite of the desired effect.4

This risk of increased anxiety comes from the way that alcohol affects the brain. Alcohol is a central nervous system depressant, which means it slows the heart rate, lowers the blood pressure, and decreases the rate of respiration. Alcohol also changes the level of neurotransmitters in the brain, including dopamine. While many individuals experience some pleasant effects due to this unnaturally rapid flood of dopamine, high levels of alcohol and the aftereffects of using alcohol often contribute to feelings of sadness and nervousness due to the sudden chemical imbalance. This imbalance may be profound during certain periods, such as feelings of anxiety and alcohol withdrawal or hangover.5

This increased anxiety from alcohol happens frequently with doctors reporting that approximately half of their patients seeking support for anxiety, panic, and phobias experience these side effects due to alcohol use, not as symptoms of a diagnosed anxiety disorder. For people who experienced symptoms of diagnosed anxiety disorders, however, alcohol seemed to increase the occurrence and intensity of their symptoms.6

The response to alcohol varies, as alcohol can either increase or decrease anxiety depending on individuals and how their brain and body respond to the alcohol.6 Some individuals may experience anxiety while using alcohol and no symptoms afterward, while it may be the opposite for others. Studies show that people who experience the most severe anxiety as a side effect of alcohol appear to be those who drink in excessive amounts for an extended time or people who struggle with preexisting mental health conditions.5

Can Alcohol Addiction and Anxiety Disorders Occur Together?

Alcohol use can manifest as a coping mechanism or influencing agent with any type of anxiety disorder. Types of anxiety disorders include:3

  • Generalized anxiety disorder
  • Separation anxiety disorder
  • Panic disorder
  • Social anxiety disorder
  • Agoraphobia, or fear of crowded places
  • Other specified phobias

Obsessive-compulsive disorder (OCD) also commonly co-occurs with alcohol use disorder. OCD was previously categorized as an anxiety disorder, however, it has additional clinical characteristics that place it in its own category.

Anxiety disorders, coupled with alcohol, have the potential to contribute to alcohol dependence and the development of addiction.1

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Studies indicate that alcohol use can vary with the type of anxiety disorder. For example, people with agoraphobia and social phobia appear to misuse alcohol more frequently than people with other anxiety disorders.7 In this situation, alcohol may temporarily relieve the anxiety of crowds and social situations associated with agoraphobia and social anxiety disorder, therefore offering short-term relief to people with these dual diagnoses.8

Research shows that problems related to alcohol use and anxiety tend to occur within the same person in the following three patterns:7

  • Anxiety disorder promotes alcohol misuse
  • Alcohol misuse exacerbates the anxiety disorder
  • A third factor promotes both conditions

People with a dual diagnosis experience two co-occurring mental health conditions simultaneously, such as an anxiety disorder and alcohol use disorder. The relationship between alcohol dependence and anxiety disorders varies depending on the anxiety disorder and the level of alcohol use.7

In addition, anxiety disorders can contribute to the maintenance of and relapse of alcohol misuse. In essence, an untreated anxiety disorder may increase your risk of relapsing into alcohol use disorder.7

Recognizing the relationship between anxiety disorders and alcohol use shows why interventions such as therapy, anxiety coping skills, and medication management as needed and appropriate can be so beneficial.7 Long-term recovery requires treatment and harm reduction for both substance use, anxiety symptoms or anxiety disorder features, and other anxiety-related behaviors. These interventions should be coupled with addictions counseling, 12-step meetings, and other addiction recovery tools so you can address your alcohol use at the same time as your anxiety disorder.7

To learn more about available treatment for alcohol addiction, including programs that treat co-occurring diagnoses, please feel free to call 800-839-1686Who Answers? at any time to discuss your options.

Resources

  1. Schuckit, M. A., & Hesselbrock, V. (1994). Alcohol dependence and anxiety disorders: what is the relationship?. The American Journal of Psychiatry, 151(12), 1723–1734.
  2. Sime, W. E., & Woolfolk, R. L. (2007). Principles and Practice of Stress Management, Third Edition. United States: Guilford Publications.
  3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  4. Hendler, R. A., Ramchandani, V. A., Gilman, J., & Hommer, D. W. (2011). Stimulant and sedative effects of alcohol. Behavioral Neurobiology of Alcohol Addiction, 489-509.
  5. Schuckit, M. A. (1996). Alcohol, anxiety, and depressive disorders. Alcohol health and research world, 20(2),
  6. Cohen, S. I. (1995). Alcohol and benzodiazepines generate anxiety, panic, and phobias. Journal of the Royal Society of Medicine, 88(2),
  7. Kushner, M. G., Abrams, K., & Borchardt, C. (2000). The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Clinical Psychology Review, 20(2), 149-171.
  8. Book, S. W., & Randall, C. L. (2002). Social anxiety disorder and alcohol use. Alcohol Research & Health, 26(2), 130.

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