3 Ways That Alcoholism and Anxiety Disorders Can Cause Each Other

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Alcohol use disorder and anxiety often co-occur, meaning those who have one disorder often have the other. Recent data indicates that up to 50% of people receiving treatment for an alcohol use disorder also have an anxiety disorder.¹ Statistics like this suggest that alcohol and anxiety disorders occur together more often than they appear independently.

Alcohol Use Disorder

Per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in order to have an alcohol use disorder, an individual must have experienced least two of these eleven symptoms in the past year. These symptoms encompass:²

Changing your alcohol use and ability to control alcohol use
Attempting to reduce or stop using alcohol but unable to do so
Spending much of your time drinking or recovering from the effects of alcohol
Thinking about drinking obsessively
Experiencing changes in your relationships as a direct result of alcohol use
Continuing to use alcohol despite negative consequences
Stopping participation in activities you once enjoyed in order to use alcohol
Increasing the amount of alcohol you use to experience the same initial effects, also referred to as tolerance
Experiencing withdrawal symptoms when you try to stop using alcohol or do not have access to alcohol for a period of time

Clinical Criteria for Anxiety Disorder Types

Anxiety disorder types include generalized anxiety, panic, phobia, social anxiety, and agoraphobia disorders.³ Although post-traumatic stress disorder (PTSD) shares many symptoms with anxiety disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) actually classifies it as a Trauma– and Stress–Related Disorder. While symptoms of anxiety often accompany alcohol misuse, not all symptoms of anxiety are diagnosable.

Mental health professionals consider the severity of symptoms when diagnosing anxiety disorders. Each type of anxiety disorder has specific DSM symptom criteria. The following is a list of the most common:³

Generalized anxiety disorder symptoms:

Heart palpitations
Dizziness
Tremors or shakiness
Shortness of breath
Fainting
Muscle tension
Nausea
Digestive problems
Constant worry
Nervousness
Sleep disturbances

Panic disorder symptoms:

Anxiety attacks for no apparent reason that come on suddenly
Anxiety attacks that include symptoms of generalized anxiety disorder but are more intense
Dry mouth
Chest pains, which can be accompanied by the belief that you may be having a heart attack
Sweating
Feeling like your throat is closing or that you are choking
Feelings that lead to agoraphobia

Agoraphobia symptoms:

Fear of places where a panic attack may occur and fear that there is no way to escape from those places
Fear of being alone

Specific phobia symptoms:

Fear of a particular person, place, thing, or event to the extent that the fear interferes with your ability to complete daily living activities

Social anxiety symptoms:

Fear being the center of attention
Fear judgment, criticism, or embarrassment in public

Post-traumatic stress disorder (PTSD) symptoms:

Nightmares
Flashbacks
Being easily startled
Nervousness and feeling on edge
Irritability and agitation
Insomnia
Emotional detachment

It’s important to note you can have symptoms of anxiety but not meet the criteria for an anxiety disorder.⁴

Some other mental health conditions are also characterized by feelings of panic, dread, and anxiety, including obsessive-compulsive disorder (OCD). OCD and related disorders were classified as anxiety disorders in previous editions of the Diagnostic and Statistical Manual of Mental Disorders, however, these disorders were put in a separate category in the DSM-5 because OCD is also characterized by compulsive behavior and other symptoms not observed in cases of anxiety disorders.

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Clinical Versus Non-Clinical Anxiety

Everyone has occasional bouts of anxiety. Preparing for an exam, walking down the aisle at your wedding, and just before giving a speech to a crowd of your peers are examples of non-clinical anxiety. Non-clinical anxiety may also be called “temporary” or “situational” anxiety because the symptoms dissipate after you get your test results, say, “I do,” or hear the applause of your audience.

Anxiety can become a clinical problem, however, and develop into a diagnosable disorder if any of the following exist:⁴

You make decisions based on whether you will feel anxiety or panic.
You feel unable to follow through with obligations due to anxiety.
You feel controlled by your anxiety.
Your anxiety is excessive in the situation or is out of proportion to actual risk.
You know you should not feel high anxiety but are unable to calm yourself.
You have periods of anxiety or panic that occur frequently or much more than on an occasional basis.

Many people live high-stress lifestyles but do not use alcohol as a reaction to stress and never develop an alcohol use disorder.⁵

Pathways to Co-occurring Alcohol Use and Anxiety Disorders

Researchers have observed several explanations to understand better the development of both anxiety and alcohol use disorders. The most common are:⁶

Common factor model—Common factor theorizes that variables other than alcohol or anxiety are responsible for someone having both an anxiety and alcohol use disorder. Examples of outside variables include genetics, personality disorders, medical, or environmental factors.
Self-medication model—The idea of self-medication explains the phenomenon in which people with anxiety start using alcohol to manage negative symptoms such as agitation, sleep disturbances, and difficulty relaxing in social environments. In this model, the self-medication method of coping with an anxiety disorder leads to the development of an alcohol use disorder.
Substance-induced model—Mental health conditions can be caused, or induced, by substances. In this model, anxiety is a consequence of misusing alcohol. Because alcohol alters the structure of the brain—specifically the neurotransmitters associated with anxiety—a comorbid relationship develops.

Risk Factors of Alcohol Use and Anxiety Disorders

Risk factors are events or situations that change the relative likelihood that a person will develop a specific diagnosis. Alcohol use disorder and anxiety disorders have certain risk factors in common.⁷

Repeated Exposure to Stressors

Study results show that individuals with a higher number of general life stressors are more likely to misuse alcohol.⁷ Individuals may also be more likely to use alcohol if they perceive a specific stressor as more significant or distressing. Stressors can include relationship breakups, employment-related issues, financial problems, and loss of a loved one.

Exposure to a Catastrophic Event

Catastrophic events are unexpected traumatic events, such as natural disasters, terrorism, war combat, pandemics, rioting, and public shootings. Devastating events can lead to anxiety disorders like PTSD. There is research showing alcohol use increases among those who experience catastrophic events.⁷

Studies found that survivors of Katrina, the 9/11 terrorist attacks, the Beverly Hills supper club fire, and Mount St. Helen’s volcano eruption used more alcohol and experienced alcohol problems in data collected both one and two years after the events.⁷

Childhood Maltreatment

Traumas that occur in childhood can have lifelong effects, including PTSD and alcohol use disorder. Maltreatment may include physical, verbal, psychological, or sexual abuse. Maltreatment also encompasses physical or emotional neglect. Studies show that children who experience abuse have a higher incidence of anxiety and alcohol use disorders in adulthood.⁷

Marginalized Identity Status

Exposure to stressors related to marginalized identity, such as prejudice and discrimination, can be traumatizing, especially those involving violence and hate crimes. Research shows those who experience stress related to racial identity, disability, and sexual orientation are more likely to misuse alcohol.⁷

Short- and Long-Term Risks of Alcohol Use and Anxiety Disorders

Untreated alcohol use and anxiety disorders put you at risk for the following short-term consequences:⁸

Interpersonal issues
Legal consequences
Poor performance at work or school
Minor or major accidents and injuries
Overdose
New medical or psychological conditions

As time goes on, the short-term effects can be progressive, including biological, psychological, social, and professional effects. There is an increased risk for:⁹

Withdrawal symptoms
Disease development such as pancreatitis and gastritis
Interpersonal issues, such as family estrangement
New mental health disorders
Neurological ailments

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Treatment of Alcohol Use and Anxiety Disorders

Comprehensive treatment begins with a screening and assessment given by a licensed mental health and substance use professional.¹⁰The screening and assessment provide background information regarding your mental health and alcohol use history. It also assesses the role of genetic, environmental, social, and other factors.

When complete, you may receive a diagnosis if you have one of the disorders or co-occurring disorders. Results of the assessment help your care team match current symptoms to the appropriate treatment level, which can begin at any of the following:¹⁰

You learn early recovery and relapse prevention skills at each treatment level to help you maintain positive mental and physical health that supports recovery of both anxiety and alcohol use disorders. You benefit from integrated pharmacotherapy, behavioral therapies, exposure therapies, recovery activities, and connections with community support services.¹⁰

Treatment facilities that use an integrated approach to treating co-occurring disorders may also include alternative or holistic therapies that teach you how to be present and aware of your body’s needs in the moment, so you can meet those needs and experience the positive benefits of whole-body healing. For example, mindfulness-based behavioral therapies, such as acceptance and commitment therapy, have been applied to help those with anxiety.¹⁰

If you have an alcohol use disorder, anxiety disorder, or both, help is available. You can overcome co-occurring conditions, and you do not have to do it alone. Call us today to begin treatment. We are available 24/7 to help you find addiction treatment services at 800-948-8417 Who Answers? .

Resources

Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol research: current reviews, 40(1).
National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Use Disorder: A Comparison Between DSM-IV and DSM 5.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.
Maddock, Richard, M.D. (2008). Checkup on Health: When is anxiety a clinical condition?UC Davis Health.
Anthenelli, R., & Grandison, L. (2012). Effects of stress on alcohol consumption. Alcohol research: current reviews, 34(4), 381–382.
Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol research: current reviews, 34(4), 414–431.
Keyes, K.M., Hatzenbuehler, M.L., Grant, B., & Hasin, D. (2012). Stress and alcohol: epidemiologic evidence. Alcohol research: current reviews, (34)4, 391-400.
Hawkins EH. (2009). A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents. Annual Review Psychology, 60, 197-227.
National Research Council and Institute of Medicine. (2004). Health Consequences of Adolescent Alcohol Involvement
Yule, A. M., & Kelly, J. F. (2019). Integrating Treatment for Co-Occurring Mental Health Conditions. Alcohol research: current reviews, 40(1).