Alcohol & Anxiety: Connections & Risks

Does Alcohol Help Anxiety?

While alcohol can lead to an immediate decrease in anxiety levels—lowering your inhibitions and causing a false sense of relaxation—drinking in excess can actually have the opposite effect, causing you to feel out of control. While it may seem like an appealing form of self-medication due to accessibility, the issue often becomes controlling the amount and frequency of alcohol consumption, as well as how dependent you become.²

Can Alcohol Cause Anxiety?

Ultimately, alcohol can cause anxiety. When you drink too much, you may do or say things that are out of character, leading to feelings of regret. Over time, drinking too much can also lead to alcohol poisoning, causing memory loss, blackouts, and brain damage. Naturally, coping with these outcomes causes stress.

Paradoxically, while alcohol can cause anxiety, anxiety can also lead to an alcohol use disorder. Someone with an anxiety disorder is three times more likely to develop an alcohol use disorder at some point in their life compared to someone who has never been diagnosed with anxiety.³

The Cycle of Drinking and Anxiety

Drinking and anxiety can create a vicious cycle. In the short term, alcohol may provide relief or distraction from anxious thoughts and lower inhibition. However, this can lead to regrets about behaviors or decisions and create more anxiety. Alcohol can also impact brain chemistry due to the impact on dopamine levels, creating a phenomenon known as “hangxiety.”

Here’s what the cycle of drinking can look like for someone with anxiety:

• Drinking alcohol to feel calm and sociable: Many people find that alcohol helps them loosen up and feel more outgoing. It can temporarily provide relief from social anxiety and allow a person to let loose and have fun.
• Withdraw and have anxiety the next day: After a night of drinking, a person may wake up feeling hungover and physically unwell, as well as having regrets about the night before. In combination with falling dopamine levels, this leads to more anxiety.
• Drink more to relieve the anxiety: At this point, a person feels like the best way to take the edge off of the anxiety is to drink more.

This is a dangerous cycle that can be easy to fall into due to the short-term anxiety-reducing effects of alcohol. After a night of drinking and waking up to increased anxiety, drinking more to take off the edge might seem like a good idea. In actuality though, this just perpetuates the cycle and can lead to alcohol dependence, even more anxiety, and other consequences.⁴

The Danger of Using Alcohol to Cope With Anxiety

Initially, using alcohol to cope may mask symptoms of anxiety, but it can worsen your condition in the long run.²

Here are some reasons why alcohol can give you anxiety:

• Changes to the brain: Heavy drinking produces physiological changes, including affecting neurotransmitter levels in the brain, which can cause anxiety.
• Panic attacks: Blackouts can also cause severe anxiety, and in extreme cases, lead to panic attacks.
• Sleep problems: Alcohol leads to interrupted sleep, which can worsen existing anxiety.
• Dehydration: Alcohol acts as a diuretic, causing frequent urination and leading to dehydration.
• Mineral depletion: Drinking alcohol in excess depletes important minerals, nutrients and electrolytes, leading to malnourishment and potentially serious health problems.⁵
• Social embarrassment: Alcohol use reduces inhibition, which can lead to making choices that one would not usually make or engaging in behaviors that lead to regret.  

How Alcohol Can Interfere With Anxiety Medications

Many anxiety medications interact with alcohol, increasing risk of drowsiness, sedation, impaired judgment, trouble concentrating, and slowed reflexes. In some cases, alcohol can cause medication to become less effective or even toxic.⁶ Combined negative effects of alcohol and certain medications on the liver even lead to liver toxicity. Specifically, benzodiazepines combined with alcohol can lead to overdose and death.⁶

Other Substances That Can Cause Anxiety Symptoms

Lots of factors can contribute to anxiety, including using substances other than alcohol. Some substances, like caffeine and nicotine, elevate the heart rate and can create symptoms of anxiety. Prescription anti-anxiety and antidepressant medications can sometimes cause an increase in anxiety as well. If you suspect that a prescribed medication may be worsening your anxiety, talk to your doctor before discontinuing.

Some other substances that can trigger anxiety include:

• Caffeine
• Energy Drinks
• Nicotine
• Benzodiazepines
• Certain antidepressant medications
• Other medications including decongestants and steroids

Alcohol Addiction & Anxiety as Co-Occurring Disorders

Alcoholism and anxiety are often co-occurring and tend to feed off each other.⁷ Many people with anxiety seek out ways to self-medicate with alcohol before ever turning to a mental health professional. About 7% of Americans use alcohol to cope with anxiety, and approximately 20% of people with social anxiety disorder suffer from alcohol dependence.

Some of the signs and symptoms of an alcohol addiction include:

• Inability to control the amount of alcohol consumed
• Withdrawing from normal activities of daily life
• Experiencing alcohol withdrawal symptoms when alcohol is not consumed
• Drinking even though one is aware of the negative impacts

In many cases, alcohol dependence develops when it’s used as a coping mechanism for stress, anxiety, and/or trauma. In general, it’s a commonly co-occurring disorder with other mental health conditions (alcohol dependence and depression are also commonly co-occurring).⁸ Also, those who have a parent with an alcohol addiction are more susceptible to developing one of their own.

Preventing Alcohol From Causing or Worsening Anxiety

Even if you don’t have a full-blown alcohol use disorder, reducing your drinking could help with your anxiety symptoms. There are steps you can take to reduce or abstain from alcohol use in order to stop the cycle and keep your anxiety from getting worse. 

• Track your drinking: Keep track of all alcoholic beverages as well as the time of day and any anxiety triggers that may have led to drinking.
• Reduce the amount of drinks per week: Set a maximum number of drinks for the week and stick to it in order to notice whether it makes a difference.
• Maintain that level and track symptoms: Continue to limit alcohol use and track anxiety symptoms throughout the week.
• Continue to decrease your alcohol use if there are still symptoms: If anxiety symptoms are still present, try decreasing your alcohol use further and continuing to track anxiety symptoms.
• Drink a glass of water between every drink: This can not only help you pace yourself when drinking, but can also help you stay hydrated and avoid some of the physical hangover effects that make anxiety worse.

Treating Co-Occurring Anxiety & Alcohol Use Disorders

You can treat co-occurring anxiety disorders and alcohol use disorders with a variety of coping mechanisms, including therapy, medication, and health alternative practices like yoga and meditation. These methods work to treat underlying symptoms instead of masking them.

Therapy

Speaking to a therapist can be an effective way of managing symptoms of alcohol use and anxiety. One of the most effective modalities is cognitive behavioral therapy (CBT), which works to identify and interrupt negative thought patterns. Another similar modality is dialectical behavioral therapy (DBT), which combines aspects of CBT and alternative mindfulness techniques. DBT is more structured and targets anxiety with mindfulness, distress tolerance, and emotional regulation.

Medication

Medication is often used in conjunction with therapy to target symptoms of anxiety, but it can be a sole treatment. Types of medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and beta-blockers. All medications should be used with caution, especially by someone struggling with alcohol dependence, due to potentially dangerous interactions.

There are also medications that curb alcohol cravings or cause you to feel ill if you consume it.

Healthy Alternatives

Mindfulness exercises are a great way to quiet the mind, focus on positive affirmations, and challenge negative thought patterns. Developing healthy routines like exercise, yoga, and meditation also help you maintain a better sense of calm. When you’re experiencing anxiety, try doing a full body scan. Breathe deeply and take an inventory of where you’re holding tension; as you breathe, calm yourself and allow fear to melt away.

Final Thoughts On Alcohol & Anxiety

If you’re dealing with alcohol and anxiety, remember, you’re not alone. Reaching out to a mental health professional (or your personal medical care provider) can be a great first step in mitigating symptoms of alcohol anxiety. It is always a good idea to expand your support system, because the more people you have to help you through, the better.⁸ One way to find the right therapy is through an online directory.