Does Alcohol Help Anxiety? Understand the Risks

Second, alcohol use in the presence of stress stimuli may interfere with extinction-based learning necessary for normal adaptation to stressors. Thus, hazardous drinking can lead to anxiety through a noxious combination of greater levels of life stress coupled with relatively poor coping skills. People with underlying mental health conditions, like depression and anxiety disorders, are more likely to experience anxiety after drinking, Dr. Schacht adds.13 “These issues can essentially shift your brain’s ‘set point’ and make it easier for alcohol to ‘tip’ the brain into anxiety,” he explains. It’s common for people with social anxiety disorder to drink alcohol to cope with social interactions. Doing this can lead to a dependence on alcohol during socializing, which can make anxiety symptoms worse.

1. The most consistent results relate to manic episodes, wherein manic-depressive patients show a small but significant increased risk for alcoholism (Winokur et al. 1993).
2. Although more data are needed, at least one study indicates that buspirone, a medication useful for treating a general nervous condition called generalized anxiety disorder, may be helpful to some alcoholics, especially those with high levels of anxiety symptoms that persist after abstinence (Kranzler et al. 1994).
3. However, the analysis also showed virtually no relationship between risk for alcohol dependence and the unique components of those diagnoses.

Lifestyle changes and treatment options for anxiety

The term “comorbidity” has become a fairly generic reference for co-occurring alcohol and anxiety or depressive disorders. Yet ontologically, the presence of two or more distinct, clinical diagnoses remains firmly fixed in an increasingly strained medical-diagnostic paradigm of psychopathology classification. Central to this strain is the assumption that specific diagnostic dyads are the appropriate unit of analysis for studying co-occurring negative affect and alcohol misuse. However, negative affect is common to many anxiety and depressive disorders and can increase the risk for alcohol misuse, particularly when drinking to cope with negative affect is the motive. Second, the possibility that a longer term anxiety or depressive disorder exists in an alcoholic must always be considered.

Pharmacotherapy for Anxiety Disorders

Plus, take note of how your mood is each day — if you’re feeling extra on edge already, try and go against the temptation of remedying that with alcohol. Alcohol is a diuretic, meaning it makes you lose water through peeing, so it’s very important to drink plenty of water as well when you’re drinking alcohol. It can help you feel less shy, give you a boost in mood, and make you feel generally relaxed. In the 2009 study, Kelly and his colleagues described is it safe to mix antibiotics and alcohol patients to more than 600 clinicians, alternating between “substance abuser” and “having a substance use disorder.” Those in the latter category were viewed more sympathetically and as more worthy of treatment. Health issues such as kidney disease or liver disease can make you more prone to adverse effects of alcohol and more severe alcohol withdrawal symptoms. Alcohol affects your brain’s chemistry and increases the risk of feeling anxious or depressed.

Alcohol and anxiety: How cutting back on drinking impacts your mood and mental health

The following sections will review fundamental concepts related to how these disorders co-occur and describe approaches to diagnosing and treating comorbid anxiety and AUDs. Third, different comorbidity patterns exist among patient subgroups with different demographic characteristics such as race/ethnicity and gender. For example, in the NESARC, Native Americans had elevated rates both of anxiety disorders and of AUDs over the past 12 months but lower rates of co-occurrence between these disorders compared with other ethnic groups (Smith et al. 2006). Gender differences in anxiety–alcohol comorbidity have been reported across a variety of samples (e.g., Hesselbrock et al. 1985; Kessler et al. 1997; Mangrum et al. 2006; Merikangas et al. 1998), and research in this area also has identified notable clinical differences between men and women. On the other hand, it is not uncommon for someone who has become addicted to alcohol to develop symptoms of anxiety.

You’ll feel less depressed

Likewise, a reduction in anxiety symptoms following alcohol treatment, which often is interpreted as an indication that the anxiety symptoms were a consequence of alcohol use, could also be explained by anxiolytic therapy and/or the natural course of anxiety independent of any effects related to abstinence. The notion of a simple, unidirectional, causal link between co-occurring disorders is not supported by the findings reviewed in this article. A prospective study has shown that either experiencing clinical-level anxiety or engaging in chronic alcohol misuse increases the risk of developing the other.21 In addition, clinical research shows that effectively treating one co-occurring condition does not substantively affect the other. Viable explanations for the relationship between co-occurring conditions include the possibility of a common cause for both conditions or bidirectional causation between the conditions. For example, dysregulated stress response or regulation may be a common risk factor for the development of both alcohol and anxiety disorders. Efforts to mitigate the deleterious effects of co-occurring anxiety disorders on alcohol treatment outcomes, as well as to illuminate causal influences between these conditions, have inspired investigations into how treatment for one co-occurring condition affects symptoms of the other condition.

As recently reviewed in the literature, some interesting data also support a possible relationship between longstanding anxiety or depressive disorders and alcoholism (Kushner et al. 1990; Kushner 1996). The most consistent results relate to manic episodes, wherein manic-depressive patients show a small but significant increased risk for alcoholism (Winokur et al. 1993). Other data also suggest a greater-than-chance association between panic disorder (and perhaps social phobia) and alcoholism (Cowley 1992; Cox et al. 1990; Kushner 1996). These studies, however, do not clearly establish the intensity of the relationship between these psychiatric disorders and alcoholism (e.g., what percentage of alcoholics have independent anxiety disorders?), and the association of alcoholism to other mood or anxiety disorders is even less clear. A recent review revealed similar results from other studies (Schuckit and Hesselbrock 1994). For example, a 10-year followup of young men and women who originally had been studied during their mid-teens by Ensminger and colleagues1 showed no close association between preexisting anxiety symptoms and AOD-use patterns in either sex.

The common-factor model of comorbid anxiety and AUDs presumes that no direct causal relationship exists between the two disorders. Instead, so-called third variables are posited to account for their joint presence. The potential relevance of such factors was demonstrated in a 21-year longitudinal study of young people (Goodwin et al. 2004), in which early presence of anxiety disorders seemed to predict the later development of alcohol dependence. However, when the investigators controlled for other variables, such as prior other drug dependence and depression, the presence of anxiety disorders no longer was a significant predictor. The results of this study suggest that the link between anxiety and AUDs was not direct but instead may have been a consequence of those other variables studied. The potential range of common factors can be difficult to estimate, but a review of the literature shows that the most consistently proposed third variables are genetic factors and personality traits such as anxiety sensitivity.

This information was published by Bupa’s Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only barbiturates: uses side effects and risks for illustrative purposes and do not reflect every presentation of a condition. If you think you need to talk to someone about how much alcohol you’re drinking, help is available – make an appointment to see your GP for advice and support.

As shown in the schematic, AUD and other mental health disorders occur across a spectrum from lower to higher levels of severity. For patients in the middle, with up to a moderate level of severity of AUD or the psychiatric disorder or both, a decision to refer should be based on the level of comfort and clinical judgment of the provider. When someone has developed alcohol dependence, cutting back significantly or quitting cold turkey can induce a panic attack.

One way to differentiate PTSD from autonomic hyperactivity caused by alcohol withdrawal is to ask whether the patient has distinct physiological reactions to things that resemble the traumatic event. When patients report mood symptoms, it helps to clarify the possible relationship with alcohol use by asking, for example, about mood symptoms prior to starting alcohol use and on extended periods of abstinence. In addition, ask about current and past suicidal ideation or suicide attempts, as well as the family history of mood disorders, AUD, hospitalizations for psychiatric disorders, or suicidality. Anxiety disorders are the most prevalent psychiatric disorders in the United States. The prevalence of AUD among persons treated for anxiety disorders is in the range of 20% to 40%,2,15 so it is important to be alert to signs of anxiety disorders (see below) in patients with AUD and vice versa.

This is because with extended alcohol use the body can adapt to need alcohol for its basic functioning, and become overwhelmed when it’s removed. It’s important to speak with your healthcare provider to make a plan for cutting back on drinking safely. It is, therefore, not surprising that more than one out of every three alcoholics has experienced episodes of intense depression and/or severe anxiety (Cox et al. 1990; Wilson 1988). These psychological conditions are often intense enough to interfere with life functioning, and the symptoms are often recognized by physicians and other health care providers as serious enough to require treatment. When depressed or anxious alcohol-dependent people are asked their opinions about cause and effect, they often reply that they believe they drink in order to cope with their symptoms of sadness or nervousness. For example, profiles of approach–avoidance drinkers have discriminated between “high lapsers” and abstainers among alcohol-dependent patients (Stritzke et al. 2007).

For augmenting treatment for AUD, would targeting biological stress reactivity (e.g., hypothalamic pituitary adrenal activation) be more promising than targeting anxiety disorders? Among people who have problems with alcohol, do those with versus those without co-occurring anxiety disorder react differently to protracted abstinence and withdrawal in terms of severity and persistence of dysregulation of the stress response? Prospective studies across the distinct bipolar disorder and alcohol stages of treatment and recovery for alcohol-related disorders may shed needed light on the relationships between alcohol, anxiety, and stress reactivity and regulation. Such studies have the potential to reveal the trajectory of re-regulation of the stress response during abstinence and how it relates to anxiety symptoms and relapse risk. Understanding these parameters could make a valuable contribution toward using the stress system as a recovery biomarker.

Small amounts of alcohol can stimulate GABA and cause feelings of relaxation, but heavy drinking can deplete GABA, causing increased tension and feelings of panic.14,15 Panic attacks can occur due to alcohol withdrawal. Only one notable study of COA’s has demonstrated a higher-than-expected risk for these major psychiatric disorders. However, as pointed out by Kushner (1996), larger studies of COA’s who have passed the age of risk for most disorders will need to be conducted before final conclusions can be drawn.