Can Alcohol Cause Anxiety Disorders?

You may have heard the buzzword “hangxiety” to describe the anxiety that can occur after a bout of heavy drinking. It’s common for this to occur, but if you’ve experienced this, it doesn’t necessarily mean that you have an anxiety disorder.
However, alcohol abuse and anxiety often co-occur, which has led to much research on the topic. The answer to the question, though, whether alcohol causes anxiety disorders, is more complex than it would seem.

What Are Anxiety Disorders?

Anxiety disorders are characterized by incessant fear or worry that lasts for six months or more. These episodes can occur frequently and have negative impacts on a person’s ability to function.

Other symptoms of anxiety disorders include:

• Restlessness
• Tension
• Irritability
• Increased heart rate
• Rapid breathing
• Sweating
• Shaking
• Weakness and fatigue
• Trouble concentrating
• Insomnia
• Gastrointestinal issues

Pre-existing Anxiety Disorders and Alcohol

Often, anxiety disorders and alcohol abuse go hand in hand because the anxiety disorder existed first and led to alcohol use as a coping mechanism. Research indicates that between 20% and 40% of people with an anxiety disorder develop an alcohol use disorder. When this occurs, the anxiety disorder and the alcohol use disorder are considered co-occurring disorders.

There are three types of anxiety disorders that have been associated with alcohol use disorders.

• Generalized anxiety disorder: Characterized by persistent worry about everyday things, and difficulty relaxing.
• Social anxiety disorder: Fear of situations that involve being under scrutiny with the potential for embarrassment.
• Panic disorder: Frequent panic attacks that can manifest physically with rapid breathing and heart rate.

While people with these disorders find short term anxiety symptom relief from alcohol, over time, the alcohol use tends to make symptoms worse. Symptoms may be particularly acute when the effects of excessive alcohol are wearing off, and during periods of withdrawal.

Alcohol Induced Anxiety

For some people, alcohol leads to anxiety disorder symptoms even though they did not suffer from an anxiety disorder prior to alcohol use. While that seems to be a “yes” answer to the original question of whether alcohol use can cause anxiety disorders, it is not so cut and dry. Research shows that this kind of alcohol induced anxiety goes away after a period of detox and abstinence. This indicates that alcohol can cause anxiety symptoms, but not an anxiety disorder, which is a lifelong condition.

Diagnosing Co-Occurring Disorders

It can be difficult to diagnose an anxiety disorder when an alcohol use disorder is also present. It may not be clear whether the anxiety symptoms existed before the alcohol abuse began if the anxiety disorder was previously undiagnosed. The patient must go through an evaluation of their symptoms and their history to determine if the anxiety was present first.

For example, at Bridges of Hope, we conduct a thorough assessment of the patient’s history in order to come to a diagnosis and build an appropriate treatment plan.

Treating Co-Occurring Disorders

When a co-occurring disorder is diagnosed, the anxiety disorder and the alcohol use disorder are treated at the same time. Anxiety treatment often involves anti-anxiety medications as well as therapy. Fortunately, the types of therapy used to treat anxiety disorders and alcohol use disorders overlap and can treat both disorders simultaneously.

The most common therapy used for treating co-occurring disorders is cognitive behavioral therapy (CBT). In CBT, patients learn to recognize their negative or harmful thoughts and to evaluate those thoughts reasonably to reach better conclusions.

For example, people with anxiety disorders often have what’s called catastrophic thinking, which means expecting the worst to happen in a given situation. In CBT, the patient will learn to reason through that catastrophic thought to conclude that the catastrophe is unlikely to occur, or that the worst-case scenario is not as catastrophic as they believe.

CBT also teaches coping skills and strategies. For someone with an anxiety disorder, they learn to deal with their anxieties and challenges in healthy ways rather than turning to alcohol.

Another type of therapy used is dialectical behavior therapy (DBT), which is similar to CBT but focuses more on confronting strong emotions and challenging them with rational thoughts. DBT also involves mindfulness, which means being present in the moment without being overwhelmed by situations.

Group therapy is also an important tool in treating co-occurring disorders. Group therapy provides a mutually supportive environment for peers who have similar challenges, and allows them to share emotions, experiences, ideas, and coping strategies. Often, those in group therapy form relationships that last beyond treatment.

In treatment for co-occurring disorders, these therapies are implemented in an inpatient setting, followed by outpatient therapy programs. For people with anxiety disorders, ongoing individual therapy is also generally recommended.

In Closing

Alcohol does not directly cause an anxiety disorder, but it can cause anxiety symptoms or worsen the symptoms of a pre-existing anxiety disorder. If you are struggling with alcohol, anxiety, or both, help is available. Your primary care doctor can provide advice and resources, or you can call Bridges of Hope to discuss treatment options. Taking that first step can lead you to a better, healthier, and happier life.