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Understanding the Link Between Alcohol and Anxiety

Stephenie Gold, MA

Reprinted from "Alcohol" issue of Visions Journal, 2006, 2 (9), p. 8-9

When you feel shy while at a party full of strangers, do you sometimes reach for a glass of wine or a cold beer to help you ‘loosen up’? If so, you are not alone. Many people who are socially anxious use alcohol to decrease their anxiety and to cope better with social situations. While it may be common to occasionally use alcohol for a temporary boost of “liquid courage,” research suggests that the link between alcohol and anxiety is not always so straightforward.

A brief look at anxiety

Everyone knows what it is like to feel anxious—butterflies in the stomach, rapid heart rate, dry throat, and racing thoughts. Anxiety is the most common mental health concern, with one in 10 people suffering from levels of anxiety that are problematic and significantly disruptive to their daily lives.

While occasional feelings of anxiety are common, anxiety that is debilitating, intense and long-lasting is characteristic of an anxiety disorder. Some of the more common examples of anxiety disorders are social anxiety disorder; panic disorder (with or without agoraphobia—i.e., the fear of public places and/or of going outside, which often results in the sufferer becoming housebound); generalized anxiety disorder; and specific phobias. Untreated anxiety can lead to continued avoidance of anxiety-provoking situations and missed opportunities, creating a significantly decreased quality of life. Fortunately, with the right kind of professional help, anxiety disorders are treatable for the vast majority of people.

The anxiety–alcohol connection

Researchers have found that the risk for having either an anxiety disorder or alcohol use disorder is about three times greater if the other disorder is present.

This is particularly true for people with social anxiety disorder (SAD), with one in five people also meeting the criteria for an alcohol use disorder (i.e., alcohol abuse or dependence).

Socially anxious individuals report finding temporary relief from debilitating shyness and self-consciousness when consuming alcohol, and thus are more likely to use alcohol as an anxiolytic (i.e., it reduces feelings of anxiety). In this way, alcohol quickly becomes a means of coping or of self-medicating. Once alcohol has become a primary coping mechanism for people with SAD, alcohol dependency may be close behind. Over time, these socially anxious individuals may require increasingly higher doses of alcohol.

SAD usually begins early in the adolescent years (and therefore precedes alcohol dependency), so clinicians have a valuable window of opportunity to treat SAD before alcohol dependency begins.

A vicious cycle

Although it makes sense that anxiety symptoms can lead to alcohol dependence, in fact, the opposite can be true as well. Both long-term alcohol misuse and alcohol withdrawal can significantly increase anxiety levels. One study of American war veterans in an alcohol treatment program found that 98% reported at least one symptom of anxiety during drinking or withdrawal, with 80% experiencing heart palpitations and/or shortness of breath, and 4% experiencing at least one panic attack.

When feelings of anxiety are a consequence of heavy drinking, alcohol is said to be acting as an anxiogenic (i.e., it creates feelings of anxiety). Unfortunately, it is during this uncomfortable time of heightened anxiety that an individual is most tempted to use alcohol to self-medicate. As Matt Kushner, a leading researcher in the area of anxiety and alcohol describes: “[D]rinking leads to greater anxiety, which in turn, leads to more drinking. Once this vicious cycle is firmly in place, which disorder is operating as the cause and which is the effect becomes murky.

Alcoholics may begin to experience panic attacks for the first time when withdrawing from alcohol. Declining blood-alcohol levels cause feelings of having ‘shakes and sweats,’ which can be very similar to the physiological symptoms of anxiety. During the withdrawal period, anxiety is most likely caused by neurochemical changes as well as environmental/life stressors. Not surprisingly, individuals diagnosed with panic disorder often avoid alcohol because of their extreme sensitivity to changes in their bodily sensations.

To summarize, the relationship between alcohol and anxiety can be described as a >reciprocal causal relationship, which means that anxiety disorders lead to alcohol dependence, and alcohol dependence lead to anxiety disorders.

Issues in treatment

For individuals suffering from co-occurring alcohol use disorder and anxiety, pharmacological and/or psychological interventions (e.g., cognitive-behavioural therapy, which looks at the role of thinking in how a person feels and behaves) are the two means of treatment. However, what disorder should be treated first is not always immediately clear. Some evidence suggests that the alcohol use disorder should be the first line of treatment, since drinking is often used to avoid feelings of anxiety.8 When deciding on a treatment plan, it is essential for clinicians to establish whether or not both clinical problems are present and, whenever possible, to ascertain which disorder developed first.

Fortunately, research in this area continues to grow, helping researchers and clinicians better understand the factors that contribute to the development and perpetuation of these frequently co-occurring issues.

 
About the Author

Stephenie has a master’s degree in counseling psychology. She has worked on several research projects involving evidence-based programs for child and adolescent anxiety, and is currently developing resources for the Anxiety Disorders Association of British Columbia (ADABC)

Footnotes
  1. Anxiety Disorders Association of British Columbia. Retrieved from www.anxietybc.com.

  2. Himle, J.A. & Hill, E.M. (1991). Alcohol abuse and the anxiety disorders: Evidence from the Epidemiologic Catchment Area Survey. Journal of Anxiety Disorders, 5, 237-245.

  3. Book, S.W. & Randall, C.L. (2002). Social anxiety disorders and alcohol use. Alcohol Research and Health, 26(2), 130-135.

  4. Schuckit, M.A., Irwin, M. & Brown, S.A. (1990). The history of anxiety symptoms among 171 primary alcoholics. Journal of Studies on Alcohol, 51, 34-41

  5. Taylor, S. (Ed.) (1999). Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. Mahwah, NJ: Erlbaum.

  6. Kushner, M.G., Sher, K.J. & Erickson, D. (1999). A prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders. American Journal of Psychiatry, 165, 723-732.

  7. Rusinko, J. (2005, August 15). Anxiety disorders can compromise success of alcoholdependence treatment. Medical News Today. Retrieved from www. medicalnewstoday.com/ medicalnews.php?newsid=29135

  8. Lingford-Hughes, A., Potokar, J. & Nutt, D. (2002). Treating anxiety complicated by substance misuse. Advances in Psychiatric Treatment, 8, 107–116.

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