Alcohol and Anxiety: Can Alcohol Cause Anxiety?

Many of us like to relax and unwind at the end of a stressful workday with a glass of wine. Or maybe we have a drink for “liquid courage” before an anxiety-inducing event or stressful situation, like public speaking or social situations.

But while drinking as a stress or anxiety reliever is seen as normal, choosing to self-medicate anxiety disorders with alcohol can lead to some undesirable side effects.

Of course, drinking by itself can have some not-so-great effects. Maybe we’ve all had that hangover the next morning that had us claiming we’d never drink again. Or perhaps certain alcoholic beverages have immediate negative side effects, such as symptoms of alcohol intolerance.

Some of these effects may be short-lived, but alcohol can also have long-term effects on both physical and mental health. For many people, this includes experiencing anxiety after drinking — and alcohol can even affect anxiety disorders. 

But does alcohol cause anxiety? Or does anxiety cause people to drink more?

We’ll explore the connection between alcohol and anxiety as well as answer the question of whether alcohol can cause anxiety.

Anxiety disorders, such as generalized anxiety disorder, are a group of mental health disorders that affect the way you think, feel and behave.

Anxiety disorders are extremely common mental health conditions, with an estimated 40 million American adults affected each year.

While everyone experiences anxiety disorders differently, and each type has its own symptoms, some general anxiety symptoms include:

• Difficulty concentrating

• Difficulty sleeping

• Feeling nervous or restless

• Rapid heartbeat

• Feeling physically weak and/or tired

• Fast breathing (hyperventilation)

• Trembling

• Irritability

• Stomachaches or nausea

• Feeling extremely self-conscious

There are different types of major anxiety disorders, including:

• Generalized anxiety disorder (GAD). Someone who has GAD worries uncontrollably about normal situations, such as money, work, school or relationships. GAD affects 6.8 million adult Americans, or just over three percent, and affects women twice as often.

• Panic disorder. A panic disorder is typically characterized by having panic attacks for no obvious reason. A panic attack can feel like sudden, overwhelming fear. Symptoms include difficulty breathing, racing heart and sweating.

• Obsessive-compulsive disorder (OCD). People diagnosed with OCD experience repeated unwanted thoughts and behaviors. They may continuously wash their hands, perform repeated “rituals” or be obsessed with symmetry. These behaviors aren’t a choice and can complicate everyday life for those with OCD.

• Social anxiety disorder.Social anxiety is an extreme fear of being in social settings or feeling like you’re being judged negatively. More than just being shy, you may have trouble talking to people, speaking in public or meeting new people. An estimated 12 percent of U.S. adults experience social anxiety at some point in their lives.

In addition to these common anxiety disorders, people may experience anxiety regarding certain situations or objects, like public speaking or a stressful situation.

Many people often self-medicate anxiety and anxiety disorders with alcohol, which can lead to serious health risks.

Many people choose to use alcohol as a way to treat an anxiety disorder, whether it’s a social phobia or generalized anxiety disorder.

A review of studies on self-medication for mental disorders found that up to 35 percent of people with symptoms of anxiety disorders used alcohol to relieve their anxiety symptoms.

It’s understandable why people choose to use alcohol as a way to reduce stress or anxiety — alcohol acts as a sedative that can take your mind off your troubles and reduce fear.

The effects of alcohol can even be similar to those of anti-anxiety medications.

Alcohol acts as a depressant that affects the central nervous system, which is responsible for movement, thought processes, balance, alertness and more. But it also affects your nervous system in other ways. Specifically, alcohol has been shown to activate gamma-aminobutyric acid (GABA), an inhibitory chemical messenger in the brain that can decrease activity in your nervous system. This causes us to feel less anxious and more relaxed.

When you consume more alcohol, GABA starts to overcompensate. But when you stop drinking, your body goes through a GABA withdrawal, which can cause intrusive thoughts and a spike in anxiety.

These heightened levels of anxiety after drinking have been dubbed “hangxiety,” or increased anxiety with a hangover. People already diagnosed with anxiety disorders are even more likely to experience increases in anxiety symptoms after drinking.

Alcohol can also provide an increase of dopamine, though this is a short-term effect. That can make you feel more relaxed, but when you stop drinking and dopamine levels drop, anxiety levels can increase.

Researchers believe this may be one reason why people who experience hangxiety have a higher risk of developing alcohol use disorder (AUD). Alcohol-induced anxiety can last for several hours, or even for an entire day after drinking.

So, if you're feeling the hangxiety, it may be time to re-evaluate your drinking habits.

What Is Alcohol Use Disorder?

Alcohol use disorder is a brain disorder characterized by a reduced or absent ability to stop or control alcohol use even if facing health, social or work consequences.

This disorder encompasses the conditions of alcohol abuse, alcohol addiction, alcohol dependence and alcoholism.

It should be noted that alcohol abuse and binge drinking are not the same.

Alcohol abuse is using alcohol in unhealthy ways that impact your life, as well as drinking more than the Centers for Disease Control’s (CDC) Dietary Guidelines for moderate alcohol intake, which is one drink or fewer per day for women.

Binge drinking can be characterized by excessive drinking or consuming four or more drinks on one occasion for women. But being a binge drinker doesn’t mean you have severe alcohol use disorder — in fact, most people who binge drink don’t.

However, binge drinking can be associated with an increased risk of alcohol use disorder.

According to a 2019 National Survey on Drug Use and Health, 14.1 million adults had alcohol use disorder.

Alcohol use disorder can be mild, moderate or severe, and is classified based on the number of these symptoms you’ve had in the past year:

• Had times when you ended up drinking more, or longer, than you intended

• Tried to cut down or stop drinking but couldn't

• Spent a lot of time drinking or being sick from drinking

• Wanted a drink so badly you couldn't think of anything else

• Found that drinking often interfered with work, social life or other responsibilities

• Continued to drink even though it was causing trouble with your family or friends

• Gotten into more than one situation while or after drinking that increased your chances of getting hurt

• Continued to drink even though it was making you feel depressed or anxious

• Found that you had alcohol withdrawal symptoms — such as trouble sleeping, shakiness, nausea, sweating, racing heart or feeling uneasy or sad — when alcohol wore off 

Alcohol Use Disorder and Anxiety

While anxiety as a result of drinking can lead to alcohol use disorder, is it possible for alcohol or alcohol use disorder to also cause anxiety?

The comorbidity (when two conditions are present at the same time) of anxiety disorders and alcohol use disorders is relatively common.

Data from multiple large-scale studies over several years have shown that anxiety disorders and alcohol use disorders occurred at the same time two to three times as often as they would appear alone.

Researchers believe there are three possible reasons for this alcohol use disorder and anxiety comorbidity:

• Self-medication when people use alcohol to treat anxiety symptoms, such as drinking to calm themselves down if they have a social anxiety disorder

• Prolonged heavy drinking or an established alcohol use disorder that leads to developing anxiety disorders or increases symptoms of anxiety

• There’s another, unknown variable that leads people to develop both alcohol use disorder and anxiety disorders

There’s support for all these potential reasons, but no matter what the answer is, the connection between alcohol use and anxiety can seem like a vicious cycle of anxiety leading to excessive drinking, which in turn causes higher levels of anxiety, which can lead to more alcohol consumption.

Other Risks of Alcohol Use for Anxiety

While having a drink to decrease anxiety or nerves may seem like a good idea, there are more risks.

Using alcohol to cope with social anxiety or social phobia can be dangerous, as this can lead to a dependence on alcohol during socializing and make anxiety symptoms worse.

You may be dependent on alcohol if you:

• Require a drink at any social event or get-together

• Need a drink to get your day going

• Drink heavily four or more days a week

• Have four or more alcoholic beverages in a day

Besides increasing anxiety symptoms and other short-term negative consequences like drowsiness, dehydration, nausea and more, alcohol use can lead to long-term negative impacts on health. These can include insomnia, weakened immune system, changes in libido, changes in weight and more.

Alcohol is not a healthy treatment for anxiety.

The treatment for anxiety disorders can vary depending on your individual symptoms and diagnosis.

Some commonly suggested and effective treatment options for anxiety disorders include:

• Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft® (sertraline) or Lexapro® (escitalopram)

• Benzodiazepines (sedatives that relieve anxiety symptoms)

• Monoamine oxidase inhibitors (typically prescribed off-label if other treatments don’t work)

• Therapy, such as cognitive-behavioral therapy

• Lifestyle changes to reduce anxiety through meditation or yoga

Our guide on medications for anxiety goes into more detail on all the possible treatments for anxiety disorders.

To accurately diagnose and treat an anxiety disorder, you may need to speak to a mental health specialist.

Anxiety and alcohol use disorder are common co-occurring disorders that can cause serious distress and interfere with your life.

Alcohol use can exacerbate an existing anxiety disorder or may lead to new anxiety symptoms, while a pre-existing anxiety disorder can contribute to an alcohol use disorder.

Having a drink might seem like a good way to ease anxiety, but you may be doing more harm than good.

You can easily build a tolerance to the de-stressing effects of alcohol, making you even more anxious and less able to cope with anxiety and stress.

So, if you struggle with anxiety, whether it's alcohol-induced anxiety or another kind, talking to a healthcare provider or therapist is the healthiest solution.