The Relationship Between Alcohol and Anxiety

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Anxiety extends beyond worry or stress. It is a sensation of overwhelming fear that affects your overall health and perception of your environment. When this pervasive worry makes it difficult or impossible to focus on your daily routine or function at work, it is classified as a disorder. Approximately 30% of U.S. adults will be diagnosed with an anxiety disorder at some point. These diagnoses may include social anxiety disorder (SA), generalized anxiety disorder (GAD), and panic disorder (PD), to name a few. 

Alcohol plays a critical role in the progression and severity of anxiety. Likewise, anxiety is a risk factor for the development of alcohol use. In fact, half of Americans receiving treatment for alcohol use disorder (AUD) also meet the criteria for an anxiety disorder. Understanding the relationship between alcohol use and anxiety is essential when addressing treatment options and recovery.

If you or someone you love is dealing with anxiety and alcohol use, Guardian Recovery can help. Our dual-diagnosis treatment programs focus on your substance use and mental health concerns. From initial medical detox to aftercare planning, our team of knowledgeable, experienced clinicians will navigate you through each step of your recovery. Contact us today to speak with a treatment advisor 24/7 who can give you more information about our comprehensive, individualized services. Read on to find out more about how alcohol use impacts anxiety.

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Does Alcohol Cause Anxiety?

When considering alcohol use and anxiety as separate disorders, it is often debated whether one condition causes the other. While this topic has been discussed heavily, studies indicate that 75% of adults with AUD have a pre-existing anxiety disorder. In many cases, an anxiety disorder is diagnosed in childhood or adolescence before alcohol can be legally purchased, leading to the theory that anxiety is more likely to be a precursor to alcohol use rather than the other way around. Other psychiatric disorders, such as major depressive disorder and schizophrenia, are also independent risk factors for the development of alcohol use.

Can Alcohol Increase Anxiety?

Alcohol’s impact on the brain is well-studied. The central nervous system (CNS), consisting of the brain and spinal cord, is altered in numerous ways by drinking. Alcohol acts as a CNS depressant, meaning it reduces brain activity, leading to slow breathing, decreased blood pressure and heart rate, sleepiness, delayed reaction time, loss of coordination, and feelings of happiness and relaxation. However, any euphoric effects are short-lived.

Once your body has fully broken down and eliminated the alcohol in your system, the depressant effects wear off and give way to the excitatory brain activity responsible for anxiety. If your alcohol use is chronic, these effects are more common and intense. Not only does alcohol withdrawal reverse the calming, inhibitory sensation of drinking, but it produces symptoms that can mimic anxiety or be physically distressing and uncomfortable.

Symptoms of Alcohol Withdrawal Include:

  • Elevated blood pressure and heart rate.
  • Insomnia.
  • Agitation.
  • Paranoia.
  • Nausea.
  • Headache.
  • Seizures.
  • Hallucinations.

Why Do People Drink To Cope With Anxiety?

For individuals with untreated or poorly controlled anxiety, alcohol is a way of self-medicating. Experts who have studied the relationship between alcohol use and anxiety disorders report that people drink to alleviate some problematic anxiety symptoms, such as racing thoughts, panic attacks, and tension. 

Brain chemicals, called neurotransmitters, are responsible for mood, energy levels, sleep, stress, pain, and other bodily functions. Several of these neurotransmitters are implicated in alcohol use and anxiety. 

The Neurotransmitters Impacted by Alcohol Use Include:

  • Gamma-aminobutyric acid (GABA) – an inhibitory or “downer” chemical.
  • Glutamate – an excitatory or “upper” chemical.
  • Serotonin, dopamine, and norepinephrine – responsible for the reward system, as well as feelings of well-being, pleasure, and increased energy.
  • Endogenous opioids – responsible for pain and stress reduction.

Alcohol increases the activity of GABA and decreases the activity of glutamate, causing sedation and reduced anxiety. It also promotes greater utilization of serotonin, dopamine, and norepinephrine triggering feelings of euphoria associated with drinking. When someone uses alcohol to treat anxiety, the effects are often immediate but fleeting. Unfortunately, more often than not, self-medicating develops into uncontrollable drinking and alcohol use disorder.

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Common Anxiety Disorders & Alcohol

Because alcohol temporarily eases many anxious sensations, the co-occurrence of AUD and anxiety disorders is significant. Coping through drinking is a frequent indication of future problems with alcohol. While certain anxiety disorders are more likely to present with comorbid alcohol use, all anxiety disorders are independent risk factors for AUD.

Social Anxiety & Alcohol

Social anxiety is characterized by a pervasive fear of being judged by others in situations such as eating in public, giving a presentation, making new acquaintances, dating, or attending a social gathering. Among all forms of anxiety, SA has the greatest association with alcohol use. It is typically diagnosed in adolescence but is left untreated more often than other anxiety disorders due to patient apprehension. As people with SA grow into adulthood, they may use alcohol in social situations to manage the uncomfortable sensations of interaction.

Generalized Anxiety & Alcohol

Unlike social anxiety, worry associated with GAD does not require a specific cause. If you have generalized anxiety, you may often be overly concerned with day-to-day events and feel perpetually on edge, restless, and irritable. The non-specific nature of GAD makes it more challenging to treat when presenting with alcohol use. Research indicates that individuals with both GAD and AUD worry more than non-anxious alcohol users about how they will stop drinking and how their anxiety will impact treatment.

Panic Disorder & Alcohol

Panic attacks can be a symptom of all anxiety disorders, but panic disorder refers specifically to frequent, recurrent attacks with no warning or known trigger. PD sufferers often report chest pain, trouble breathing, sweating, shaking, and a sense of impending doom. The sedating effects of alcohol are typically felt within 15 minutes, making it a quick solution. Over time, however, you will require more alcohol to achieve the same level of calm, a condition known as physical dependence.

Alcohol-Induced Anxiety & Mood Disorders

Although AUD regularly presents with pre-existing anxiety disorders, anxiety can be a sign of alcohol use in people with no prior mental health history. Substance/medication-induced anxiety disorder is caused by ongoing alcohol use. Anxious symptoms are noted before, during, and after intoxication and alcohol withdrawal.

Alcohol-induced disorders are not limited to anxiety. Chronic, excessive drinking can also elicit symptoms of mood and psychotic conditions, such as depression, mania, hallucinations, or paranoia. When left untreated, substance-induced mental disorders cause significant social, occupational, and emotional impairment. Treatment primarily focuses on alcohol use, understanding that anxiety or mood disorder symptoms will resolve with sobriety.

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When To Seek Treatment for Alcohol Use & Anxiety

Knowing when to pursue help for alcohol use can be difficult, especially if you are also trying to manage anxiety. Because AUD and anxiety disorders are generally linked, both conditions must be addressed in treatment. 

Reasons to Seek Treatment for AUD and Anxiety Include:

  • Inability to limit how much or how often you drink.
  • Constantly thinking about how to get alcohol or when you will have your next drink.
  • Drinking interferes with your ability to complete your job duties, fulfill social obligations, or take care of yourself.
  • Engaging in risky behaviors when under the influence, such as driving.
  • Increasing alcohol intake over time to achieve the same effect (tolerance).
  • Needing to drink to function or avoid negative symptoms (dependence).
  • Experiencing withdrawal symptoms like nausea/vomiting, irritability, headaches, and uncontrollable shaking.
  • Being unable to cope with major and minor life stressors without using alcohol.

Overcoming the combination of alcohol use and anxiety can seem daunting. Treatment for one condition requires treatment for both. At Guardian Recovery, our goal in dual-diagnosis therapy is to address your mental health and substance use. Our evidence-based programs utilize 12-Step Immersion and Relapse Prevention Training to guide you toward sobriety.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.


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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

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Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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