Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations Alcohol Research: Current Reviews

Disagreement also exists about whether longer term independent treatment for depressive or anxiety diagnoses is required for the alcoholic person to achieve a normal level of life functioning. As previously mentioned, it is possible that many depressed or anxious alcoholics demonstrate mood or nervousness conditions caused by intoxication or withdrawal from alcohol; these psychiatric states are likely to improve markedly during the first several weeks to 1 month of abstinence. Thus, long-term psychiatric treatment does not appear to be required for alcohol-induced psychiatric conditions to be resolved (Brown and Schuckit 1988; Schuckit and Hesselbrock 1994). Similarly, in the absence of clear evidence of a long-term major anxiety disorder that predates the onset of alcoholism or that remains intense after an extended period of abstinence, few indications exist for using medications related to anxiety for alcoholics. Panic attacks that are likely to develop during alcohol withdrawal are also likely to diminish in frequency and intensity on their own without medications (Schuckit and Hesselbrock 1994).

  1. If they continue to use alcohol to help them feel more relaxed or at ease, they might eventually feel the need to avoid any social situations where they would be unable to drink.
  2. Dr. Elizabeth Bulat is the medical director of addiction medicine at Henry Ford’s Maplegrove Center in West Bloomfield.
  3. The distinction is important, because symptoms might be only temporary, whereas true psychiatric disorders are likely to require long-term and more intensive treatments, including psychotherapy and medication.
  4. According to some animal research, those who drink alcohol in their youth may be more prone to anxiety in adulthood, which might suggest a causal relationship.

The major problem encountered in these studies involved the use of research methods that failed to address several important issues that might have explained the observed relationships (Allan 1995; Schuckit and Hesselbrock 1994). Specifically, some studies focused on drinking patterns rather than on alcohol dependence or described mood/anxiety symptoms rather than true psychiatric disorders. The distinction is important, because symptoms might be only temporary, whereas true psychiatric disorders are likely to require long-term and more intensive treatments, including psychotherapy and medication. Thus, few of the investigations offered assurance that an alcoholic or alcoholic’s relative actually had a long-term psychiatric syndrome rather than a temporary alcohol-induced condition.

Maybe you need a drink to get to work in the morning or one to eat dinner at the end of the day. Your thought patterns when physically sober might be disproportionately focused on drinking. Maybe you intend not to drink or even promise yourself you won’t, but you end up drinking regardless of your desire or intention.

Some people with chronic AUD develop a neurological disorder called Wernicke-Korsakoff syndrome, also sometimes referred to as a “wet brain,” which leads to brain damage, chronic psychosis, and loss of motor function. If, despite these efforts, you still periodically wake up after drinking with feelings of anxiety, practice mindfulness. And when anxious feelings surface, turn to healthy alternatives like meditation, deep breathing or exercise. Similarly, the majority of alcoholics admit to experiencing periods of nervousness, including at least 40 percent who have had one or more intense panic attacks characterized by a brief episode of palpitations and shortness of breath (Kushner et al. 1990). One potential explanation for these findings is that the reasons for using alcohol may differ by gender. For example, women may be more prone than men to self-medicate for mood problems with substances such as alcohol (Brady and Randall 1999).

A primer on anxiety disorders

From the psychological perspective, behavioral research demonstrates that drinking to cope with negative affect is a potent marker for current and future problems with alcohol. Neuroscientific research implicates overlapping neurobiological systems and psychological processes in promoting the rise of negative affect and alcohol misuse. The psychiatric perspective that alcohol misuse and co-occurring anxiety represent neurobiologically distinct diagnostic conditions has dominated the field for many decades. However, recent research provides increasing support for the neuroscientific perspective that these conditions share underlying, mutually exacerbating, neurobiological processes.

Finally, neurobiological research on the relationship between negative affect and alcohol use is reviewed, and the opponent process model is explained. The concluding section synthesizes the discipline-specific research to identify conclusions and unanswered questions about the connections between alcohol use and negative affect. A key challenge to applying a comparative perspective across disciplines and time is the use of unique and evolving terminology and definitions for similar phenomena. Terms such as anxiety, anxiety disorder, depression, mood disorder, tension, stress, stress disorder, and negative affect are used differently across disciplines and time. The relationships among these constructs can be conceptualized as a Venn diagram, with the shared spaces representing overlapping constructs. In these overlapping spaces, the greatest opportunities for integration across disciplines can be found.

Behavioral therapies

So what does this mean for you as someone who has anxiety in the modern world? Your brain may react to perceived threats, like a slight at the grocery store, the same way our ancestors’ brains reacted to, say, a saber-toothed tiger. As your tolerance increases, you need to drink more and more to get the desired effects.

Conversely, the three types of studies highlighted in this section indicate that if an association between alcoholism and anxiety/depressive disorders does exist, it is likely to operate in a relatively small subgroup of alcoholics. An alcohol-dependent person who demonstrates such psychological symptoms needs more intense intervention and support than may otherwise be provided, and if not appropriately treated, the symptoms may carry a worse prognosis for alcohol-related problems. High levels of depression are especially worthy of concern, because the risk of death by suicide among alcoholics, estimated to be 10 percent or higher, may be most acute during these depressed states. For example, profiles of approach–avoidance drinkers have discriminated between “high lapsers” and abstainers among alcohol-dependent patients (Stritzke et al. 2007). These findings jointly suggest that ambivalence about changing alcohol use may be particularly salient among people with comorbid anxiety and AUDs, such that decisional balance likely is a principal treatment target. If you are using alcohol as a self-medicating measure, you might feel it “works” to help you cope with your symptoms.

Alcohol-induced anxiety is the uncomfortable feeling that can happen after drinking heavy amounts of alcohol. For those who have an alcohol use disorder, it’s a symptom of alcohol withdrawal syndrome. In fact, 50% of people receiving treatment for alcohol use disorder also live with an anxiety disorder.

Development of Comorbid Anxiety and AUDs

Let’s say you drink a beer and martini but you don’t drink any water in between. 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. When you drink, your motivation in recovery brain sees an influx of gamma-aminobutyric acid (GABA), making you feel calm and relaxed. But your body also uses it as a crutch, and when the alcohol leaves your system, even if it is not much, your brain suffers from withdrawal, which can increase anxiety.

An oversensitive amygdala might react to everyday stressors by flooding your body with hormones designed to save you from mortal harm. Alcohol may have a negative impact on your relationships and your work, school, or home life—yet you keep on drinking. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) offers guidelines for alcohol consumption based on your gender and the number of drinks you have on a given day. Despite the window of relief you may experience after your first couple of drinks, alcohol doesn’t promote anxiety reduction. What’s more, the impact alcohol has on your brain can actually work against you to increase anxiety.

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.

If you’re feeling overwhelmed by your anxiety disorder, there are other ways to seek help. If you have a history of anxiety or mental disorders, make sure to share this with your healthcare provider so you know how alcohol or other substances may affect you differently. About 3.1% of the U.S. population is affected by generalized anxiety disorder, according to the Anxiety & Depression Association of America. If you’re feeling nervous about being in a social setting, you may pour yourself a glass of wine to self-regulate any stress. Only one notable study of COA’s has demonstrated a higher-than-expected risk for these major psychiatric disorders.

It is best to ride out the wave because you don’t want to train your body to rely on alcohol whenever it experiences anxiety or withdrawal symptoms. Any anxiety can increase the likelihood of developing an alcohol use disorder. You may also have very low blood sugar and physical pain from other hangover symptoms the morning after drinking. Those symptoms combine to worsen your anxiety and sometimes leave you feeling guilty, insecure, and flustered. We’re excited to bring you evidence-based health information that makes a real difference in your life.

Leave a Comment

Your email address will not be published. Required fields are marked *