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 The Link Between Alcohol and Anxiety—and How to Cope

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Written By: Ashley Laderer

Jordanne Greenberg is a clinical provider at Charlie Health.

Clinically Reviewed By: Jordanne Greenberg

January 13, 2025

7 min.

Do you drink to ease your anxiety? If so, you’re making matters worse. Keep reading to learn about the harmful cycle and link between alcohol and anxiety.

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Many people turn to alcohol to wind down after a stressful day or ease anxiety and take the edge off during social situations. Although drinking alcohol may seem like a quick fix in these instances, research shows that alcohol actually increases anxiety levels and can result in other negative consequences for mental health.  Read on to learn more about what the science has to say about adverse health effects related to alcohol use, how alcohol impacts the brain, and when alcohol consumption turns into alcohol use disorder.

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The connection between alcohol and anxiety

There’s an undeniable link between alcohol consumption and anxiety, and the connection also exists between anxiety disorders and alcohol use disorder (sometimes referred to as AUD, alcohol addiction, alcohol dependence, or alcohol abuse).  “There are both short-term connections and long-term connections between alcohol and anxiety,” says Charlie Health Clinical Supervisor Sarah Lyter, LCPC, MA. “For short-term effects, alcohol can reduce the feelings of anxiety. But the problem is, in the long-term, it can exacerbate anxiety.”

Not to mention, consistently leaning on alcohol as a short-term solution for anxiety can ultimately result in tolerance and dependence, says Lyter. In some cases, this can turn into alcohol abuse. Research has found a bidirectional relationship between anxiety disorders and alcohol use disorder, meaning that having an anxiety disorder increases your risk of developing AUD, and having AUD increases your risk of developing an anxiety disorder. 

So, why exactly does drinking alcohol lessen anxiety at first but ultimately worsen it? It comes down to brain chemistry and neurotransmitters, which are chemical messengers in your brain.

Alcohol is a central nervous system depressant, meaning it slows down brain activity. When you’re feeling anxious, your nervous system is overactive, and since alcohol can depress the nervous system, it provides that initial sense of relaxation, Lyter explains.

Additionally, a neurotransmitter called gamma-aminobutyric acid (GABA) plays a large role in alcohol’s effects. This neurotransmitter promotes feelings of calmness. When you drink alcohol, GABA activity in your brain increases. However, when you stop drinking and the alcohol wears off, your brain tries to find balance and regulate neurotransmitters, which leads to a drop in GABA activity. With an overall net decrease of GABA in the brain, this leads to rebound anxiety, and the anxiety might feel even worse than it did before you drank, Lyster says.

Furthermore, the impacts can compound over time. “Long term, there are changes in our brain chemistry, particularly to specific neurotransmitters GABA and glutamate, that can change how our brain regulates anxiety, leading to more anxiety long term,” says Lyter.

All of this can result in a vicious cycle: experiencing increased anxiety levels, drinking, having even worse rebound anxiety, and drinking more. This vicious cycle of drinking can lead to dependency and patterns of withdrawal, not only increasing your anxiety levels but also putting you at a greater risk for panic attacks — a very intense (but short-lived) episode of fear and panic, which can result in chest pain, shortness of breath, a sense of impending doom, and other troubling symptoms. Studies show that being in a repeated state of alcohol withdrawal results in chemical changes within the brain that make you more susceptible to panic attacks and subsequent development of panic disorder. 

In addition to panic attacks, other symptoms of withdrawal that can occur as the effects of alcohol are wearing off include:

  • Anxiety
  • Irritability
  • Confusion
  • Shakiness
  • Insomnia
  • Headache
  • Sweating
  • Upset stomach
  • High heart rate and blood pressure
  • Hallucinations and seizures (in severe cases)

How does self-medication with alcohol impact mental health?

Around 20% of people with anxiety disorders report self-medicating with alcohol. Self-medication is never the answer. If you’re drinking to decrease your anxiety, you are only putting a (not-so-useful) band-aid on the situation rather than addressing the root cause. When you use alcohol to cope, you limit yourself from learning healthy and effective ways to manage anxious feelings. Heightened anxiety will continue to ensue. 

On top of exacerbating anxiety in the long run, chronic alcohol use leads to other mental health concerns. For example, chronic heavy drinking can lead to worsening depression and an increased risk of suicide. In rare cases, alcohol can even lead to psychosis.

Signs of alcohol use disorder in individuals with anxiety

Alcohol use disorder and anxiety commonly co-occur. An estimated 20%-40% of people receiving treatment for an anxiety disorder also have AUD. The most common anxiety disorders that co-occur with AUD are:

Many anxious people drink as a maladaptive coping mechanism to reduce anxiety –– but how do you know when a drinking habit becomes something more?

Put simply, alcohol use disorder is when you can’t control your alcohol intake or stop your consumption, even despite the negative consequences that drinking has brought upon your life. Some possible signs of alcohol use disorder include:

  • Craving alcohol
  • Having an increased tolerance for alcohol (needing to drink more to get the same effect)
  • Trying to cut back or quit drinking but not being able to
  • Consuming more alcohol than you intended
  • Spending a lot of time drinking
  • Spending a lot of time hungover or dealing with the aftermath of drinking
  • Spending a significant amount of mental resources planning to obtain or obtaining alcohol to the extent that it interferes with your ability to focus on your responsibilities at school, work, or with your family
  • Continuing to drink even when alcohol causes relationship troubles
  • Engaging in risky, dangerous behaviors while drunk
  • Experiencing withdrawal symptoms after drinking (like restlessness, shakiness, or trouble sleeping)
  • Feeling shame about your drinking and hiding evidence of your drinking from loved ones

Treatment options for alcohol use disorder and anxiety

When seeking treatment, Lyter stresses the importance of addressing both the AUD and anxiety disorder. “The way that they interact with each other is really complex. You can’t just ignore one of them because they interact,” Lyter says. “Because of that, it’s really important to seek professional help from someone who specializes in co-occurring treatment for substance use and anxiety disorders so that both can be equally analyzed, assessed and addressed.”

Both therapy and medication can help treat AUD and anxiety disorders. Some common treatment approaches include:

1. Cognitive behavioral therapy (CBT)

CBT is a first-line treatment for anxiety disorders. This form of talk therapy focuses on how your thoughts, feelings, and behaviors are connected. People with anxiety have distorted, irrational thought patterns that contribute to their anxiousness. CBT allows you to examine these negative thought patterns and create healthier ones that can ultimately lessen your anxiety symptoms.

For AUD, CBT helps you identify the triggers that contribute to drinking and address the thought patterns that are related to alcohol consumption and abuse. You’ll learn healthy coping skills to use in place of alcohol to learn how to manage anxiety and negative emotions on your own. 

2. Motivational interviewing

Motivational interviewing (MI) is a goal-based therapy that helps you identify and focus on your personal motivations for getting sober. The emphasis is on your autonomy, giving you the confidence that you can make changes for good. One key aspect of MI is overcoming ambivalence or mixed emotions about quitting, granting you the power to get sober.

3. Acceptance and commitment therapy (ACT)

ACT is a therapy modality helpful for both anxiety disorders and AUD. It’s a mindfulness-based therapy that teaches you to be more present and change the way you relate to your thoughts rather than trying to change the thoughts themselves. ACT encourages you to take action to live in line with your values.

4. Peer support groups

Peer support from other sober people can greatly impact your recovery journey. These groups provide a sense of community and help you feel less alone. The people you meet in these groups will understand exactly what you’re going through and hold you accountable. Some examples of these groups are:

  • Alcoholics Anonymous (AA)
  • Refuge Recovery
  • Yoga 12-step recovery (Y12SR)
  • SMART Recovery

5. Medications

On top of therapy, there are also medications that can help you cope with anxiety and AUD.

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are a first-line treatment for anxiety disorders. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also common options. Both of these classes of medications are taken daily and long-term. There are also some anti-anxiety medication options that are taken on an as-needed basis to relieve anxiety symptoms. 

Additionally, there are medications FDA-approved for alcohol use disorder, including:

  • Acamprosate reduces cravings for alcohol.
  • Disulfiram makes you have adverse reactions when you consume alcohol, which will discourage you from drinking. 
  • Naltrexone blocks the positive feelings that alcohol brings and reduces cravings.

A psychiatrist can assess you and determine whether you’re a good candidate for medication for your anxiety, AUD, or both. 

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How Charlie Health can help

If you struggle with severe anxiety, alcohol use disorder (AUD), or both, Charlie Health can help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people dealing with serious mental health conditions, including AUD and anxiety disorders (such as generalized anxiety disorder, panic disorder, and social anxiety disorder). 
Our compassionate clinicians meet you where you are on your recovery journey. We incorporate evidence-based therapies into individual counseling, family therapy, and group sessions to address co-occurring conditions. With this kind of holistic treatment, recovery from AUD and anxiety is possible. Fill out the form below or give us a call to start healing today.

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