Heavy Drinking Can Make Your Anxiety Disorder Worse

If you're going to examine the relationship between alcohol and anxiety, you need to look at the concept of "self-medication." There's a very strong link between possessing an anxiety disorder of any kind — from obsessive-compulsive disorder to panic disorder — and the propensity to self-medicate with alcohol. And that, in turn, can lead to alcohol abuse, as people become more and more reliant on a drink (or several) to get them through anxiety-inducing situations and having an anxiety disorder in general. It's an understandable link, but it's also a very worrying one.

Alcohol abuse is particularly strong in people with social anxiety disorder, who find social interactions excruciating and difficult to navigate. A study from the National Institute of Health found that up to 20 percent of people who have social anxiety disorder also meet the criteria for alcoholism. The study also found, notably, that experiences of severe anxiety are actually rarely reduced by having a drink:

"[Alcoholics with anxiety disorders] may have started drinking as a coping mechanism because of their positive expectancies, but they may continue to use alcohol because they associate alcohol consumption with symptom relief. Unfortunately, few experimental studies have investigated expectancies about alcohol's ability to reduce social fears..."

The idea that alcohol can reduce anxiety dates back, as the American Journal of Psychiatry points out, to the ancient Greeks. Hippocrates recommended that a watered-down wine would "put away anxiety and terrors." And alcohol's depressant nature may indeed mean that you feel (or expect to feel) slightly more relaxed afterwards. However, increased use of alcohol as a crutch is an obvious problem.

And it's not just an issue among those who suffer from social anxiety, either. A study of in-patient alcoholics back in 1984 found that people seeking treatment had a wide range of phobias — a classic mark of anxiety — and 44 percent suffered from some sort of anxiety disorder.

But the relationship between alcohol and anxiety isn't all about self-medication. Alcoholics may also be more likely to develop anxiety disorders because of the ways in which substantial alcohol abuse works on the brain; and anxiety induced by alcohol is a problem, too. It's a tricky knot to unravel.

Alcohol plays a nasty trick on those who struggle with it: even if you think you're relaxing by drinking heavily, in the end, it may actually make you more anxious. Beyond Blue, an Australian depression organization, explains that the link exists even in those of us without alcohol or previous anxiety issues:

"... it can also be quite common to feel a bout of anxiety after a night out drinking, particularly if you are already prone to feeling anxious or experiencing panic attacks [...] The anxiety can be triggered as your body works to remove alcohol from your system, with blood sugar levels dropping...Some antidepressant medications also interact with alcohol to increase ‘rebound’ symptoms of anxiety.... The anxiety-fueled hangover is so common it has even coined the slang terms 'hangxiety' and 'boozanoia' in recent years."

The temptation to use alcohol to calm down in the moment, in other words, may be offset by a worsening of symptoms later.

But the alcohol-anxiety link goes further. Research has shown that comorbidity — the technical term for the coexistence of two disorders or illnesses — of alcoholism and anxiety disorders has a bit of variation, and what starts what is often unclear. "Evidence for a causal relationship," Comprehensive Psychiatry noted in 1998, "is not unidirectional [ie it doesn't just go one way] as alcoholism is often observed as a primary disorder, and the presence of problem drinking itself may generate severe anxiety or depressive syndromes." People who are alcoholics have a two to threefold higher likelihood of having an anxiety disorder than people who aren't; but part of this, scientists think, is that alcohol can actually set off or create the conditions for anxiety problems.

A possible reason for this was uncovered in 2012, when scientists at the University of North Carolina found that heavy drinkers seem to "rewire" their brains in ways that make them more susceptible to anxiety issues. They experimented with mice, putting them through experiences that had the potential to be slightly traumatic, while also plying them with minute quantities of alcohol (but enough, in a mouse's small body, to replicate heavy drinking). The mice who were teetotal didn't really get very upset at the experiences; but the ones who were "heavy drinkers" were completely horrified and miserable about them, even if there was nothing actually traumatic happening at the time. Researchers discovered that the brains of the alcohol-affected mice were reshaped and a key nerve cell wasn't working properly, creating huge potential for anxiety. In other words, if an alcoholic suddenly starts to develop anxiety disorders, this is likely why.

Things continue to get intriguing when you turn to the science on inheritance. It looks as if, according to a study on comorbidity of alcoholism, depression and anxiety in families, you can inherit a propensity to be both an anxiety sufferer and an alcoholic from a parent.

It also turns out that people who struggle with both alcoholism and anxiety disorder are at serious risk of not getting through a rehab treatment course. A 2001 study of how people were doing after alcoholism treatment found that 60.5 percent of patients who didn't have any other mental health issues besides addiction managed to remain sober. However, when it came to patients who also struggled with depression or anxiety, only 26.7 percent of them were able to maintain their sobriety — and only 12.5 percent of the patients who struggled serious anxiety and depression, in addition to addiction, were able to remain sober.

And in 2005, a study of people with anxiety disorders who had gone through rehab for alcohol found that they were "significantly more likely" to relapse than people who didn't have other mental health issues in addition to addiction. "Baseline social phobia," the scientists wrote, "was the single best predictor of a return to any drinking after treatment, whereas panic disorder was the single best predictor of a relapse to alcohol dependence after treatment."

Clearly, getting healthy while suffering the comorbidity of alcoholism and anxiety disorders is a massive hurdle, and we're not entirely sure how to fix it. But scientists at the National Institute for Alcohol Abuse And Alcoholism suggest that medication may be "particularly important" for alcoholics with comorbidity for a few reasons:

"First, some alcohol–dependent people with comorbid diagnoses face greater difficulties in accessing and using traditional alcoholism treatment and self–help groups in which many members do not have comorbid disorders... Second, pharmacological treatments are generally familiar to dually diagnosed patients, because many already are used to taking medications for their psychiatric disorder, and dosage scheduling can be readily integrated into a medication schedule for the comorbid condition. Third, the cognitive symptoms common in comorbid mental disorders may undermine patients' motivation and ability to learn new material in psychosocial treatments, particularly early in recovery."

None of this means that anxiety sufferers should lose hope when it comes to dealing with addiction — far from it. Rather, being aware of the potential hazards going in can help you have a higher likelihood of avoiding them. And if you don't struggle with addiction, but do get drunk to deal with your anxiety issues? Know that it may feel like it solves the problem in the moment, but in reality, getting professional help is a real long-term solution.