Alcohol Abuse and Anxiety Disorders: Signs, Symptoms and Treatment
Treating Anxiety and Alcohol Addiction
Alcohol abuse and anxiety disorders commonly occur together. 1, 2 Understanding how these two conditions are related, diagnosed and treated can help you find the right recovery program for yourself or a loved one.
What Are Anxiety Disorders?
This article is for educational purposes only and is not to be used to diagnose a mental health or substance use disorder. If you believe you or someone you love has a problem with anxiety and/or alcohol, speak with a licensed mental health professional.
Almost everyone experiences temporary anxiety during stressful or uncomfortable situations. However, when anxiety becomes long-term or begins to negatively affect one’s daily life, it may require professional treatment.
Different types of anxiety disorders exist, and they impact people in different ways. 3 What distinguishes an anxiety disorder from occasional or temporary anxiety are the associated symptoms and the long-term effects the symptoms have on the person. These symptoms are characterized by fear or feelings of uneasiness that the person struggles to control. The fear can range from a generalized feeling of worry to severe phobia. 4
Anxiety disorders also have many causes. The following factors can contribute to a person developing an anxiety disorder:
- Environmental elements.
- Adverse childhood experiences. 4
What Is Alcohol Abuse?
Alcohol abuse or alcoholism is known in the clinical setting as alcohol use disorder. It can lead to serious consequences in a person’s life, including health conditions, damaged relationships, employment issues and legal problems.
For a person to be diagnosed with alcohol use disorder, they must display at least 2 of the following symptoms over a 12-month period: 7
- Consuming more alcohol than intended or drinking over a longer period of time than intended.
- Experiencing unsuccessful attempts to reduce alcohol use.
- Spending a great deal of time using, obtaining or recovering from the effects of alcohol.
- Having strong cravings for alcohol.
- Neglecting major responsibilities at work, school or in relationships due to alcohol use.
- Continuing to drink despite problems directly related to alcohol use.
- Giving up important social, recreational or employment activities as a result of using alcohol.
- Frequently using alcohol in situations where it is physically dangerous.
- Continuing to use alcohol even though it is causing physical or psychological problems.
- Experiencing tolerance and/or withdrawal symptoms.
Relationship Between Alcohol and Anxiety DisordersRecent studies have shown high rates of co-occurring anxiety disorders and alcohol abuse. 5, 6 Further studies have shown that substance use disorders, such as alcoholism, are a risk factor for the development of anxiety disorders. Likewise, anxiety disorders are also a risk factor for substance abuse, since people may use alcohol to reduce anxiety.
However, while alcohol can provide some temporary relief from anxiety, the risk of an alcohol use disorder increases when the person uses alcohol regularly to deal with his or her anxiety. In fact, in some cases, alcohol abuse may worsen anxiety.2 The short-term benefits of using alcohol to cope do not outweigh the associated risks.
Prolonged alcohol abuse can also result in substance-induced anxiety disorder. This is because frequent use and withdrawal from alcohol can cause disturbances in the nervous system that can worsen or invoke the feelings associated with anxiety disorders. 1
Social Anxiety Disorder and Alcohol Abuse
Social anxiety disorder, formerly known as social phobia, occurs when a person suffers from a fear of social situations. Feelings that can result from these fears include:
- Fear of being rejected and/or judged.
- Fear of offending others. 3, 7
Other symptoms associated with social anxiety disorder include:
- Feeling anxious around other people, especially strangers.
- Difficulty talking to others in social situations.
- Feeling self-conscious in front of others.
- Worrying about being humiliated or saying the wrong thing.
- Worrying for days or weeks prior to a social event.
- Avoiding social situations.
- Having a hard time making or keeping friends.
- Blushing, sweating or trembling around others.
- Feeling nauseated or sick when around others. 3
Roughly 28% of those with social anxiety disorder also abuse alcohol as a way to reduce the fear associated with social situations. 8
Panic Disorder and Alcohol Abuse
Panic disorder is associated with recurring, unexpected panic attacks. These attacks include symptoms such as:
- Heart palpitations or pounding
- Accelerated heart rate.
- Trembling or shaking.
- Shortness of breath.
- Chest pain.
- Feeling dizzy and/or lightheaded.
- Numbness and tingling.
- Chills and/or hot flashes.
- Nausea or abdominal pains.
- Feeling detached.
- Fear of losing control.
- Fear of dying.
- Feelings of being smothered or choking.
- Feelings of impending doom. 3, 7
Several studies have shown a relationship between panic disorders and alcohol abuse. 10 One study found that 25% of those seeking treatment for panic attacks had some history of alcohol abuse. 11
Other studies suggest that experiencing panic attacks is a risk factor for future alcohol abuse. 12
Generalized Anxiety Disorder and Alcohol Abuse
Generalized anxiety disorder involves ongoing feelings of fear or worry related to daily activities, such as a job, school, relationships or chores. Physical symptoms of generalized anxiety disorder include:
- Easily fatigued.
- Difficulty concentrating.
- Irritability or feeling on edge.
- Muscle tension.
- Difficulty controlling the worry or racing thoughts.
- Difficulty falling or staying asleep. 3, 7
Similar to panic disorders, those with generalized anxiety disorder have a higher rate of concurrent substance abuse. In some cases, symptoms associated with generalized anxiety disorder are related to alcohol abuse. 5
Treatment for Anxiety Disorders and Alcohol Abuse
Dual diagnosis occurs when a person has both a mental health disorder and a substance abuse disorder. Dual diagnosis is more common in people diagnosed with depression, anxiety, schizophrenia or personality disorders. 13 As previously stated, dual diagnoses of alcohol abuse and anxiety disorders are common. 1, 2 It is important to treat both diagnoses at the same time in order to have a successful recovery. 13
Treatment settings vary depending on the individual’s needs and the severity of his or her addiction and/or symptoms. Various factors that determine the appropriate setting for someone include:
- Level of intoxication and potential for withdrawal.
- Presence of other medical conditions.
- Presence of other comorbidities.
- Readiness and willingness to change.
- Risk of relapse.
- Recovery environment. 17
The different types of settings include: 18
- Inpatient – Inpatient treatment is often provided in a residential or hospital setting with 24-hour medical supervision. This program is recommended for those with severe levels of need and who require continuous care and support during their recovery process. Treatment approaches may vary between different rehab centers. But in general, most inpatient or residential treatment will include an intake process, a detox period, ongoing therapy and aftercare planning prior to discharge.
- Outpatient – Outpatient treatment includes a variety of options, such as individual and group counseling, and allows you to still live at home during treatment. This form of treatment is recommended for those with less severe levels of need.
- Support groups and 12-step – Twelve-step programs use the self-help philosophy developed by Alcoholics Anonymous. Members receive peer support and work with a sponsor on completing the recovery steps while maintaining abstinence from all substances.
- Self-care – People recovering from anxiety and alcohol abuse can use a variety of self-care techniques in addition to other treatment options. These can include exercising, meditating and breathing techniques.
Evidence-based treatment options for anxiety and alcohol addiction include:
- Medication-assisted treatment (MAT) – MAT uses a combination of medications and behavioral therapy to treat substance use disorders. Disulfiram, acamprosate and naltrexone are commonly prescribed medications for the treatment of alcohol abuse. No medication can cure alcohol abuse, and each is most successful when combined with counseling and/or behavioral therapy. Always speak to your healthcare provider about all the medications you are taking.
- Behavioral therapy – Behavioral therapy aims to make adjustments or modifications to behaviors associated with anxiety and alcohol abuse. 14, 15 One of the most commonly used behavioral therapies for the treatment of anxiety and alcohol abuse is cognitive behavioral therapy (CBT). CBT teaches people to recognize maladaptive behaviors, triggers and negative thoughts that can lead to anxiety and alcohol abuse, and to develop new skills that help them lead a healthy, positive and productive lifestyle. 14, 16 CBT is among the most effective behavioral treatment options for both anxiety and alcohol abuse. 2
Alcohol Withdrawal and Anxiety
Some studies have shown an increase in panic attacks after stopping alcohol use after chronic and/or long-term abuse. 10 This is due to many people experiencing symptoms generally associated with anxiety during the initial stages of withdrawal. Often, people will return to alcohol to calm those feelings, creating a cyclical effect.
The only way to treat alcohol-induced anxiety is to give up alcohol completely. 19 A treatment program can provide medically supervised detoxification that can ease withdrawal symptoms and make the process more comfortable.
Find Treatment Centers for Anxiety and Alcohol Abuse
Find the right treatment center based on your needs by calling today. It is free to call, and representatives are available 24 hours a day, 365 days a year. A representative will help you select the right treatment option in your area.
If you not have health insurance, call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) toll-free helpline at 1-800-662-HELP (4357) for more information on low-cost treatment programs and support groups in your area.
. Smith, J. P., & Randall, C. I. (2012). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Research-Current Reviews 34(4), 414.
. Back, S. E., & Brady, K. T. (2008). Anxiety disorders with comorbid substance use disorders: diagnostic and treatment considerations. Psychiatric annals 38(11).
. National Institute of Mental Health. (2016). Anxiety Disorders.
. Substance Abuse and Mental Health Services Administration. (2015). Mental Disorders.
. Compton WM, Thomas YF, Stinson FS, Grant BF. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions Arch Gen Psychiatry May; 64(5):566-76
. Hasin DS, Stinson FS, Ogburn E, Grant BF (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry Jul; 64(7):830-42
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association
. Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S. M., Grant, B. F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological medicine 40(06), 977-988.
. American Psychiatric Association. (2015). What are Anxiety Disorders?
. Canan, F., & Ataoglu, A. (2008). Panic Disorder After the End of Chronic Alcohol Abuse: A Report of 2 Cases. Primary care companion to the Journal of clinical psychiatry, 10(4), 332.
. Otto MW, Pollack MH, and Sachs GS. et al. Alcohol dependence in panic disorder patients. J Psychiatr Res. 1992 26(1):29-38
. Goodwin RD, Lieb R, and Hoefler M. et al. Panic attack as a risk factor for severe psychopathology. Am J Psychiatry. 2004 161:2207-2214
. S. National Library of Medicine. (2016). Dual Diagnosis.
. National Institute of Health. (n.d.). Psychotherapies.
. National Institute on Drug Abuse. (2012). Behavioral Therapies. In: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
. National Institute on Drug Abuse. (2012). Cognitive-Behavioral Therapy. In: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
. National Institute on Drug Abuse, & United States of America. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
. National Institute on Drug Abuse. (2016). What to do if you have a problem with drugs: for adults.
. Center for Substance Abuse Treatment. (2005). 9 Substance-Induced Disorders.