The Relationship Between Alcohol and Anxiety

The Biochemical Connection

The connection between alcohol and anxiety goes deeper than the temporary stress relief you feel after a few drinks. 

Neurotransmitter Disruption

Alcohol disrupts the chemical balance in your brain. The neurotransmitter GABA, for example, has calming properties. Alcohol mimics the effects of GABA, which reduces anxiety in the moment. But over time, alcohol causes your brain to produce less GABA—and fewer GABA receptors.⁵ The same process happens with serotonin, dopamine, and other mood-regulating brain chemicals. This builds long-term anxiety by reducing your natural capacity to manage stress.

Impact on Sleep

While alcohol’s drowsiness-inducing effects might help you fall asleep, it negatively impacts your sleep quality throughout the night. Alcohol reduces the amount of time we spend in deep sleep, which in turn affects our mood and ability to regulate emotions. Poor sleep quality due to alcohol⁶ makes you feel sleepy throughout the day, affects your productivity, and worsens anxiety symptoms. Chronic sleep disturbances make anxiety far worse and create a feedback loop where poor sleep due to alcohol fuels anxiety, which then further disrupts sleep.

Psychological and Social Factors

Behavioral Patterns

Alcohol-related behaviors can also fuel anxiety. For someone with social anxiety, for example, drinking might seem like a welcome icebreaker. But those relaxed inhibitions can be a double-edged sword, as poor decision-making and awkward interactions only reinforce social anxieties once the fog clears. Depending on alcohol to be social can make you afraid to socialize without it, which limits your scope of connections as your social circle narrows to focus on party friends. 

Social Consequences

We don’t often think our behaviors pose risks to those around us, but problematic drinking will eventually affect our friends. 

The behavioral patterns that stem from heavy drinking are notorious for ruining relationships. Drinking destabilizes our mood, making us more irritable and less likely to show up to our relationships as our best selves. You might be more short-tempered or cynical for days following a heavy drinking session—which, if you drink several times a week, means your mood is affected virtually all the time. The effects of this get worse as alcohol dependence sets in: “Evidence suggests that alcoholics experience increasing dysphoria⁷ as a consequence of alcohol consumption,” say researchers. 

Drinking causes us to act impulsively, without regard for consequences, or without even realizing what we’re doing, leaving us with an embarrassing emotional hangover as we try to remember our actions the night before. 

All of this strains relationships and makes us feel isolated and more socially anxious. This erodes the very support systems that are so important when we’re changing our drinking behaviors and learning to manage anxiety.

Identifying the Signs of Co-Occurring Alcohol Use and Anxiety Disorders

Behavioral Signs

Spotting a co-occurring problem with alcohol and anxiety can be tricky. Here are some signs to watch for: 

• You only feel comfortable socializing after drinking. 
• You avoid social situations where alcohol isn’t available.
• You drink more during periods of heightened anxiety.
• You’re becoming more socially isolated.
• Your sleep patterns are changing. 

If you notice any of these signs, it might be time to reevaluate your relationship with alcohol. 

Physical and Emotional Symptoms

Physical symptoms can also signal co-occurring alcohol use and anxiety disorders. These might include tremors, sweating, or difficulty sleeping, which can be caused by both anxiety and alcohol withdrawal. 

Emotional signs include chronic worry, irritability, and difficulty concentrating. Panic attacks⁸ (a hallmark of anxiety disorders) might also become more frequent. If these symptoms worsen with alcohol use or persist even when you’re sober, it may be time to seek professional help.

Treatment and Management Strategies

Professional Help

Breaking the cycle of anxiety and alcohol dependence is a complex process and is best taken on with professional support. 

If you require alcohol detox, it’s important to do so in a medically supervised environment. Alcohol withdrawals can be highly dangerous and should not be attempted alone. You can contact a detox center for an over-the-phone assessment to determine your level of need.

In a reputable addiction and mental health treatment program therapists provide a safe space to explore the underlying causes of both conditions, teach coping skills to manage anxiety without the use of alcohol, and help you implement lifestyle changes that sustainably support your well-being. Rehabs offer programs at different levels of intensiveness and use a variety of treatment approaches (which may include medication management, talk therapy, and complementary therapies) according to your needs. Your treatment team can help you determine the most effective path toward getting—and staying—well.

Integrated Treatment Programs

For people who struggle with both alcohol use disorder and anxiety, the most effective treatment is a comprehensive program that specializes in dual diagnosis treatment. These programs address both conditions simultaneously and recognize the synergy between them. Therapists experienced in treating co-occurring disorders can tailor interventions to treat symptoms and address the root causes of anxiety and alcohol addiction. This might include therapies like CBT alongside medication management for anxiety, as well as relapse prevention strategies for staying sober long-term. Integrated programs can be highly effective, healing underlying problems and teaching the skills you need to manage your anxiety and live a fulfilling, alcohol-free life.

Medications

As part of your treatment plan, doctors might prescribe medications to target anxiety symptoms,⁹ such as selective serotonin reuptake inhibitors (SSRIs). These medications may also reduce cravings for alcohol. 

Your treatment team might also recommend medications like buspirone or hydroxyzine to address anxiety and potentially decrease alcohol use as a coping mechanism. 

Medications should only be prescribed by a qualified prescribing doctor after in-depth psychological testing to determine your specific needs and best course of action. 

Not everyone is open to medication, and that’s okay. But for those who are, it can be effective for managing both alcohol and anxiety. Medication is most effective when combined with psychotherapy,¹⁰ which helps you learn coping strategies and make lasting behavioral changes. Medication management can help you get symptoms under control so that talk therapy is more effective. 

Self-Help and Lifestyle Changes

Mindfulness and Stress Reduction

Mindfulness practices and stress reduction techniques can help you manage anxiety without relying on alcohol. Mindfulness meditation helps you cultivate self-awareness as you learn to observe your thoughts and feelings without judgment. This can also help you place some distance between feeling triggered and acting on it, meaning you’ll gain more control over your reactions as you learn to self-regulate your emotions.

Stress reduction techniques can include deep breathing exercises, which slow your heart rate and activate your body’s natural relaxation response. Spending time in nature, taking up a new hobby (or rediscovering an old one), and getting regular, good-quality sleep all support your emotional well-being. By making these practices a regular part of your life, you’ll build resilience and get better at managing your anxiety.

Healthy Habits

Long-term recovery from anxiety requires a strong foundation of healthy habits. These lifestyle changes include getting regular exercise, nourishing your body with a nutrient-dense, anti-inflammatory diet, and improving your sleep hygiene. Doing things that nourish your spirit and allow your mind and body to recharge increases your capacity for handling stress and sets you up for success in daily life. 

Support Systems

No one should fight anxiety or alcohol addiction alone—strong support systems are key to long-term success. As you make these life changes, surround yourself with friends and family who understand your struggles and offer nonjudgmental support. Consider joining a local or online support group specifically focused on anxiety. Sharing your experiences openly and hearing those of others reminds you that you’re not alone. 

Feeling Anxious and Doing It Anyway 

There are times when it’s okay to pull back from situations that make us uncomfortable, and times when it’s helpful to push through to achieve your goals. O’Hara says he finds it helpful to put himself in social situations without alcohol¹¹ even if it feels uncomfortable at times: 

You have to put yourself into situations where, if there was no alcohol around, you might normally feel awkward about it. But every time you do that, you learn something. You gain a more confidence in yourself and your abilities.

Resources for Further Help

These hotlines, websites, and support groups are great starting points to learn more about co-occurring anxiety and alcohol use disorder and find the help you need: 

• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) (1-800-662-HELP) funds research and provides information to help people with co-occurring disorders understand treatment options and find resources.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) (1-800-662-HELP) offers a national helpline, treatment referrals, and resources to connect people with co-occurring disorders to the support they need.
• The Anxiety and Depression Association of America (ADAA) provides education, support groups, and even a therapist finder to help people with anxiety.
• Alcoholics Anonymous (AA) is a free, peer-supported network of meetings specifically designed to help people struggling with alcohol addiction. 
• The National Alliance on Mental Illness (NAMI) offers support groups, educational resources, and information on finding treatment for mental health conditions including anxiety.

If you’re struggling with anxiety and alcohol addiction, a treatment center can help you uncover the cause of both conditions and make a plan to address them. Search co-occurring disorder treatment centers and reach out to their admissions teams directly to find the right program for you.