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Alcohol and Anxiety: A Dangerous Comorbidity

Alcohol and Anxiety: A Dangerous Comorbidity

If you have turned to alcohol as a means of relieving stress, you are certainly not alone.

One study published in the Archives of General Psychiatry found that 13% of American adults surveyed reported drinking alcohol to moderate feelings of anxiety, stress or panic at least once in the previous year. The researchers also found individuals with confirmed anxiety disorders who reported self-medicating at the start of the investigation period were 2 to 5 times more likely to develop a substance problem within 3 years when compared with their counterparts who did not self-medicate.

self medicating

Alcohol acts as both a sedative and a depressant, both of which help to take your mind off of anything that might be causing you stress. In this way, alcohol has certain effects that mirror anti-anxiety medications. The problem comes, however, when you drink to excess and eventually build a tolerance to the destressing elements of alcohol use. At this point, alcohol may become the biggest exacerbator for anxiety.

The outcomes of this comorbidity are compelling. One meta-analysis published in the journal of Alcohol Research suggests comorbid alcohol abuse and anxiety come with significant societal costs. Alcohol use disorders (AUD) cost the United States an estimated $184.6 billion each year while anxiety disorders cost somewhere between $42 billion and $47 billion annually.

It’s important for you to understand the relationship between AUDs and anxiety. In the event you feel you may have fallen into this situation, you know how to get help so you can get your life back on track.

Prevalence of Alcohol Consumption in the United States

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), almost 88% of people ages 18 and older say they’ve consumed alcohol at some point during their lifetime. Seventy-one percent say they’ve had a drink within the last year, and about 57% say they’ve had a drink in the past month. Meanwhile, nearly 25% of people in this age group report having binge drank within the past month and 6.7% say they’ve engaged in heavy drinking during the past month.

alcohol consumption

NIAAA reports almost 7% of all people in the U.S. ages 18 and older meet the criteria for having an AUD. Sadly, just 8.9% of people who should be receiving treatment for AUD actually received in 2014.

alcohol use disorder

The major signs of alcoholism include:

  • Consuming alcohol on 4 or more occassions each week.
  • An inability to stop consuming alcohol once you’ve started. In other words, being unable to drink in moderation.
  • Feeling as though you need a drink in the morning in order to get yourself moving.
  • Experiencing feelings of guilt or remorse after a night of drinking.
  • Having someone close to you, including family, friends or a coworker, tell you it might be time to slow down on the drinking.

Prevalence of Anxiety Disorders in the United States

Collectively, anxiety disorders are among the most common mental health disorders in the United States. Anxiety symptoms should not be confused with the normal, everyday stresses that accompany the trials and tribulations we all face.

anxiety stats

According to the National Institute on Mental Health (NIMH) approximately 18% of adults experience symptoms of anxiety in a given year, and anxiety has a lifetime prevalence of about 29%. About 4% of the U.S. adult population experiences anxiety symptoms consistent with the definition of severe anxiety.

Broken down further, NIMH data reveal that, of the U.S. adults with lifetime prevalence of anxiety, women are nearly two-thirds more likely than men to have an anxiety disorder. Blacks and Hispanics are 20% and 30% less likely to experience anxiety in their lifetimes.

The majority of anxiety disorders fall within 4 major categories.

Generalized Anxiety Disorder (GAD)

Individuals with GAD obsess about run-of-the-mill issues relating to finances, family, health and their jobs. People with GAD frequently imagine the worst possible outcome for any situation. Additionally, individuals suffering from GAD often exhibit certain physical symptoms directly related to stress, including muscle tension, short or noncontiguous sleep, or stomach pains.

Panic Disorder

Individuals with panic disorder suffer crippling terror that comes out of nowhere, despite not facing any actual danger. The hallmark feelings associated with these attacks include doom and losing control. People with panic disorder may mistake their panic attacks for physical symptoms. Those who have panic attacks often report believing that they’re having a heart attack, losing their mind or dying.

Social Anxiety Disorder

People who get very anxious or self-conscious in their everyday social life may have social anxiety disorder. They may be paranoid and worry about being judged or watched by others. They are typically embarrassed easily. According to the Anxiety and Depression Association of America, 7% of U.S. adults (15 million people) report having symptoms of social anxiety in a given year.

social anxiety

Specific Phobia

People who have specific phobia disorder experience a sharp fear of a thing or situation that typically pose no immediate threat. Some common phobias include heights, small spaces and animals. A panic attack could occur just by imagining facing that fear.

Other anxiety conditions include obsessive-compulsive disorder, separation anxiety disorder and substance-induced anxiety disorder.

Higher in Women vs. Men

According to research, 6% of men and 13% of women experience some form of anxiety within any given 6-month period. Women are also twice as likely as men to have panic disorder. In general, women and men show strong differences in how they respond to stress.

men vs women

Compared with men:

  • Women report higher stress levels, with married women reporting more stress than single women.
  • Women under stress are more likely to believe they’ve lost control over their lives.
  • Women report increasing stress as they age. Most reported balancing employment and family needs as major reasons behind higher stress.
  • Women report increased physical and emotional reactions, including crying, stomachaches, fatigue and irritability.
  • Women experience higher rates of stress-induced insomnia.

Does Alcohol Cause Anxiety?

Many people believe the most common reason for the development of comorbid alcohol abuse and anxiety is the tendency for people to attempt self-medication. Drinking alcohol to cope with anxiety symptoms can lead to a later onset of an AUD.

The study cited earlier from Archives of General Psychiatry found individuals with confirmed anxiety disorders who reported self-medicating at the start of the investigation period were 2 to 5 times more likely to develop a substance problem within 3 years when compared with their counterparts who did not self-medicate.

 Normally, self-medicating anxiety with alcohol follows a familiar, vicious cycle of events:

  1. Something happens that makes you feel anxious socially or personally. The anxiety from this is persistent, and you can’t figure out how to shake it.
  2. You might find that having a few drinks really takes the edge off your anxiety. You may feel less self-conscious in social settings and less worried about life in general.
  3. You start using this strategy as a means of coping with your anxiety more often, which in turn causes you to abandon healthier ways of coping. This causes a dependence on alcohol to manage anxiety setbacks both large and small.
  4. You eventually become aware of the dependency you’ve developed, which in turn becomes just another life stressor. You may not be ready to admit it to others or seek help, so you try to hide it from everyone, including yourself at times. This can cause silent bouts of anxiety with no outlets beyond having more alcohol to create a short-term fix.
  5. Your dependence becomes stronger, and you start to experience alcohol-induced anxiety. You stop being honest with yourself about the problem and begin turning more and more to alcohol to relieve anxiety.
  6. Life’s inevitable complications start to pop up, and you are less prepared than ever to weather them. People in your life may start to notice that you’re “off.” At this point, you’re dealing with both your substance dependence and also the life circumstances that drove you to self-medicate in the first place.
  7. You may have developed an addiction at this point and your anxiety is more painful than it ever has been. The growing pain only exacerbates your wish to continue self-medicating because the idea of addressing the issue head-on is enough to send you into a full-blown panic attack. You may think you’re stuck.
  8. As addiction takes hold, you experience more pain and more self-medicating. The cycle goes on and on.

Some research has shown AUD can rewire the brain. One such study, conducted by NIAAA researchers and published online in the journal Nature Neuroscience, found mice that had been exposed to alcohol never stopped fearing the electric shock that came with the sound of a bell despite being trained to do so. Mice that did not receive alcohol, however, did eventually stop fearing the bell. This, they wrote, provides insight into the relationship between alcohol and post-traumatic stress disorder (PTSD).

alcohol effects

How Alcohol Directly Affects Anxiety Symptoms

Most people agree alcohol can affect you physically and mentally in 6 key ways:

Mood

Using alcohol interferes with our mood because it can affect levels of serotonin. Serotonin levels are also associated with sexual desire and function, appetite, sleep, memory and learning, temperature regulation and certain social behaviors.

Low Blood Glucose or Sugar

Excessive amounts of alcohol can make your blood sugar drop, which leads to dizziness, confusion, weakness, shaking and an overall feeling of numbness. These symptoms can also lead to anxiety.

Dehydration

Although not directly related to anxiety, dehydration can cause nausea, dizziness, fatigue, light-headedness and muscle weakness — and these senses of illness can exacerbate anxiety.

Nervous System

The body goes into a state of hyperactivity when it attempts to ward off the sedative effects of alcohol, and this mechanism can lead to nervous system issues. Signs of nervous symptom issues include shaking, insomnia and sensitivity to light or sound.

Heart Rate

Alcohol consumption can increase your heart rate, which can trick your brain into going into a state of anxious anticipation.

Concentration

Drinking an excessive amount of alcohol can make you feel discombobulated, which can contribute to a heightened sense of anxiety.

How Does Alcohol Affect Anxiety Medications?

Anti-anxiety agents are not normally anyone’s first choice when looking for a drug to abuse, but many people with anxiety use alcohol to enhance the euphoric or relaxing effects that accompany their medications. Alcohol can interact dangerously with both anxiety and antidepressant medications, and so treating either condition can, therefore, be difficult if you’re drinking any amount of alcohol, let alone an excessive amount. Codependence is also a serious issue.

medication interaction

A treatment plan for people with anxiety may include one or more of the following drug classes:

Benzodiazepines
Although benzodiazepines are effective for acute symptom relief in people with anxiety, they are typically not used as a monotherapy because they aren’t effective in treating any of the underlying causes of anxiety. The purpose of benzodiazepines is primarily to provide rapid relief for intermittent or episodic anxiety attacks.

Commonly used benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). Consuming alcohol when taking benzodiazepines can be very dangerous because of the addiction potential and the chances for fatal overdose.

Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are used to treat the underlying cause of anxiety, though greater symptoms may be seen within the first few weeks of use. You should avoid drinking alcohol regularly while taking SSRIs, as the combination may leave you feeling drowsier than usual. The most commonly prescribed SSRIs used to treat anxiety include fluoxetine (Prozac), sertraline (Zoloft), Celexa, paroxetine (Paxil) and escitalopram (Lexapro).

Tricyclic Antidepressants
Examples of tricyclic antidepressants indicated to treat anxiety include maprotiline (Ludiomil), doxepin (Silenor), and clomipramine (Anafranil). Alcohol may increase the sedative effects of these drugs.

Monoamine Oxidase Inhibitors (MAOIs)
MAOIs aren’t usually prescribed as a first-line treatment for anxiety, but some providers try them if others aren’t working well. Examples of MAOIs sometimes used to treat anxiety include phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan). If you’re taking MAOIs, you should be aware that drinking alcohol might blood pressure to skyrocket.

Beta-Blockers
Beta-blockers are not normally prescribed on their own to treat anxiety, but some people like to use them concurrently with other anxiety drugs because they can help to treat or prevent certain physical symptoms of anxiety — such as sweating or trembling. Drinking alcohol with beta-blockers can be dangerous.

Nonpharmacological Treatment Options for Anxiety

Although medication is certainly important for people who have anxiety, there are a number of ways you can relieve the acute symptoms of anxiety without turning to alcohol or drugs. Here are a few natural ways to relax: 

Chamomile

A cup of chamomile tea can help reduce feelings of anxiety because some compounds in chamomile attach to the same brain receptors as calming drugs such as Valium. Chamomile can also be taken in supplement form.

Valerian Root

Although valerian can be ingested as a tea, most people opt to consume it in capsule form due to a slightly unpleasant smell. Valerian contains sedative compounds that help to relieve insomnia and other anxiety-induced sleep issues.

Drinking Extra Water and Staying Hydrated

Water is an essential component of all bodily functions — and so it should come as no surprise to hear staying hydrated may help you control the way you feel and experience anxiety.

Exercise

The benefits of exercise for people with anxiety are numerous. Exercise regulates hormones that may cause anxiety, burns away stress hormones, and rids the body of excess, pent-up energy.

Keeping a Journal

Writing out your feelings helps you to remove them from your head. The brain has an easier time letting go of information that is kept permanently elsewhere.

Cognitive Behavioral Therapy (CBT)

CBT is a form of talk therapy that champions the idea that if you are aware of the things that stress you out or bring negativity in your life, you will be more prepared to control those feelings. The tools you learn from CBT can be applied to many other areas of your life where you feel you are unable to control your emotions.

Knowing When It’s Time to Get Help

According to the Substance Abuse and Mental Health Services Administration, 7.9 million adults had co-occurring disorders in 2014, including AUDs and anxiety. Some 23.5 million people in the U.S. are in need of professional treatment, and just 11.2% of people in need of treatment go on to receive what they need.

professional help

Besides anxiety, other common co-occurring mental health disorders in a dual diagnosis include:

  • Moderate to severe depression
  • Personality disorders, such as antisocial personality disorder or borderline personality disorder
  • Mood disorders
  • Schizophrenia

It’s important to know anxiety as a comorbid mental health problem could be exacerbating your alcohol abuse issues. For you, a medically managed or monitored inpatient program is likely the most appropriate treatment strategy. Signs that indicate you might be an ideal candidate for such services include:

  • You avoid being social with people due to your anxiety
  • You’ve started drifting away from friends, family members and other loved ones as a result of your anxiety.
  • You have lost jobs or thwarted opportunities for professional advancement due to anxiety.
  • Your anxious feelings are preventing you from getting a proper night’s sleep.
  • You feel as though your anxiety is out of control.
  • Your anxiety feels as though it may be getting progressively worse.
  • You do or say things because of your anxiety that you later regret.
  • You’ve held back on pursuing your dreams because of anxiety.
  • Your health provider has previously told that you if you don’t start treating your anxiety, you could experience serious adverse medical events.

With respect to an AUD, if any of the following scenarios or characteristics apply to you, you owe it to yourself to seek alcohol rehabilitation treatment services:

  • You lie about your drinking habits to others.
  • You drink at odd hours of the day and often drink alone.
  • You feel the effects of drinking taking a toll on you physically.
  • The people in your life, such as friends, family or even a health professional, have strongly suggested you seek help for your drinking habits.
  • You are starting to become afraid of the person you are or the things you might do when you drink alcohol.

Getting Help for Alcohol Addiction and Anxiety

It is extremely important for you to avoid detoxing from alcohol on your own. The process requires professional oversight. Treatment facilities such as JourneyPure Emerald Coast can provide an integrative approach to the care you need — which is especially critical in success cases of dual-diagnosis like anxiety and alcohol abuse.

The facility is one of the best in Florida because the staff understands that successfully addressing the complex interaction between mental illness and addiction demands implementation of specific therapeutic interventions meant to address both problems.

In particular, our anxiety treatment program can help you:

  • Learn to manage both anticipated and unanticipated stressors known to lead to anxiety attacks. Recognizing these triggers means you will have the power to stop them from erupting.
  • Learn how to help yourself out of situations where you feel trapped by your anxiety. You’ll gain problem resolution skills that can stop you from shutting down and being too anxious to do anything.
  • Manage the physical health symptoms that often accompany severe anxiety, including rapid heartbeat, hypertension and increased risk for stroke.
  • Achieve the things you’ve wanted to achieve in life without anxiety weighing you down.

Most importantly, JourneyPure Emerald Coast’s staff will get you on the right track to start enjoying your life each day — free of the worry that anxiety will bogart your day. You will begin to feel more in control.