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The Connection Between Anxiety Disorders & Alcoholism

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One of the unfortunate truths when considering alcohol abuse and alcoholism is that these issues often exist alongside other problems one may have in their life—physical, psychological, social, or otherwise. Alcoholism and anxiety disorders often co-occur together, at an estimated 2-3 times the rate than would be expected by chance.1 In some cases, people with anxiety self-medicate with alcohol to alleviate their distress; conversely, people who abuse alcohol may also feel anxious when they stop drinking and experience acute alcohol withdrawal. For reasons such as these, the dual phenomena of anxiety and alcohol abuse can reinforce each other and could potentially create a vicious cycle that quickly spirals out of control.

If you or someone you care about struggles with compulsive drinking and you suspect that an anxiety disorder might be a factor, it’s important to get help for both issues so one doesn’t continue to feed into the other.

Signs of Alcoholism

Alcoholism is a long-used term that some use interchangeably with the medical diagnosis of alcohol use disorder (AUD). As such, the concept of alcoholism describes a chronic, relapsing condition characterized by severe, uncontrollable problem drinking. It is an alcohol addiction, which means that you are unable to control your drinking behaviors. You continue drinking despite negative physical, social, and psychological consequences.

The criteria for alcohol use disorder have been established by the American Psychiatric Association (APA) and are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Some of the common signs and symptoms of alcoholism include:2

  • Drinking larger quantities or for longer periods than you intended.
  • Being unable to stop or control your drinking.
  • Spending a lot of time and effort to obtain, use, and recover from alcohol use.
  • Experiencing strong alcohol cravings.
  • Failing to meet work, school, or home obligations because of drinking.
  • Continuing to drink despite negative social or interpersonal problems caused by alcohol use.
  • Giving up activities you once enjoyed because of alcohol use.
  • Drinking in physically hazardous situations (such as driving or while operating machinery).
  • Continuing to drink despite knowing that you have a psychological or physical problem that has probably been caused or worsened by alcohol.
  • Developing a tolerance, or need for larger amounts of alcohol to feel desired effects.
  • Experiencing withdrawal symptoms when you try to stop drinking.

If you or someone you know shows signs of an alcohol addiction, help is available in the form of detox and substance abuse treatment. It’s never too late to change your life around.

What are Anxiety Disorders?

Anxiety disorders are a grouping of several mental health conditions that all involve pronounced, problematic levels of anxiety and the accompanying behavioral disturbances that subsequently occur. Anxiety disorders are distinguished depending on the types of situations or objects that lead to fear, anxiety, or avoidant behaviors.2

Everyone experiences anxiety from time to time, but people with anxiety disorders suffer from excessive anxiety or anxiety that persists longer than is appropriate. The symptoms of an anxiety disorder do not go away once a stressor subsides, which differentiates it from normal anxiety or fear.2

Anxiety disorders cause significant distress and impair your well-being and ability to function in social, occupational, or other important areas. The most common anxiety disorders include:3

  • Generalized anxiety disorder: You experience excessive worry for months and suffer from symptoms such as irritability, muscle tension, concentration issues, sleep problems, and restlessness.
  • Panic disorder: You experience frequent and recurring panic attacks, which are sudden episodes of extreme fear and physical symptoms such as heart palpitations, sweating, and chest tightness. You live in fear of having another panic attack, you fear being out of control during a panic attack, and you avoid places where you may have experienced a panic attack previously.
  • Social anxiety disorder (social phobia): You fear being in situations where you may be judged or embarrassed. You are extremely nervous in social settings, feel self-conscious around others, may worry for days or weeks ahead of a social event, may have a difficult time making friends or meeting new people, and may feel physically ill when you are around others.

Co-occurring Disorders

Anxiety and alcoholism frequently occur together, a situation referred to as a dual diagnosis or co-occurring disorders. Sometimes, people with alcoholism suffer from anxiety when they experience withdrawal.4 People with anxiety may also try to self-medicate with alcohol as a way of managing their symptoms. One study found that 18.3% of people self-medicated with alcohol for generalized anxiety disorder, whereas 3.3% self-medicated with alcohol and drugs due to specific phobias and panic disorder without agoraphobia (a fear of enclosed spaces).5 Another study based on the National Epidemiologic Survey on Alcohol and Related Conditions found that nearly 13% of people with anxiety who self-medicated with alcohol developed an alcohol addiction, compared to 4.7% of individuals with anxiety who did not self-medicate.6

People who have co-occurring disorders need more comprehensive treatment than people with just one disorder to better address both conditions. One study compared individuals with alcoholism and no anxiety disorder to those with co-occurring anxiety and alcoholism and found that those with a dual diagnosis:7

  • Are less socially adjusted.
  • Experience more hospitalizations.
  • Drink more heavily.
  • Are more disabled.
  • Have more severe psychiatric illness.

Furthermore, those with co-occurring disorders in general may be more likely to experience or suffer from:8

  • Health issues.
  • Suicide.
  • Homelessness.
  • Incarceration.
  • Early death.

A clinical review examined the relationship between alcohol use disorders and anxiety disorders, and found that:1

  • Anxiety disorders are more frequently associated with alcohol dependence than alcohol abuse (with ‘abuse’ in this instance meaning problem drinking without suffering from withdrawal symptoms when you stop).
  • People with panic disorder, generalized anxiety disorder, or social phobia may be more likely to self-medicate than people with other anxiety-related conditions such as obsessive-compulsive disorder.
  • Alcohol withdrawal can mimic or exacerbate symptoms of anxiety.
  • People with social anxiety disorder have greater alcohol dependence severity and more dependence symptoms than people without social anxiety.
  • Symptoms of generalized anxiety disorder and social anxiety disorder can hamper efforts to treat substance use.
  • Anxiety disorders are associated with an increased risk of relapse after alcohol treatment.

Oftentimes, anxiety and alcohol use disorder reinforce each other, thus creating a vicious cycle. It can be extremely difficult to stop one without addressing the other, which is why integrated treatment that focuses on both disorders and how they influence one another is so vital.

Alcohol Withdrawal Anxiety

When someone who is dependent on alcohol tries to stop drinking, they may experience withdrawal, because their body has adapted to and can no longer function properly without the presence of alcohol. Anxiety is one of the most prominent symptoms associated with alcohol withdrawal.2

Anxiety and other troublesome withdrawal symptoms may cause a person to continue drinking as a way to alleviate anxiety and other symptoms. A fear of anxiety and other withdrawal symptoms can lead to continued alcohol use in order to avoid them, but the emergence of unpleasant withdrawal symptoms can also contribute to relapse after a period of abstinence.9 This can result in a compulsive cycle of alcohol use that can be challenging to break. Further, if a person repeatedly attempts to quit and experiences multiple withdrawal episodes, this can result in changes in brain chemistry (a phenomenon known as “kindling”) that can increase a person’s susceptibility to anxiety when they stop drinking, thus making it even more difficult to quit without professional assistance.1

Integrated Treatment

Integrated treatment is geared toward treating co-occurring disorders. This form of treatment is necessary to address alcoholism and anxiety disorders. It occurs in one setting that treats both substance abuse, such as alcoholism, and mental health disorders, such as anxiety disorders. Treating both conditions in the same setting can reduce patient confusion and create a more cohesive path to recovery.10 In such a program you are treated by trained and qualified practitioners who are skilled at identifying and treating both substance abuse disorders and mental illnesses and the interactions of the conditions.10

Co-occurring alcoholism and anxiety disorders are treated in stages, with different services provided at each stage. Treatment methods can include:10,11

  • Motivational interventions to enhance your motivation to recover and help you to identify personal goals for recovery.
  • Substance abuse counseling using a cognitive-behavioral approach. This helps you identify and stop maladaptive thought and behavioral patterns that lead to alcohol use.
  • Individual, group, and family counseling, depending on your unique needs and stage of treatment.
  • Contingency management, which involves providing motivational incentives for achieving specific treatment goals.

Your recovery journey doesn’t end once you complete a treatment program. Since people with anxiety disorders may be at increased risk of relapsing following alcohol abuse treatment, it’s crucial that they follow an aftercare plan to prevent a return to old habits.1

Aftercare might consist of:

  • Participating in a 12-step group like Alcoholics Anonymous (AA) or a non-12-step group like SMART Recovery.
  • Regularly engaging in individual or group counseling.
  • Residing in a sober-living home for a period of time after treatment has ended.

Preventing relapse is the main goal of aftercare. Aftercare can help fortify coping skills, build sober social skills, and enhance your sober support system.

Sources

  1. Smith, J. P., & Randall, C. L. (2012). Anxiety and Alcohol Use Disorders: Comorbidity and Treatment ConsiderationsAlcohol Research: Current Reviews34(4), 414–431.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
  3. National Institute of Mental Health. (2016). Anxiety Disorders.
  4. Nunes, E.V., McGrath, P.J., & Quitkin, F.M. (1995). Treating Anxiety in Patients with Alcoholism. Journal of Clinical Psychiatry, 56(Suppl 2), 3–9.
  5. Robinson, J., Sareen, J., Cox, B., & Bolton, J. (2009). Self-Medication of Anxiety Disorders with Alcohol and Drugs: Results from a Nationally Representative Sample. Journal of Anxiety Disorders, 23 (1), 38–45.
  6. Robinson, J., Sareen, J., Cox, B., & Bolton, J. (2011). Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders: A Longitudinal Investigation. Archives of General Psychiatry, 68(8), 800–807.
  7. Alegría, A. A., Hasin, D. S., Nunes, E. V., Liu, S.-M., Davies, C., Grant, B. F., & Blanco, C. (2010). Comorbidity of Generalized Anxiety Disorder and Substance Use Disorders: Results from the National Epidemiologic Survey on Alcohol and Related ConditionsThe Journal of Clinical Psychiatry71(9), 1187–1195.
  8.  Substance Abuse and Mental Health Services Administration. (2016). Co-Occurring Disorders.
  9. Becker, H. C. (2008). Alcohol Dependence, Withdrawal, and RelapseAlcohol Research & Health, 31(4), 348–361.
  10. Substance Abuse and Mental Health Services Administration. (2009). Integrated Treatment for Co-Occurring Disorders: Building Your Program. DHHS Pub. No. SMA-08-4366. Rockville, MD: Center for Mental Health Services.
  11. Drake, R., O’Neal, E., & Wallach, M. (2008). A Systematic Review of Psychosocial Research on Psychosocial Interventions for People with Co-Occurring Severe Mental and Substance Use Disorders. Journal of Substance Abuse Treatment, 34(1), p. 123–138.
  12. Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse Prevention. An Overview of Marlatt’s Cognitive-Behavioral Model. Alcohol Research & Health, 23(2), 151–60.

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