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.
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
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.
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
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
Furthermore, those with co-occurring disorders in general may be more likely to experience or suffer from:8
A clinical review examined the relationship between alcohol use disorders and anxiety disorders, and found that:1
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.
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 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
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:
Preventing relapse is the main goal of aftercare. Aftercare can help fortify coping skills, build sober social skills, and enhance your sober support system.