If you suffer from anxiety, you’ll know the constant feeling of being on edge, and even on calmer days, those butterflies in your stomach still come out to play.
At times, the only way to quiet the overwhelming surge of panic can feel like turning to something that offers an immediate fix to an immediate problem. For many, this fix is alcohol. Underlying anxiety is often a root cause that contributes to alcohol addiction and relapse, making it essential to address both issues for lasting recovery.
The problem here, though, is that while alcohol can work in the moment, it offers only a temporary fix and is followed by rebound anxiety after drinking, or even panic attacks after drinking. As a result, self-medicating anxiety with alcohol comes with a range of consequences, one of the most serious being the risk of developing Alcohol Use Disorder (AUD).
According to the National Institute on Alcohol Abuse and Alcoholism, alcohol problems and comorbid anxiety disorders are common, and their guidelines highlight the importance of understanding how alcohol consumption can influence mental health outcomes.
If you feel that alcohol addiction has entered your life as a way of coping with anxiety, or that anxiety has grown alongside your drinking, the first step is understanding the relationship between alcohol addiction and anxiety. Alcohol problems can be particularly complex when anxiety is also present, as individuals with both conditions face unique risks and considerations in treatment and recovery.
Understanding the links between Alcohol Addiction and Anxiety
f you were to ask an expert if there are links between anxiety and alcohol addiction, the answer would be a resounding ‘yes’, followed closely by ‘but which type of anxiety’? This is because anxiety comes in many different shapes and sizes, making it important to understand how alcohol addiction interferes with different types of anxiety disorders. Comorbid anxiety and alcohol use disorders are common, and their co-occurrence requires special treatment considerations due to the complex clinical relationship between these conditions.
For example, alcohol misuse, such as binge drinking or heavy drinking, can increase the risk of developing alcohol use disorders, particularly in individuals with comorbid anxiety. This highlights the importance of understanding how unhealthy alcohol consumption can impact both mental health and the development of alcohol use disorders.
When planning treatment for individuals with both alcohol addiction and anxiety, it is crucial to recognise disorders’ comorbidity. This ensures that treatment considerations address the unique challenges presented by co-occurring alcohol use disorders and anxiety, leading to more effective and tailored interventions.
Generalised anxiety and alcohol addiction
Generalised anxiety disorder (GAD) involves chronic excessive worry and research shows strong links between GAD and alcohol dependence. Generalised anxiety disorder is the most common anxiety disorder in the UK and can significantly interfere with daily life, making it difficult for individuals to function normally in their routine environment. GAD often presents with physical symptoms such as muscle tension, sweating, and rapid heartbeat, alongside emotional symptoms. One study in particular found that individuals with GAD are about two to three times more likely to struggle with alcohol addiction. This doesn’t mean everyone with anxiety will develop a drinking problem, but it does show that anxiety can increase vulnerability.
Social Anxiety Disorder and alcohol addiction
A large study published in 2023 followed adults for around ten years to see whether different anxiety disorders increased the risk of developing Alcohol Use Disorder later on 2.
Social anxiety disorder (SAD), also known as social phobia, involves chronic anxiety in social settings and can lead to physical symptoms like sweating and a racing heartbeat. People with social phobia often experience intense fear and feel anxiety in social or performance situations, such as meeting new people, public speaking, or dating. In these situations, individuals may use alcohol for its initial calming and disinhibiting effects, which can lead to dependence.
What stood out was that SAD was the only anxiety type that clearly predicted future alcohol dependence. After accounting for other factors, people who had SAD at the start of the study were about 70% more likely to develop AUD over the following decade compared to those without it 2.
Panic Disorder and alcohol addiction
Panic disorder is a condition marked by recurring panic attacks, which can include symptoms such as sweating, a pounding heart, chest pain, and a sense of impending doom. Research shows that panic disorder is very strongly linked with alcohol dependence. For people already vulnerable to panic, alcohol can induce panic by affecting brain chemistry, particularly by altering GABA levels, which may trigger panic attacks or feelings of panic. This risk is heightened during hangovers or withdrawal periods when the nervous system becomes overstimulated. Large reviews of population studies have found that people with panic disorder are roughly two to four times more likely to develop alcohol dependence compared to those without it 3.
Other types of anxiety, like specific phobias 3 and separation anxiety 4, were also linked with alcohol use disorder, but on a smaller scale.
What causes the strong link between alcohol addiction and anxiety?
From the research, it’s clear to see that there is a strong link between different types of anxiety and alcohol use disorder, but why? As is the case with any mental health condition and addiction, the reasons behind this are complex and rarely come with a single explanation. Often, a vicious cycle or vicious circle develops: anxiety leads individuals to use alcohol as a coping mechanism, but alcohol use can actually worsen anxiety over time, creating an ongoing feedback loop that is difficult to break.
To understand this more clearly, we need to explore the bidirectional relationship that anxiety and alcohol addiction share. Many people with anxiety disorders may self medicate with alcohol to temporarily reduce their anxiety levels, but this can result in needing more alcohol to achieve the same effect, increasing the risk of dependence. Alcohol affects brain chemistry by altering neurotransmitters, which can initially lower anxiety but ultimately disrupt chemical balance, leading to heightened anxiety levels, panic attacks, and negative feelings such as regret or guilt.
Once comorbidity between anxiety disorders and alcohol use disorders (AUDs) is established, the two disorders may influence and maintain each other independently of their developmental pathways. This is described by the mutual maintenance model, where a positive feedback loop means the outcomes of one disorder maintain or worsen the other, further complicating recovery.
Existing anxiety leading to alcohol addiction
Research consistently shows that anxiety disorders come before problematic drinking and can play a major role in the development of AUD. Underlying anxiety can drive individuals to self-medicate with alcohol, leading to co occurring anxiety and alcohol use disorders. Substance abuse, including alcohol abuse, is common among those with anxiety disorders, and substance use disorders often co-occur with anxiety, complicating treatment. In fact, 1 in 5 individuals with anxiety report using alcohol to cope with stress. This is largely due to the fact that many people with existing anxiety use alcohol to temporarily calm their nerves, an act known as self-medication.
One major survey found that self-medicating anxiety with alcohol increased the odds of later dependence more than fivefold and also made ongoing dependence far more likely.
Out of all of the anxiety disorders, social anxiety seems to be especially linked to self-medicating anxiety with alcohol. People who fear the perceived judgment or discomfort a social situation can bring will drink to ease tension. In fact, studies tracking real-time alcohol use show that socially anxious individuals drink more heavily in unfamiliar social environments, which suggests that experiencing anxiety around others drives heavier drinking.
Reviews highlight that this pattern is not limited to social anxiety and people with panic disorder, generalised anxiety and sub‑threshold anxiety symptoms also report using alcohol to cope.
Although alcohol may feel calming at first because it slows brain activity, tolerance can build very quickly. This means that the next time a person resorts to drinking in social situations, larger quantities are needed. This then brings on stronger hangovers and rebound anxiety after drinking, and for some people, panic attacks after drinking, where physical anxiety symptoms surge once alcohol leaves the system.
Studies involving people with alcohol dependence show that alcohol withdrawal is accompanied by anxiety from severe sleep disruption 8, and in some cases, panic attacks after drinking during the withdrawal phase. When these symptoms become overwhelming, many people return to drinking as a way to find quick relief, not realising they are reinforcing a cycle driven by rebound anxiety after drinking.
Alcohol addiction leads to anxiety
Long-term, heavy alcohol consumption can bring with it a lot of negative outcomes, one of them being changes in how the brain regulates mood and emotional stability. Alcohol acts as a depressant on the central nervous system, slowing down brain processes and affecting emotional regulation.
Alcohol initially boosts calming chemicals, like GABA 9, while reducing excitatory activity like glutamate, giving us the relaxed feeling associated with drinking alcohol.
But when the brain is subjected to alcohol over a long period of time, it starts to adapt to these repeated changes and begins to function differently, even when alcohol isn’t present 10.
These adaptations affect several key systems involved in emotional regulation, including 11:
GABA
Glutamate
Dopamine
Serotonin
Stress-related neuropeptides
Excessive drinking and drug use can worsen anxiety symptoms, as frequent episodes of excessive drinking and withdrawal can increase the risk of developing or exacerbating anxiety disorders. Drug abuse, particularly of substances like benzodiazepines, is also a risk for those with alcohol use disorders and can further complicate anxiety and addiction.
As the addiction to alcohol develops, these now altered pathways increase baseline stress levels and make the brain more sensitive to anxiety. Gradual reductions in alcohol consumption can lead to improvements in anxiety symptoms as the brain’s chemical balance returns to normal.
Sleep disruption from consuming alcohol is another major contributor to anxiety. Alcohol may help people fall asleep faster at first, but it severely reduces sleep quality. If a person tries to stop drinking after a long period of time, deep sleep decreases and REM sleep becomes unstable 12. This leads to frequent waking or vivid dreams, which then affects the person’s day-to-day functioning the next morning.
Many people return to alcohol simply to escape the chronic insomnia and subsequent anxiety issues, which only strengthens the addiction cycle.
If anything mentioned in this section has struck a chord, it may be worth taking the time to place your relationship with alcohol and anxiety under the spotlight.
Am I suffering from anxiety and issues with alcohol?
On the surface, it can seem easy to spot when alcohol and anxiety are causing problems, as both come with recognisable symptoms. This leads many to believe they are easy to identify, but this is not always the case.
For some, alcohol has been part of life for so long that the idea of addiction feels unfathomable. They may not look or behave like a stereotypical alcoholic, which reinforces the belief that everything is fine.
The same can happen with anxiety. When someone has lived with it for years, it can start to feel like a normal part of day-to-day life. However, it’s important to distinguish between normal anxiety—such as feeling nervous before a presentation or during social situations—and clinical anxiety disorders, which are more persistent, severe, and can significantly impact daily routines, work, relationships, and physical well-being. Anxiety can make it much harder to function in day-to-day life, even if you have learned to manage the symptoms enough to get by without extra support.
In both situations, the person adapts and learns to live with alcohol and anxiety side by side. In fact, approximately 20% of people diagnosed with an alcohol or substance use disorder also suffer from an anxiety or mood disorder.
If any of this strikes a chord with you, it may be worth taking time to reflect by answering a few simple questions:
Do you drink alcohol to reduce feelings of anxiety?
Do your anxiety symptoms feel more intense on days when you do not drink?
Has your alcohol use increased over time as your anxiety has persisted?
Do you feel anxious when you think about cutting down your drinking?
Do you experience anxiety after the effects of alcohol wear off?
Do you feel trapped in a repeating pattern where anxiety leads to drinking?
If several of these questions resonate, it can be a sign that anxiety and alcohol are interacting in a way that’s becoming difficult to manage alone. That doesn’t mean anything about who you are as a person, but it may mean that support focused on both, rather than just one, could be helpful.
What is a dual diagnosis of alcohol addiction and anxiety?
A dual diagnosis means a person is living with both a mental health condition and a substance use disorder at the same time. When both issues are present, in this case, alcohol addiction and anxiety, recovery usually requires a more tailored, longer-term approach 13. Addiction and anxiety disorder are considered co-occurring conditions that often require integrated treatment to address both simultaneously.
This is because the two can become closely entangled, making it difficult to treat one without addressing the other. Other mental health disorders, such as depression, bipolar disorder, and psychotic illnesses, as well as substance use disorders, may also be present and can further complicate the clinical picture.
For example, someone may enter treatment focusing only on their alcohol use. While they may succeed in reducing or stopping drinking, unmanaged anxiety can quickly resurface. Persistent worry, physical tension, disrupted sleep, or fear of social situations can increase the risk of turning back to alcohol as a coping mechanism. The clinical impact of comorbid mental disorders, such as anxiety and alcohol use disorders, is significant and associated with substantial societal costs.
On the other side, a person may seek help primarily for anxiety. Therapy may improve insight and coping, but ongoing heavy drinking can interfere with emotional regulation and restorative sleep. Anxiety from alcohol withdrawals can also limit how effective anxiety treatment feels, even when appropriate support is in place. Treatment considerations for dual diagnosis include accurate assessment, integrated care, and modifying standard approaches to address the complexities of both conditions.
This back-and-forth effect means progress in one area can be undermined by difficulties in the other, which is why identifying a dual diagnosis of alcohol addiction and anxiety tends to support more stable and sustainable recovery. Women with alcohol dependence have a higher prevalence of co-occurring anxiety disorders compared to men, and the presence of anxiety disorders may exacerbate the course and severity of alcohol problems, particularly in women.
How is a dual diagnosis of AUD and anxiety treated at rehab?
Rehab is a very personal and private experience, meaning you’re far less likely to find people openly sharing what it’s really like. This leaves the door wide open for misconceptions about what happens behind the closed doors of the rehab centre. In fact, studies have found that not knowing what to expect during rehab can be a barrier to seeking help altogether. For those struggling with alcohol addiction and anxiety, understanding available addiction treatment and treatment options for dual diagnosis is crucial, as professional guidance can help select the most effective approach for both conditions.
With this in mind, we feel it’s almost our duty to explain what happens in rehab, the structure it takes, how dual diagnoses are treated and what you can expect. Integrated treatment approaches for co-occurring anxiety and alcohol use disorders are recommended to address both conditions simultaneously and prevent higher relapse rates.
What to expect during the assessment
Rehab programmes begin with a dual-diagnosis alcohol and anxiety assessment in order to prepare a plan for treatment of both conditions. Staff will ask gentle questions about your history of alcohol use, like how long you’ve been drinking, as well as your history with anxiety.
Treatment considerations are crucial at this stage, as clinicians evaluate and plan comprehensive strategies tailored to individuals with both alcohol addiction and anxiety, ensuring that the treatment plan addresses the complexities of dual diagnoses.
This is an essential part of the treatment process so that co-occurring disorders can be treated in an effective way.
What will happen in the alcohol detox stage?
Due to the fact that chronic alcohol use changes brain chemistry, stopping suddenly can cause dangerous withdrawal symptoms. Detox is the process of safely removing alcohol from your body while managing any of the withdrawal symptoms that may arise. Doctors and nurses will monitor you closely and administer medications if necessary to help make the process more manageable.
While alcohol withdrawal can look a little different from person to person, it usually follows a well-known timeline and set of symptoms 14:
In the first 6-12 hours after your last drink, you can expect minor symptoms like shaking hands, headache, nausea, worsened anxiety, fast heartbeat, and sweating.
Between 12 and 24 hours, some people may experience alcohol-related hallucinations.
By 24-48 hours, generalised seizures can occur if alcohol withdrawal is severe.
48-72 hours after stopping, a small percentage of people can develop delirium tremens, known as DTs, which can be quite a dangerous state to be in.
While this sounds concerning, a rehab environment is well prepared for these potential alcohol withdrawal symptoms. Rehab centres will provide safe withdrawal from alcohol by providing medications like benzodiazepines, which are given to calm your nervous system. Benzodiazepines are the gold standard for alcohol withdrawal and greatly reduce the risk of seizures or DTs 14, but should not be administered outside of a medical environment. This is due to the strong addictive nature of the drug. There is a significant risk of drug abuse and drug addiction with benzodiazepines, especially among individuals with a history of substance use or alcohol use disorders, so careful prescribing and monitoring are essential.
Medication-based treatments for anxiety include benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, and serotonergic-based medications.
How does therapy help me with anxiety and alcohol addiction?
Once you have completed alcohol detox, the focus will change to therapy and skills training. These therapeutic interventions target both alcohol addiction and anxiety, creating a comprehensive treatment plan. Cognitive-behavioral therapy (CBT) is considered the practice standard to treat anxiety disorders.
One of the most well-known and evidence-backed therapies is Cognitive Behavioural Therapy (CBT). In CBT, you learn to identify and challenge unhelpful thoughts like: “I can’t handle stress without alcohol,” and replace them with statements like “I’m stressed, but alcohol will not help me.” CBT techniques include exposure to feared stimuli and anxiety management techniques.
CBT will also teach you relaxation and problem-solving skills to combat the anxiety you may be facing. For alcohol use, CBT can teach you relapse prevention skills, like spotting triggers, learning how to refuse offers of alcohol, and managing cravings. SSRIs and SNRIs are generally used as first-line treatment options to treat anxiety disorders due to their consistent efficacy.
If anxiety is at the forefront of your alcohol cravings, CBT aims to help break the cycle where anxiety leads to drinking and drinking leads to more anxiety. Therapies such as motivational interviewing (MI) can help individuals with co-occurring anxiety and alcohol use disorders resolve ambivalence about changing their alcohol use.
Decades of research show CBT is effective for reducing drinking and improving anxiety 15, which is why it’s considered the cornerstone of treatment. Breathing exercises are also a useful technique to manage anxiety symptoms, helping to calm the nervous system and regain control during stressful moments.
Aside from CBT, other well-documented therapies used in treating a dual diagnosis of AUD and anxiety include:
Group therapy for peer support
Family counselling for improvement of the home environment
DBT and mindfulness for dealing with cravings and anxiety symptoms in the moment
The idea here is to give you multiple treatment options to cope by addressing both the anxiety and drinking together.
Aftercare and relapse prevention
When you’ve finished rehab, you’re not shown the back door and wished all the best. Many rehab programmes offer an aftercare service, which typically includes continued therapy and revisiting your relapse prevention strategies.
Aftercare is especially important for individuals with substance use disorders, as ongoing support and monitoring can significantly reduce the risk of relapse and help manage co-occurring conditions like anxiety.
Research shows that aftercare is important for keeping the gains you made in rehab, while helping maintain abstinence and limiting the chance of relapse 16.
Life has a habit of changing quickly and without warning, meaning some aspects of your relapse prevention plan may need to be adjusted. For example, moving home or changing jobs can create new stressors and, along with them, new triggers.
Clinical experts emphasise that patients’ needs evolve over time 16, meaning treatment plans must remain flexible. This could mean scheduling a session if you notice anxiety creeping back or having a sober buddy list you can call when alcohol cravings appear.
When you stay engaged with aftercare and show a willingn
What are the next steps?
If you, or someone you care about, is struggling with anxiety and alcohol use, the next step is to contact the experts in recovery.
It’s important to seek help for alcohol problems as well as anxiety, especially since these issues often occur together and can impact each other.
Reaching out for professional support allows both anxiety and alcohol use to be explored together, rather than in isolation. A thorough assessment helps clarify what role alcohol and anxiety is playing in your day-to-day, and what kind of support would actually feel manageable right now.
At X, support is shaped around the individual, with care that looks at the whole picture rather than a single symptom. If this resonates, getting in touch could be the first steady step toward feeling more in control again.
FAQs
Can alcohol cause anxiety even if I’m not dependent?
Alcohol can increase anxiety even without dependence because it affects brain chemistry linked to calm and stress. Anxiety may appear during hangovers or after occasional heavy drinking. Alcohol misuse, such as binge drinking or exceeding recommended limits, can significantly impact anxiety levels by disrupting the brain’s chemical balance and increasing the risk of anxiety symptoms.
Why do I feel anxious for days after drinking?
Anxiety can linger after drinking because alcohol disrupts neurotransmitters that regulate mood. As the brain rebalances, heightened alertness and unease can persist for several days. Alcohol affects brain chemistry by acting as a depressant, which can lower anxiety levels temporarily but often leads to increased anxiety as its effects wear off.
Is it safe to stop drinking suddenly?
Stopping alcohol suddenly can be unsafe for some people. If drinking has been frequent or heavy, withdrawal symptoms may occur, so speaking with a healthcare professional first is strongly advised.
