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Alcohol and anxiety have a complex relationship. Anxiety disorders are more common among people with alcoholism, and those who are alcoholics are more likely to have anxiety. We don't completely understand which comes first or why, but the relationship is strong. In fact if you have alcoholism, or you have an anxiety disorder, you are 3 x as likely as anyone else to have the other (Himle 1999). This means alcoholism and anxiety disorders are comorbid, or occur together. Between 22 percent and 69 percent of alcohol-dependent patients have comorbid anxiety disorders (Roberts 1999).
If you took statistics, or any research class, you know that correlation or co morbidity does not tell us much about causality. The question of which came first is important for treatment. Therapists and other treatment providers to understand the relationship between alcohol and anxiety in each particular client.
There is research that suggests anxiety in people who have alcohol dependence may actually only occur during intoxication. So consuming alcohol can actually cause anxiety ( even though you would think of the opposite). Other research suggests that alcohol dependent people experience anxiety during withdrawal, and detox that they wouldn’t normally experience if they were not dealing with the addiction. One they successfully stop using alcohol the anxiety symptoms go away. So this suggests that some people may be diagnosed with an anxiety disorder when they don’t really have it. In these cases its actually a feature of discontinuing alcohol use. Additionally, people who are experiencing this kind of anxiety would not respond to treatment in the same way as someone who had a primary anxiety disorder.
Social anxiety , in particular is most closely associated with alcoholism. If you have ever had a drink, you know that it almost immediately relaxes you. If you have anxiety in social situations, especially, alcohol can be the thing that helps you relax, calm down, and have a good time! However, like all forms of avoidance, alcohol does nothing but exacerbate the initial problem, even if you are unaware that it is doing so. In fact research among people with social anxiety disorder shows that when they consume alcohol and are studied, their actual symptoms of social anxiety do not go down (Himle 1999).On the other hand , specific phobias, don't seem to be strongly correlated with alcoholism at all.
One thing that is clear about alcohol and anxiety is that if you are using alcohol to cope with anxiety, you are not really solving your problem.
Avoidance is a coping skill ( often a poor one) that we have discussed before in the pages of this website. Using alcohol to control anxiety is usually the best example of avoidance. Usually this cycle can begin with the first drink. Take the example below.
A teenage with some mild social anxiety may be so nervous she doesn't think she can get through the experience, so she has a drink and her anxiety goes away almost immediately. Had this girl went to the party and not used alcohol to control her anxiety what would have happened? She would have learned she could survive this experience,and that the feeling goes away. Instead of learning from this experience she learned to use alcohol instead. Learning is very powerful when it comes to anxiety.
This may or may not be very significant in this girls life, depending on the severity of her anxiety, the genetic loading in her family for alcoholism and her family life etc. The risk with alcohol is that it provides an immediate effect of relaxation. It may be possible this girl will choose avoidance rather than experiencing her emotions in the future. Alcohol is a powerful form of avoidance.
If you are wondering about your own relationship with alcohol and anxiety, you may need to experiment some to see what the relationship is. If for example, you are trying to stop drinking but become anxious in situations and then begin drinking again, you may want to resist the urge to drink in anxiety provoking situations several times so that you can learn your anxiety will subside on its own.
If you find you drink frequently and you have symptoms of anxiety after you drink, it may be caused by the alcohol. If you drink excessively, it may be difficult to sort through the relationship. For example if you drink, become depressed after drinking, and then anxious, your anxiety may be caused by your drinking. If you are finding you need alcohol in social occasions more and more to relax, or alcohol is causing you to make choices which negatively affect your life, you may also want to explore the relationship between anxiety and alcohol in your life.
The relationship may be even more complex. For example, if you drink several glasses of wine at a party, you may be hungrier that usual because of your blood sugar levels. Then you may make poor food choices and feel anxiety about weight gain. In this case, the anxiety is still caused by the alcohol.
No one can tell you what is right or wrong for you, however, if you feel your anxiety and alcohol use is related, you may want to explore in a journal or through some other method to increase your awareness, what the actual relationship is.
Obviously, in our society, alcohol is an acceptable social lubricant. Many events revolve around food alcohol and clearly the fact that it relaxes people adds to the fun. Whether or not it is a problem is a matter of personal opinion and depends on several factors. Every person is different.
Himle, Joseph A., Abelson, James L., Haghightgou, Hedieh, Hill, Elizabeth M., Nesse, Randolph M., Curtis, George C.Effect of Alcohol on Social Phobic Anxiety Am J Psychiatry 1999 156: 1237-1243
Kushner, Matt G., Sher, Kenneth J., Erickson, Darin J.Prospective Analysis of the Relation Between DSM-III Anxiety Disorders and Alcohol Use DisordersAm J Psychiatry 1999 156: 723-732
Roberts, Mimi C., Emsley, Robin A., Pienaar, Willem P., Stein, Dan J.Anxiety Disorders Among Abstinent Alcohol-Dependent PatientsPsychiatr Serv 1999 50: 1359-1361
Schuckit, Marc A., Hesselbrock, VictorAlcohol Dependence and Anxiety Disorders: What Is the Relationship?Focus 2004 2: 440-453
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