Alcohol Use Disorder & Anxiety Disorders | Dual Diagnosis Risks & Treatment

Worry and anxiety are natural responses to uncertainty. But when you worry too much, too long, or about too much, anxiety can become harmful.

For some, alcohol intoxication can seem like such a relief from worry or fear. But using alcohol to self-medicate against anxiety is both risky and counter-productive in the long run.

Alcohol & Anxiety

While firm figures are hard to come by, the Anxiety and Depression Society of America estimates that those with anxiety disorders are between two and three times more likely to develop a substance use disorder at some point in their lives than the general population. 

Other reports confirm that alcohol use disorder (AUD, also known as alcohol addiction) commonly co-occurs with all five major types of anxiety disorders, namely:

• generalized anxiety disorder (GAD)
• obsessive-compulsive disorder (OCD)
• panic disorder
• post-traumatic stress disorder
• social anxiety disorder (or social phobia/agoraphobia)

Self-Medicating Anxiety

Alcohol abuse often begins and increases as a form of self-medication against the symptoms of anxiety. Alcohol provides temporary relief (and reduced inhibition) through central nervous system (CNS) depression and dopamine release, which increase as blood alcohol levels increase.

A Vicious Cycle

As with any drug, tolerance and dependence will likely develop together as use continues. And as this happens, anxiety and alcohol consumption can together form a vicious cycle. 

This cycle of chronic alcohol use changes the structure of the brain and can worsen feelings of anxiety. It can also increase the likelihood of panic attacks once the effects of the alcohol wear off, or if symptoms of alcohol withdrawal begin, prompting further alcohol use. 

Symptoms & Side-Effects Of Alcohol Use Disorder

Aside from increasing various symptoms of anxiety over time, chronic alcohol use can have significant long-term health effects that may include:

• alcohol dependence
• high blood pressure
• increased heart rate
• heart disease
• stroke
• liver disease
• digestive issues
• cancer
• immune system dysfunction
• learning and memory issues, including dementia
• depression
• financial or legal jeopardy

Other short-term effects of heavy drinking/overconsumption of alcohol include:

• decreased inhibition
• impaired decision making
• accidental injuries (car accidents, drowning, falls)
• aggression
• risky sexual behaviors
• miscarriage, stillbirth, or fetal alcohol spectrum disorders in pregnant women
• alcohol poisoning

Alcohol Poisoning

Alcohol poisoning is a potential consequence of binge drinking, defined as drinking between four and five alcoholic beverages in two hours. 

If too much alcohol is absorbed into your body, it can cause problems with breathing, heart rate, body temperature, and gag reflex, potentially leading to choking on vomit, stopped breathing, dehydration, seizures, low body temperature, brain damage, and death.

And even if someone goes to sleep or passes out it is possible that alcohol poisoning may develop as the alcohol in their stomach continues to be absorbed.

Signs and symptoms of alcohol poisoning include:

• confusion
• vomiting
• seizures
• slow or irregular breathing
• blue-tinged or pale skin
• low body temperature
• unconsciousness

Anxiety & Alcohol Withdrawal Symptoms

If someone with AUD has an anxiety disorder and chooses to stop drinking, the effects can be concerning.

Alcohol withdrawal syndrome typically begins between six hours and several days after the last dose and may involve a number of symptoms including:

• severe anxiety, panic, or discomfort
• cravings to resume drinking alcohol
• tremors
• nausea and vomiting
• headache
• fast heart rate
• high blood pressure
• sweating
• irritability
• confusion
• difficulty sleeping
• hallucinations
• nightmares

These symptoms usually continue and worsen for two to three days before fading. But some symptoms may persist for weeks, and withdrawing from alcohol alone won’t resolve a co-occurring disorder like an anxiety disorder. 

Instead, both mental health disorders need to be professionally treated at the same time.

Treating Anxiety & Alcohol Use Disorder

Comorbidities like anxiety disorders and substance use disorders feed one another. Breaking this pattern likely requires a professional addiction treatment program optimized for dual diagnoses. 

Substance Abuse Treatment

On the substance abuse side, AUDs are typically treated with medical detox for withdrawal.

After treatment, treatment may include psychotherapy (typically cognitive behavioral therapy) participation in a 12-step peer support program, and sometimes the use of certain approved medications like:

• acamprosate (Campral), which reduces withdrawal symptoms
• disulfiram (Antabuse), a drug that causes nausea and discomfort when you drink alcohol
• naltrexone (Vivitrol), which reduces alcohol cravings and interferes with the mental reward that follows alcohol consumption

Treating Anxiety Disorders

Anxiety disorders are also treated with CBT as well as other forms of talk therapy/psychotherapy, as well as the short-term use of medications including benzodiazepines and antidepressants. 

Exercise, stress management, and relaxation courses can also help provide individuals with positive, healthy coping mechanisms beyond self-medicating with alcohol or other medications.

All treatment methods are designed to help break the cycle of alcohol and substance use while providing participants with the motivation, support, and personal resources they need to maintain a lasting recovery.

If you or a loved one struggles with co-occurring alcohol use and mental health disorder, please contact us today to learn more about our treatment options.