According to the Anxiety and Depression Association of America, 15 million adults in the U.S. suffer from social anxiety disorder, another 6.8 million suffer from generalized anxiety disorder and people with these conditions are more likely to struggle with alcohol addiction. The relationship between anxiety disorders and alcohol is a complicated one, though, and there is some debate as to whether anxiety disorders lead to problems with alcohol, whether alcohol disorders lead to anxiety disorders or whether they exacerbate one another. Regardless of the precise form of the relationship, many people with anxiety disorders “self-medicate” with alcohol, and this could serve to make the problem worse.
Anxiety Disorders—The Basics
Anxiety disorders are conditions where excessive worrying has a significant impact on the individual’s day-to-day life. Anxiety is a normal feeling, but for some it becomes extreme and even debilitating, causing problems with worry even when there is no obvious cause. There are several types of anxiety disorders, but the two most relevant for alcohol consumption are generalized anxiety disorder and social anxiety disorder. In generalized anxiety disorder, sufferers feel anxious about a wide range of issues rather than one or two things specifically, which usually creates a persistent sense of anxiety. In social anxiety disorder, the sufferer fears that he will do something embarrassing or even that he will show symptoms of anxiety and that will cause him embarrassment. These symptoms are usually severe and can occur even if the individual is meeting only a small group of people. For many sufferers, avoidance of social situations becomes a common strategy for avoiding problems.
Comorbidity of Alcohol and Anxiety Disorders
The issue of whether a relationship exists between alcohol and anxiety disorders is convincingly settled by the strong overlap seen between the two. There has been much research indicating that people with one of the two conditions are more likely to have the other, and it has been determined that around 20 percent of people suffering from social anxiety disorder also suffer from alcoholism, and about 15 percent of those with alcoholism have social anxiety disorder. Additionally, there is a stronger relationship between these two conditions for women. Other research indicates that those with alcohol dependence or who abuse alcohol are four-and-a-half times as likely to have generalized anxiety disorder. There are also significant relationships between drinking and other anxiety-related issues, including panic disorder, specific phobias and post-traumatic stress disorder (PTSD). In short, there is a strong suggestion that alcohol and anxiety are inexorably linked.
Does Alcohol Come Before Anxiety or Vice-Versa?
The relationship between alcohol and anxiety could go in either direction—alcohol could produce anxiety, or anxious people could be more likely to drink. The latter hypothesis is more easily understandable: people with anxiety problems could turn to alcohol to “self-medicate.” In other words, people could assume that alcohol will ease their anxiety, particularly in social situations. This is called the “tension-reduction” hypothesis. This hypothesis is very plausible, and it has been definitively shown that some people who struggle with anxiety do turn to alcohol because they assume it will reduce their symptoms. However, the relationship is more complex than it might seem, because some people with social anxiety believe that being inebriated will make them behave foolishly and thereby create even more embarrassment. This has led many researchers to conclude that differing expectations of the effect of alcohol explains why some people with anxiety drink more alcohol than non-anxious people, but others drink less. There is also evidence that excessive alcohol use can lead to anxiety, both from the direct pharmacological properties of alcohol (i.e., the effects it has on the brain and body) and from the process of withdrawal. Withdrawal produces symptoms similar to those of anxiety, and repeatedly going through withdrawal can make this anxiety worse. It has also been hypothesized from a psychological perspective that alcohol might interfere with the normal response to stressors in the environment, and also that the other consequences of alcohol abuse—for example, lost jobs and jeopardized relationships—could cause anxiety. Studies have shown that anxiety symptoms sometimes precede problems with alcohol, and alcohol problems sometimes precede problems with anxiety. This indicates that the relationship between the two is “bidirectional,” or in other words, alcohol problems could cause anxiety and anxiety could cause alcohol problems. Additionally, other factors could be affecting the odds of having either condition.
Underlying Issues at Work
The best strategy for treatment appears to be—as is often the case—identifying the underlying issue (in simple terms, whichever came first) and focusing treatment on resolving that. For example, somebody whose anxiety led him to drink may be helped to stop drinking by teaching him more effective strategies for dealing with anxiety, whereas somebody whose alcoholism led to anxiety problems could have his anxiety resolved by addressing his drinking problem. The research suggests that discussing possible anxiety problems with drinkers is an important step toward ensuring the most effective treatment is offered. If you’re struggling with alcohol and anxiety problems, understanding the link between the two may help you see when anxiety is causing you to drink or vice-versa, but staying in treatment is essential. Having professional help to identify and cope with the root cause of your issue maximizes your chance of kicking your addiction and overcoming anxiety, even if you might have a more difficult time than somebody with only one problem to deal with.