Alcohol and anxiety: why a drink to calm down can make anxiety worse

Why alcohol seems to help at first

Many people drink to take the edge off. NIAAA, the US government institute for alcohol research, says that because alcohol is readily available, it is commonly used to cope with anxiety, and that it may appear to relieve anxiety in the short term.

Its hangover guidance explains part of what happens next. While drinking, people may feel calmer and more relaxed, but the brain quickly adjusts to those effects; when the buzz wears off, people can feel more restless and anxious than before they drank. NIAAA calls this a "mini-withdrawal".

The cycle: how drinking can feed anxiety

In its guidance for clinicians, NIAAA says that over time, heavy drinking and repeated withdrawal can escalate both the anxiety symptoms and the drinking. It adds that anxiety-like symptoms can occur after a single heavy drinking episode, which the popular press calls "hangxiety", and can increase between drinking episodes, reaching high levels during alcohol withdrawal.

That is the loop many people recognise: drink to feel calmer, feel worse the next day, and reach for a drink again to fix it. The NHS describes the same pattern from the other side, saying hangovers often make you feel anxious and low, and that if you already feel anxious or sad, drinking can make this worse.

If your anxiety is worst the morning after, our guide to hangxiety explains what a hangover does to mood and how long it lasts.

Does alcohol cause anxiety disorders?

Alcohol and anxiety disorders often go together. NIAAA says anxiety disorders are the most common psychiatric disorders in the United States, and that among people treated for an anxiety disorder, 20% to 40% also have alcohol use disorder. It says genetic and environmental factors both contribute to the two occurring together, and that the anxiety disorders most often seen alongside alcohol use disorder are generalised anxiety disorder, social anxiety disorder and panic disorder.

Among the longer-term risks of drinking too much, the NHS lists mental health conditions such as anxiety and depression, and the CDC lists depression and anxiety among the long-term effects of excessive drinking.

Whether drinking caused someone's anxiety, or the anxiety came first, is something a doctor works out with them. NIAAA advises clinicians to build a timeline: when the anxiety started compared with the drinking, the longest time the person has gone without alcohol, and whether the anxiety was there during long alcohol-free periods.

What the NHS advises if you have anxiety

For people with generalised anxiety disorder, the NHS lists things to try that may ease symptoms, and things to avoid. Among the things to avoid, it says not to use alcohol, cigarettes, gambling or drugs to relieve anxiety, because they can all contribute to poor mental health. It also advises against drinking lots of coffee, tea, cola or energy drinks, because caffeine can disrupt sleep and make anxiety harder to control.

The things it suggests trying include talking about your feelings to a friend, family member, health professional or counsellor; recommended self-help therapies; breathing exercises, yoga or pilates; getting enough sleep; regular exercise; and regular, healthy meals.

On the benefits of drinking less, the NHS says that because drinking can make anxiety and sadness worse, cutting down may put you in a better mood generally. It also says alcohol disrupts sleep, and that cutting down should help you feel more rested.

A break from drinking as a test

NIAAA's timeline questions point to a practical idea: noticing how anxious you feel during a period without alcohol. If you can cut down or stop safely, a few alcohol-free weeks can show you and your doctor whether your anxiety eases. Our free tracker counts alcohol-free days privately, and our guide on how to cut down on alcohol covers ways to start.

Be careful with one thing. The NHS lists anxiety among the symptoms of alcohol withdrawal, alongside difficulty sleeping, feeling sick, a racing heartbeat, sweating and shaking. If you feel anxious, shaky or sweaty when you go without a drink, that can be withdrawal, and the NHS says stopping suddenly can be very dangerous if you are dependent. Get medical help before you stop; our guide on how to quit drinking safely explains how.

Getting help for anxiety and drinking together

The NHS says to see a GP if you think you might have generalised anxiety disorder, or if treatment is not helping. If you are 18 or over, it says you can also refer yourself directly to an NHS talking therapies service, without a GP referral. The main treatments it describes are talking therapies, usually cognitive behavioural therapy, and medicines, usually a type of antidepressant called an SSRI.

NIAAA says that when someone has both alcohol use disorder and another mental health condition, the chance of recovery is higher if both are treated. Being open with a doctor about how much you drink helps them treat the anxiety properly.

If you need someone to talk to now, Samaritans are available on 116 123 in the UK. In the US, call or text 988, the Suicide & Crisis Lifeline. If you are in danger, call your local emergency number.

Common questions

When to get help

This site offers self-help tools and information, not medical advice. Talk to a doctor, or call one of the lines below, if:

• you feel shaky, sweaty, sick or anxious when you haven't had a drink;
• you find it hard to stop once you start, or you want to cut down and can't;
• drinking is causing problems with your health, work or the people close to you.

Before you stop: It can be very dangerous to stop drinking suddenly if you are dependent on alcohol. If you get withdrawal symptoms, get medical help before you try to stop drinking.

Sources

1. Mental Health Issues: Alcohol Use Disorder and Common Co-occurring Conditions (Core Resource on Alcohol). National Institute on Alcohol Abuse and Alcoholism (NIAAA). niaaa.nih.gov
2. Hangovers. National Institute on Alcohol Abuse and Alcoholism (NIAAA). niaaa.nih.gov
3. Generalised anxiety disorder (GAD). NHS. nhs.uk
4. Tips on cutting down on alcohol. NHS. nhs.uk
5. Alcohol-use disorder. NHS. nhs.uk
6. About Alcohol Use. Centers for Disease Control and Prevention (CDC). cdc.gov
7. To Cut Down or to Quit (Rethinking Drinking). National Institute on Alcohol Abuse and Alcoholism (NIAAA). rethinkingdrinking.niaaa.nih.gov