Anxiety and Alcohol: Does Drinking Cause Anxiety & Panic Attacks?
Anxiety and alcohol use disorder are common co-occurring disorders that can cause serious distress and impair your daily functioning. Alcohol use disorder can exacerbate an existing anxiety disorder or may lead to new anxiety symptoms and vice versa, meaning that a pre-existing anxiety disorder can contribute to an alcohol use disorder (as many individuals use alcohol as an unhealthy coping mechanism).
If you or someone you care about is struggling with anxiety and alcohol use disorder, anxiety could be the result or a contributing factor of alcohol abuse.
This article will help you understand alcohol misuse, anxiety signs and symptoms, and how both disorders often co-occur. This article will also explain a few ways to help calm anxiety symptoms if you should experience alcohol-induced anxiety or an alcohol panic attack.
American Addiction Centers offers co-occurring disorder treatment at many of our nationwide treatment centers for substance and alcohol use disorders. Call us today at
Can Alcohol Cause Anxiety or Make it Worse?
Alcohol use can cause new onset anxiety and worsen pre-existing anxiety symptoms. Many individuals will use alcohol as an unhealthy coping tool to reduce symptoms of anxiety.
Alcohol may be a temporary, unhealthy way to relieve anxiety and forget about your underlying stressors, however using alcohol does not erase these underlying triggers. Whether your anxiety is related to past trauma, financial stress, or untreated depression; alcohol is merely a temporary Band-Aid and the longer one depends on alcohol to help treat their anxiety, the more at risk they are for developing an alcohol use disorder. Additionally, symptoms of anxiety will still be lurking around the corner as the underlying triggers have not been properly addressed and treated.
Chronic alcohol use affects your ability to respond to stress in healthy and effective ways, which can lead to anxiety. This may be due to alcohol’s effect on the amygdala, the area of your brain that regulates negative emotions. Brain imaging studies have found abnormalities in amygdala functioning in individuals with alcohol use disorder.3
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Understanding Alcohol Use & Abuse
Alcohol is one of the most commonly used (and misused) substances in the U.S. In 2019, 85.6% of people reported drinking alcohol at some point in their lives, 25.8% of people aged 18 and older reported binge drinking in the past month, and 14.5 million people aged 12 and older had an alcohol use disorder (AUD), the clinical term for alcoholism or alcohol addiction, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).1
Alcohol abuse means that you use alcohol in unhealthy ways that impact your life. It involves drinking more than the Centers for Disease Control’s (CDC) Dietary Guidelines for alcohol, which states that people who choose to drink should do so in moderation. This means 2 drinks or fewer for a man and 1 drink or fewer for a woman per day. A standard drink is the equivalent of 12 ounces of 5% beer, 8 ounces of 7% malt liquor, 5 ounces of 12% wine, or 1.5 ounces of 80 proof distilled spirits or hard liquor (such as vodka, gin, rum, or whiskey). Excessive alcohol use (alcohol abuse) includes binge drinking, heavy drinking, and drinking while pregnant.2AUD is a chronic brain disorder that causes a person to continue to drink alcohol despite the negative consequences it has on their lives. According to the NIAAA, it is characterized by compulsive drinking, an inability to control your alcohol use, and negative feelings when you don’t drink.2
A large proportion of people who abuse alcohol also have co-occurring anxiety disorders. Having either an alcohol use disorder or an anxiety disorder can substantially elevate your risk of developing the other.3
Symptoms & Types of Anxiety
Most people experience anxiety at some point in their lives. In fact, anxiety is a normal (and a very human) response to a fearful situation or a stressor, such as the way you might feel before a doctor’s appointment or before an exam. In a perfect world, feelings of anxiety would generally subside after an upsetting situation or stressor has been resolved. However, when feelings of anxiety persist, you may experience excessive fear or worry that doesn’t go away and doesn’t always seem to be influenced by stressful external factors. For example, feelings of anxiety may be present in the absence of fear or a stressor. When these symptoms interfere with your ability to function in daily life as a healthy adult, it may be a sign that you have an anxiety disorder.4
There are several types of anxiety disorders that may manifest in different ways, depending on the individual, but all them share symptoms of excessive worry and fear. Common types of anxiety disorders include:4,5,6
- Generalized anxiety disorder (GAD). The main symptoms are chronic, excessive worry and fear about general, everyday things that interfere with your ability to function. The feelings must occur most days and last at least 6 months to qualify for this diagnosis.
- Panic Disorder. Characterized by recurrent, unexpected panic attacks, which are sudden, intense episodes of fear and dread that are often debilitating and can feel life-threatening. Some people feel like they are having a heart attack. Symptoms can include chest pain, difficultly breathing, feelings of impending doom, heart palpitations, and feeling like you’re out of control.
- Characterized by intense fears or aversions to specific triggers such as claustrophobia (fear of enclosed spaces) or agoraphobia (fear of public places, crowds and situations where you cannot escape). You experience intense fear related to specific things or places that is out of proportion to the actual situation.
- Social Anxiety Disorder (SAD). Previously referred to as social phobia, this involves intense fear of social or performance situations such as public speaking. You may worry that your feelings and behaviors will be judged negatively by others or have an intense fear.
Triggers of Anxiety & Coping Mechanisms
Certain issues, lifestyle factors, and triggers can influence anxiety. These include:9
- Chemical stimulants such as caffeine, cocaine and amphetamines.
- Physical health problems, especially a chronic or life-threatening condition.
- Other mental health disorders, such as depression.
- Side effects from medications.
- Stress and addiction are linked. Life problems that cause excessive stress, such as money concerns, exposure to abuse or bullying, worries about housing or family, etc.
On the other hand, certain factors and self-care measures may help to improve anxiety, such as:10
- Alternative practices, like aromatherapy, mindfulness meditation, yoga, massage, or hypnotherapy.
- Deep breathing exercises.
- Seeking support from people you trust.
- Taking care of your physical health.
- Participating in peer support groups for people with anxiety.
What is the Relationship Between Alcohol & Panic Attacks?
One study reported that 25% of people who sought treatment for panic disorder had a history of alcohol dependence.16 Alcohol has an effect on many chemicals in the brain including GABA, serotonin and dopamine and when these brain chemicals are altered, it can throw off how the body reacts in everyday situations. Alcohol can induce panic because of its effects on GABA, a chemical that normally has a relaxing effect. Mild amounts of alcohol can stimulate GABA and cause feelings of relaxation, but heavy drinking can deplete GABA, causing increased tension and feelings of panic.17,18
Individuals with panic disorder, and many other types of anxiety disorders, may try to self-medicate with alcohol in hopes of reducing their anxiety levels. When more and more alcohol is used over time, they can potentially become dependent on alcohol and as a result, when they stop drinking, they are at risk of alcohol withdrawal which can result in severe anxiety.16
Do All Types of Alcohol Cause Anxiety?
There are no specific studies that suggest that one type of alcohol can affect anxiety levels more than other types of alcohol. While some people may believe that wine and beer may cause less anxiety than hard liquor due to its alcohol content, this is not true. It’s not necessarily the type of alcohol you drink that can affect your levels of anxiety, but rather anxiety is related to the amount and frequency of alcohol use.
Is Anxiety Associated with Alcohol Tolerance and Dependence?
Alcohol tolerance occurs when the individual needs more alcohol over time in order to induce the same feelings of euphoria. This can become a vicious cycle, because you may initially use alcohol as an unhealthy coping mechanism to help relieve your underlying anxiety but overtime you will need more alcohol to produce the same effects (tolerance).20
Dependence, different from tolerance, develops when the body adapts to regular alcohol use. A telltale signs of dependence is the presence of alcohol cravings or alcohol withdrawal symptoms when the individual reduces their alcohol use or stops drinking altogether. Alcohol withdrawal can worsen a pre-existing anxiety condition, or it can create new symptoms of anxiety, potentially resulting in the need to drink again..3,15
How Long Does Alcohol-Induced Anxiety (“Hangxiety”) Last?
The length of alcohol-induced anxiety varies among each individual. One study in mice found that alcohol-induced anxiety that occurs from withdrawals can last 14-16 hours after initial hangover symptoms.21 abstract Another study in mice showed that binge drinking anxiety from alcohol withdrawals appeared to last 24 hours after initial hangover symptoms began.
If you are physically dependent on alcohol, you can experience anxiety symptoms associated with alcohol withdrawal that last approximately 3-7 days, with the first 48 hours being the most difficult. Some people can experience anxiety symptoms that last longer than 7 days.22
How to Calm My Anxiety After Drinking?
It might not be possible to completely calm yourself down if you experience hangover-induced anxiety (or hangxiety), but there are some things you can do to make your experience a bit easier, such as:
- Stay calm and give yourself plenty of time to rest. Reassure yourself that this is a temporary feeling that should subside after you’re feeling better.
- Participate in a self-help group like Alcoholics Anonymous if you feel like you need help.
- Educate yourself about anxiety. Think about whether your anxiety is caused or exacerbated by alcohol use.
- Commit to reducing or quitting drinking if you are continually distressed by alcohol-induced anxiety or if your drinking habits are interfering with your daily life.
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Can Quitting Alcohol Cure Anxiety?
The only sure way to avoid anxiety caused by drinking is to stop drinking or drastically reduce your alcohol consumption. However, it depends on whether your anxiety is alcohol-induced or if you have an underlying anxiety disorder that you have been self-medicating with alcohol.
Regardless, quitting alcohol (or other mind-altering substances) can help you feel more grounded and level-headed and provide a beneficial baseline for the treatment of any co-occurring disorders you may be struggling with.
Seeking professional treatment for AUD and anxiety can help you take back control of your life and prevent the negative consequences and feelings associated with alcohol-induced anxiety. An integrated form of treatment is usually best for treating co-occurring disorders, such as anxiety and alcohol use disorder. This may include detox, inpatient treatment, outpatient treatment, medication, psychotherapy, participating in support groups, or a combination of these.25
- National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
- Centers for Disease Control and Prevention. (2021). Alcohol Use and Your Health.
- Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Research: Current Reviews, 40(1).
- National Institute of Mental Health. (2018). Anxiety Disorders.
- American Psychiatric Association. (2021). What Are Anxiety Disorders?
- S. Department of Health & Human Services. (2014). What are the five major types of anxiety disorders?
- Marcinkiewcz, C. A., Mazzone, C. M., D’Agostino, G., Halladay, L. R..& Kash, T. L. (2016). Serotonin engages an anxiety and fear-promoting circuit in the extended amygdala. Nature, 537(7618), 97–101.
- Science Daily. (2016). How do antidepressants trigger fear and anxiety?
- (2021). Anxiety and panic attacks: What causes anxiety?
- (2021). Anxiety and panic attacks: How can I help myself?
- Science Daily. (2012). Heavy drinking rewires brain, increasing susceptibility to anxiety problems.
- Wolosker, H., & Balu, D. T. (2020). D-Serine as the gatekeeper of NMDA receptor activity: implications for the pharmacologic management of anxiety disorders. Translational Psychiatry, 10(1), 184.
- Alcohol and blood sugar.
- Centers for Disease Control and Prevention. (2021). Manage blood sugar.
- Banerjee, N. (2014). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian Journal of Human Genetics, 20(1), 20–31.
- Canan, F., & Ataoglu, A. (2008). Panic disorder after the end of chronic alcohol abuse: a report of 2 cases. Primary Care Companion to the Journal of Clinical Psychiatry, 10(4), 332–333.
- Camden and Islington NHS Foundation Trust. The unhealthy mix between alcohol and mental health.
- Cosci, F., Schruers, K. R., Abrams, K., & Griez, E. J. (2007). Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship. The Journal of Clinical Psychiatry, 68(6).
- University of Toledo Counseling Center. Blood Alcohol Content.
- Alcohol and anxiety.
- Karadayian, A. G., Busso, M. J., Feleder, C., & Cutrera, R. A. (2013). Alterations in affective behavior during the time course of alcohol hangover. Behavioral Brain Research, 253, 128–138.
- Alcohol withdrawal symptoms.
- Lee, K. M., Coelho, M. A., Class, M. A., & Szumlinski, K. K. (2018). mGlu5-dependent modulation of anxiety during early withdrawal from binge-drinking in adult and adolescent male mice. Drug and Alcohol Dependence, 184, 1–11.
- Marsh, B., Carlyle, M., Carter, E., Hughes, P…Morgan, C. (2019). Shyness, alcohol use disorders and ‘hangxiety’: A naturalistic study of social drinkers. Personality and Individual Differences, 139 (1), 13-18.
- National Alliance on Mental Illness. (2020). Substance Use Disorders.