What is Anxiety?
Anxiety is a common mental health concern, characterised by excessive worry, nervousness, or fear that interferes with daily life. Alcohol use is also widespread globally, ranging from light social drinking to heavy or dependent use. The question of whether drinking alcohol causes anxiety is medically important because both conditions affect large numbers of people and often occur together.
Many people use alcohol to relax, but ironically, it can leave them feeling more anxious afterward. Understanding why that happens can help you make informed choices about drinking and mental health.
The connection between alcohol and anxiety
Epidemiological associations
- Numerous studies observe that people with an alcohol-use disorder (AUD) often also have an anxiety disorder (and vice versa). For example, in a review article, it was reported that having either an anxiety- or alcohol-related diagnosis elevates the prospective risk for developing the other disorder (Smith & Randall, 2012)
- A study found that individuals with anxiety or major depression experienced greater symptoms of AUD even when drinking the same amount as people without those disorders.
- Among adolescents, higher levels of anxiety symptoms (particularly among girls) were associated with earlier onset of alcohol use and more frequent intoxications.
Patterns and complexities
- Some people drink because they feel anxious (so-called self-medication), which can increase the risk of problematic use.
- Others appear to develop anxiety after or because of alcohol use (or withdrawal), suggesting the relationship is bidirectional.
- Importantly, not everyone who drinks becomes anxious, and not everyone with anxiety drinks; thus, the relationship is complex and influenced by many factors.
How Alcohol Affects Anxiety Over Time
| Drinking Pattern | Short-Term Effect | Long-Term Effect |
|---|---|---|
1–2 drinks |
Temporary relaxation, social ease |
Minor sleep disruption, dehydration |
Binge drinking |
Loss of inhibition, emotional release |
Hangxiety, panic, and low mood the next day |
Regular heavy use |
Numbness, tolerance buildup |
Chronic anxiety, irritability, withdrawal symptoms |
Alcohol withdrawal |
Relief when drinking resumes |
Severe rebound anxiety, tremors, restlessness |
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How alcohol might cause or worsen anxiety
Here are some of the mechanisms by which alcohol may contribute to increased anxiety:
Neurochemical and brain effects
- Alcohol interacts with brain chemicals, including GABA (gamma-aminobutyric acid) and glutamate. GABA is normally calming; alcohol in small amounts can increase GABA’s effect (leading to relaxation), but heavier or chronic use can deplete GABA and increase excitatory glutamate activity, raising anxiety.
- Alcohol affects the stress system of the brain, including the hypothalamic-pituitary-adrenal (HPA) axis, which regulates cortisol and other stress hormones. Dysregulation of this system can contribute to anxiety.
- Animal models confirm that after binge drinking, anxiety-like behaviour appears the next day (in mice) and is linked to certain stress-related brain receptors.
Withdrawal, rebound anxiety, and hangxiety
- When the effects of alcohol wear off, the brain shifts from a depressant state to a rebound with heightened excitatory activity, which may manifest as anxiety, panic, or emotional dysregulation.
- Many people describe feeling anxious the morning after heavy drinking, sometimes called hangxiety, which may reflect a combination of dehydration, neurochemical shifts, sleep disruption, and psychological regret.
Secondary effects that contribute
Other ways alcohol can contribute to anxiety indirectly:
- Sleep disruption: Sleep disruption: Though alcohol may help you fall asleep, it disturbs the sleep architecture (less restorative sleep, less REM), which increases anxiety (Mental Health Foundation)
- Nutrition, dehydration, and physical functioning: Alcohol can interfere with nutrient absorption, cause dehydration and electrolyte imbalance, all of which can trigger physical sensations (palpitations, shakiness) that mimic or provoke anxiety (Medical News Today)
- Psychological/regret factors: After drinking, someone may feel guilt, embarrassment, or perceive risk in what they did while intoxicated; these feelings can cause anxiety.
- Vulnerability & dose: Pre-existing anxiety or mood disorders. Studies show people with anxiety or major depression experience worse alcohol-related outcomes and a greater risk of AUD (National Institutes of Health, n.d.)
Longitudinal studies & systematic reviews
- A systematic review (2024) found that there is a paucity of longitudinal research using representative populations to assess the long-term causal effect of alcohol consumption on anxiety.
- Some older longitudinal research found that excessive alcohol consumption was not clearly associated with the onset of anxiety or depression in follow-up, though abstainers were less likely to develop anxiety (Boden & Fergusson, 2011)
- Another recent study using Granger causality methods reported that while alcohol can act as an acute anxiolytic, its long-term use may exacerbate anxiety, especially during withdrawal.
Who is most at risk?
Understanding risk factors helps to identify individuals for whom alcohol may be more likely to lead to anxiety.
Vulnerability factors
- Pre-existing anxiety or mood disorders. Studies show people with anxiety or major depression experience worse alcohol-related outcomes and a greater risk of AUD.
- Heavy and frequent alcohol use or binge drinking and withdrawal episodes raise the risk of anxiety.
- Adolescents: In a study of 16-18-year-olds in Norway, girls with anxiety symptoms had a higher risk of early drinking onset and intoxication.
- Sleep problems, poor physical health, high-stress environments, and a lack of coping mechanisms.
Gender and developmental differences
- Some research suggests differential effects by sex. For example, the mechanism of alcohol’s influence on anxiety may differ in male vs female brains (in animal models).
- During adolescence, the brain is still developing, so the combination of alcohol use + anxiety symptoms may be especially harmful.
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Risk profile summary
| Risk factor | Why it matters |
|---|---|
Pre-existing anxiety/mood disorder |
Increases vulnerability to alcohol’s negative mental-health effects |
Heavy, frequent use or binge drinking |
Greater neurochemical withdrawal, sleep, and physical stress burdens |
Adolescence or developmental stage |
The brain is still developing, and is more sensitive to alcohol and stress |
Poor sleep / high stress/lack of coping |
Amplifies anxiety and reduces resilience to alcohol’s effects |
What This Means for You
Here are some key implications for someone wondering about their alcohol use and anxiety.
If you drink and also experience anxiety
- Recognise that even if drinking helps you feel relaxed temporarily, it may be contributing to overall anxiety in the long run (especially after the drink wears off).
- Keep track of how you feel after drinking: Does anxiety increase shortly after, or the next day? Does drinking lead to sleep problems?
- Consider reducing the amount of alcohol, limiting frequency, and avoiding binge patterns.
If you have anxiety and are considering drinking
- Understand that using alcohol to cope with anxiety is risky: drinking may reduce anxiety temporarily, but may worsen it over time and increase the risk of AUD.
- Before using alcohol as a coping mechanism, explore healthier coping mechanisms (therapy, sleep hygiene, lifestyle, relaxation techniques).
- Check in with a healthcare professional if you have a diagnosed anxiety disorder and are also drinking regularly.
Reducing or stopping alcohol may benefit anxiety
- A review reported that among people who reduced their alcohol intake, improvements in anxiety (and depression) were observed.
- Even if you’re not problematic in your drinking, cutting back may improve sleep, reduce physical stress, and thus reduce anxiety risk.
Additional self-care strategies
- Ensure good sleep hygiene (since alcohol disrupts sleep).
- Maintain a balanced diet and hydration (to reduce physical triggers of anxiety).
- Consider stress-management practices (e.g., exercise, mindfulness, therapy).
- Seek support if you find yourself drinking more when anxious or unable to reduce.
Treatment and intervention considerations
When someone presents with both anxiety symptoms and problematic alcohol use, there are some important considerations.
Integrated approach
- Research suggests that treatment addressing both conditions concurrently (anxiety + alcohol use) produces better outcomes than treating them in isolation.
- For example, in one review, combined therapy (medication + therapy) reduced anxiety symptoms among patients with co-morbid alcohol dependence and anxiety disorder.
Therapeutic options
- Psychotherapy: Cognitive-behavioural therapy (CBT) that targets both drinking behaviours and anxiety coping strategies.
- Medications: In cases of co-occurring AUD and anxiety disorder, non‐benzodiazepine anxiolytics are sometimes used because of lower abuse potential.
- Screening: Healthcare providers should routinely screen patients with anxiety for alcohol use, and those with alcohol problems for anxiety disorders. The overlap is substantial.
When to seek help
- If you notice increasing anxiety after drinking, cannot reduce drinking despite anxiety symptoms, or if anxiety interferes with function.
- If you experience withdrawal symptoms when stopping alcohol (which may include anxiety, tremor, and rapid heart rate), medical supervision is required.
Myths & Misconceptions
1. Alcohol relaxes me, so it must help my anxiety
- It’s true that alcohol can temporarily reduce anxiety or inhibit inhibitions, but that effect is short-lived and can lead to rebound anxiety or dependence.
2. Moderate drinking is safe if Idon’thave an anxiety disorder
- Moderate drinking may carry a lower risk, but moderate depends on the individual, context, and vulnerability. For someone with high anxiety risk, even moderate use may be problematic.
3. If I only drink occasionally, I won’t have anxiety problems
- Occasional drinking generally carries less risk, but even single heavy episodes (binge) can trigger anxiety the next day. Sleep, hydration, and brain chemistry matter.
4. Anxiety from drinking will go away on its own
- Sometimes mild anxiety after drinking resolves, but if there is a pattern of worsening anxiety, frequent rebound anxiety, or alcohol dependence features, then help is needed.
Get Professional Help with SDKare
If you’re struggling with anxiety that worsens after drinking or you’re unsure whether alcohol is playing a role, you don’t have to face it alone. At SDKare, our licensed mental health and addiction specialists are here to help you understand your symptoms, develop healthier coping strategies, and get your confidence back through confidential online sessions.
Take the First Step Toward Calm
Managing anxiety and alcohol use can feel overwhelming, but the right guidance makes all the difference. If you need short-term therapy, support, or just someone to talk to, SDKare connects you with trusted clinicians who care.
Book Your Online Consultation Today. Start your journey to better mental health with SDKare’s expert help, on your schedule.
FAQs
Possibly. Even low doses can disrupt sleep or blood sugar, which may trigger mild anxiety in sensitive people.
It can significantly reduce anxiety symptoms, but if anxiety persists, therapy or medication may help.
Usually less than 24 hours, but in people with frequent drinking or high stress, it can persist longer.
Any drink containing ethanol can contribute. Sugary mixers or caffeinated drinks (like energy cocktails) may worsen anxiety.
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