It can be easy to dismiss occasional feelings of nervousness, stress or fear as just a part of the human condition. Everyone worries, right? However, when anxiety becomes persistent and seemingly uncontrollable, it can be disabling, leaving you feeling like there is no light at the end of the tunnel.
If these thoughts begin to interfere with your everyday life, it may point to a more serious mental health condition. In people with anxiety disorders, worry is more than just a temporary feeling and can get worse over time.1
Referring to specific psychiatric disorders that involve extreme fear or worry, the term “anxiety disorder” includes the following:1
- Generalized anxiety disorder: This occurs when individuals have long periods of ongoing anxiety occurring more days than not over the course of 6 months.11
- Panic disorders: These occur when individuals who have experienced panic attacks begin to develop dysfunctional behaviors as a result of anticipating future panic attacks for a period of at least 1 month.11
- Phobias: These are anxiety disorders that occur as a result of extreme anxiety or fear of specific types of objects, living things, or situations. The anxiety that the person experiences is out of proportion to the actual threat these objects or situations present and typically lasts 6 months or more.
- Social anxiety disorder: Individuals with social anxiety disorders tend to have excessive feelings of anxiety for 6 months or more when they think they are going to be exposed to social situations and may believe they will be harshly evaluated by other people.
- Agoraphobia: This disorder includes extreme anxiety when individuals are in situations where they believe they cannot escape, such as open spaces, enclosed spaces, in a crowd or while inside or outside the home. In order for a formal diagnosis of agoraphobia to be made, the individual must have this extreme fear or anxiety associated with two different situations and typically for six months or more.
What’s the Difference Between Anxiety and an Anxiety Disorder?
Before diving into how alcohol and anxiety disorders are linked, it’s helpful to know the difference between a healthy amount of anxiety and a disorder that interrupts your life. Anxiety has a functional component to it that allows individuals to anticipate fear in order to recognize and deal with potentially harmful situations.2
The experience of anxiety can trigger our fight-or-flight response that occurs when the body shifts its energy resources toward fighting or fleeing from a potential threat.2 For example, a person walking down an alley at night may experience a high level of anxiety and fear as they spot a stranger coming toward them in the dark. Once the person has safely escaped the situation, their fear and anxiety will normally dissipate.
However, individuals who suffer from anxiety disorders continue to experience chronic levels of anxiety for extended periods of time that are either out of proportion to any tangible or perceived threat and/or continue to experience high levels even when a perceived threatening situation has long resolved. These individuals experience such a high level of significant distress and dysfunction as a result of their anxiety that it interferes with their normal functioning.11
While various anxiety disorders have their own unique or specific symptoms, they all share persistent, excessive dread or worry even in situations that are not threatening. Those with anxiety disorders may experience the following symptoms:1
- Feeling jumpy or tense.
- Upset stomach, frequent urination or diarrhea.
- Sweating, tremors and twitches.
- Headaches, fatigue and insomnia.
- Feelings of apprehension or dread.
- Restlessness or irritability.
- Being watchful for signs of danger and anticipating the worst.
- Pounding or racing heart, shortness of breath.
How Are Anxiety Disorders and Alcohol Use Disorders Linked?
In the U.S., anxiety disorders are the most common and prevalent mental disorders with around 48 million people experiencing one in any given year.3 Yet only about 43.4% of those individuals received treatment in 2018.3 Studies have shown that many people use drugs or alcohol to cope with anxiety disorders or relieve symptoms of anxiety.4 Over time, this may develop into a substance use disorder such as alcoholism.4
According to a survey by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), individuals who had co-occurring diagnoses of an anxiety disorder and a substance use disorder (e.g., an alcohol use disorder), were far more common than individuals who simply had a singular diagnosis of an anxiety disorder.5
However, when it comes to understanding both disorders, it can be hard to determine which came first—an alcohol use disorder that led to an anxiety disorder or vice versa. According to the Textbook of Anxiety Disorders, a large number of individuals who have a co-occurring anxiety disorder and alcohol use disorder report that they had issues with substance and/or alcohol abuse prior to developing issues with anxiety.6
Additionally, some studies show that though individuals report their alcohol abuse beginning as a way to cope with anxiety, other studies study shows that individuals diagnosed with panic disorder developed alcohol abuse issues before their disorder was recognized.6
Many researchers and clinicians currently believe that the relationship between anxiety and alcohol abuse is multifaceted and consists of variables that interact with one another to produce specific presentations in different people. One of the most common explanations of the relationship between anxiety disorders and substance abuse is a shared liability model that conceptualizes most anxiety and substance use disorders as being interrelated.7
According to this model, individuals who develop an anxiety disorder are at an increased risk of developing a substance use disorder and vice versa.7 The factors that interact to produce this vulnerability include genetic and environmental factors, such that different interacting factors are more likely to produce different co-occurring disorders.1 Meaning, simply having either a diagnosis of an anxiety disorder or a diagnosis of an alcohol use disorder could cause the other disorder to occur.
Treating Co-Occurring Anxiety and Alcohol Use Disorders
When a person has more than one mental health disorder —such as an anxiety disorder and an alcohol use disorder—it is referred to as a dual diagnosis or co-occurring disorders. Regardless of which disorder developed first, each condition may influence the course of the other; and if left untreated, could potentially result in an exacerbation of mental health symptoms or increased drinking.
Because of this, an integrated approach to treatment is recommended in order to have both issues addressed at the same time.8 An integrated approach uses specific therapeutic techniques or treatment strategies within a comprehensive, individualized treatment plan that focuses on both disorders within the same sessions or interactions.
To treat alcoholism, effective treatment may involve medications to ease alcohol withdrawal symptoms, private and group counseling, behavioral therapies, and long-term aftercare planning (e.g., support groups/mutual help meetings, sober living arrangements) to help avoid relapse and maintain sobriety.9 Anxiety disorders are typically treated with medication, psychotherapy, or a combination of the two.1
Behavioral therapies for treating co-occurring anxiety disorders and alcoholism may include cognitive behavioral therapy, contingency management and dialectical behavioral therapy.10 Treatment may also include both mental health and substance abuse education to teach healthy coping skills and better inform individuals on how they are related.
How Can I Get Help?
When considering treatment for an anxiety disorder and alcohol use disorder, it is beneficial to look into facilities that offer treatment for co-occurring disorders. Alcohol.org is a subsidiary American Addiction Centers (AAC) which provides a network of facilities equipped to treat co-occurring disorders. AAC’s therapeutic staff will tailor your mental health and recovery treatment plans in order to best address the comorbidity. While there may be no cure for alcohol use disorders and mental illnesses, treatment interventions and evidence-based therapies may help manage dual diagnosis disorders.
If you’re interested in learning more about your treatment options, our admissions navigators are available 24/7 to chat with you. Call our hotline at 1-888-685-5770 to begin your journey toward recovery now.
. National Institute of Mental Health. (2018). Anxiety Disorders.
. American Psychological Association. (n.d.). Stress Effects on the Body.
. National Alliance on Mental Illness. (2019). Mental Health by the Numbers.
. Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and anxiety, 35(9), 851–860.
. Institute of Alcohol Abuse and Alcoholism. (2006). Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders. General Psychiatry, 29(2), 107-120.
. Eric J.L. Griez, Carlo Faravelli, David Nutt, Joseph Zohar. (2009). Textbook of Anxiety Disorders. American Psychiatric Publishing, Inc.
. Smith, J. P., & Book, S. W. (2008). Anxiety and Substance Use Disorders: A Review. The Psychiatric times, 25(10), 19–23.
. Substance Abuse and Mental Health Services Administration. (2019). Detoxification and Substance Abuse Treatment, Tip 45.
. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.
. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.