The Science Behind Alcohol-Induced Anxiety
Why alcohol makes anxiety worse.
As a nurse and recovering alcoholic, I understand the biological processes that precipitate anxiety in alcohol users. I also have a deep understanding of how alcohol affects the nervous system. The trouble is, this info just isn’t out there. Doctors and other health professionals don’t teach anyone about this. I aim to change that by creating educational articles like this.
If anyone has any doubt, let me clear it up: alcohol will absolutely make your anxiety worse.
Heavy drinkers can tell you that anxiety is one of the most uncomfortable symptoms of alcohol withdrawal. The trouble is, most people don’t understand why alcohol causes anxiety. And it doesn’t take vast amounts of alcohol to produce this disturbing effect either.
As we’ve lived through the overwhelming stress of Covid19, many have turned to alcohol to soothe their woes. This was proven in the spring of 2020 when alcohol sales sky-rocketed in the US around the start of the pandemic. Not surprisingly, mental health issues and crisis calls also increased dramatically.
Many people use alcohol to self-medicate their emotional distress only to cause more emotional distress. They are also more likely to get addicted because of it. But the confusing part of using alcohol to self-medicate is that it seems to work for the first drink or two in the beginning. Sadly, most people don’t realize that the addition of alcohol is akin to throwing gas on a fire. Over time, heavy alcohol use will not calm you down; it will only make mental health issues and anxiety much worse.
The anxiety-provoking aspect of alcohol use is not when you drink; it’s after you stop drinking. And these effects can sometimes last a few days depending on the sensitivity and genetic makeup of the individual.
If you don’t know how alcohol creates and worsens anxiety, let’s break it down into simple terms. This is information that every person needs to know, no matter how much alcohol they drink.
The effect of alcohol on the nervous system
For our brain and nervous system to work, we need a proper balance of neurotransmitters. Neurotransmitters are chemicals your body uses to transmit messages between neurons. Some neurotransmitters slow down the messages (inhibitory) while others speed them up (excitatory). The body needs both inhibitory and excitatory neurotransmitters to create a good balance.
For simplicity, let’s look at the two primary neurotransmitters that are affected by alcohol — GABA and glutamate. There are other neurotransmitters involved, but these two are the important ones.
GABA causes messages to slow down (inhibitory) while glutamate speeds them up (excitatory). Alcohol increases the effect of GABA, which means that the nervous system slows down when alcohol hits the brain. This slowing down is what gives us the “high” that we feel from alcohol. It tricks us into thinking we feel relaxed, carefree, and everything seems brighter and lighter.
To better understand this, see the diagram I created below based on a report by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Now, if you only drink one or two drinks every few weeks, then you won’t likely notice anything beyond this relaxed state. This is because one or two drinks on an infrequent basis won’t throw your nervous system off its delicate balance. However, some people are more sensitive to the effect of alcohol than others and may progress to an unbalanced nervous system, and that’s where alcohol begins to affect anxiety levels.
However, if you drink more significant amounts frequently, your nervous system will be thrown off its balance and has to compensate to bring it back to equilibrium.
What happens to the nervous system with increasing amounts of alcohol
As I said above, alcohol increases the inhibitory effect of GABA on neurons. With increased amounts of alcohol, the nervous system tries to adapt by decreasing the receptor’s sensitivity that receives GABA. The body senses that the nervous system is too slow, so it blocks the GABA coming in, leaving more GABA between the two neurons.
At the same time, it increases the receptors for another neurotransmitter — glutamate — which has an excitatory effect on the neurons. To keep the nervous system running smoothly, the body tries to fight against the alcohol by making it easier for glutamate to excite the neuron and bring the nervous system back to equilibrium.
To understand this better, see the diagram I created below.
The effect of the body trying to maintain equilibrium is that it takes more alcohol to produce that relaxing, calm, ‘drunk’ effect.
As more alcohol is consumed, the nervous system adapts by further desensitizing GABA receptors and further increasing the glutamate receptors. Many alcoholics will say that daily drinking just makes them feel normal again. And to actually feel “drunk,” they need a large amount of alcohol in a short duration of time to trick their adapted nervous systems into getting “high” again.
Alcohol withdrawal and anxiety
The number one symptom of alcohol withdrawal is anxiety. And the more a person drinks, the more they will experience this uncomfortable symptom.
As we discussed above, alcohol increases the inhibitory effect of GABA and increases glutamate receptors. So what you have is a nervous system wired for excitation. This is due to inhibitory receptors that no longer work well, so they can’t help in keeping the nervous system calm. On top of that, with many glutamate receptors ready for excitation, the nervous system is primed like an elastic stretched out.
All it takes is removing alcohol, and the spring snaps into motion with the result being — increased anxiety, among other troubling symptoms.
For those who drink moderately a few times a week, alcohol withdrawal may only cause anxiety, insomnia, headaches, and stomach upset. Almost anyone I know who has drunk alcohol can attest to these symptoms.
However, for those that drink heavy amounts more often, the removal of alcohol can be life-threatening. Symptoms of an over-excited nervous system can progress to hallucinations, sweating, crawling sensations, diarrhea, vomiting, and even seizures.
Delirium Tremens (DT) is the most severe alcohol withdrawal syndrome as it can cause prolonged seizures, psychosis, dangerous increases in blood pressure and heart rate, and coma. Those who experience DT usually drink large amounts daily and for many years.
New research shows that DT is more common in heavy drinkers as well as people with pre-existing mental health issues such as anxiety. However, long-lasting nervous system impairment is common in binge drinkers — where large amounts of alcohol are consumed at one time, followed by a period of sobriety for a few days.
This information is essential for “weekend warriors” and those who get dangerously drunk once a week. It seems that if the nervous system goes through frequent periods of alcohol withdrawal, the more unbalanced it becomes.
In some cases, chronic alcohol-related nervous system impairments can compromise one’s ability to recover from alcoholism by causing difficulties in decision-making, disinhibition, and emotional regulation. In simple terms, this means that the more alcohol a person uses and the more they go through withdrawals, the less their nervous system will function properly over time.
Discussion
The idea that chronic alcohol use can have serious long-term effects on mental, emotional, and physical health is why I write educational articles for the general public. As a recovering alcoholic myself, I can tell you that it’s taken several years of sobriety and many treatment mechanisms to get my nervous system back to a decent level of functioning. But even now, I still have issues.
The good news is that many people recover well from chronic alcohol use. It may take time, but usually, symptoms reverse, and the constant anxiety calms down. However, this may take longer for those with more severe addictions, and some may never fully recover. Unfortunately, research shows that difficulties with post-recovery emotional regulation, decision-making, and disinhibition correlate with relapse.
Also, one reason health professionals are reluctant to push their patients towards sobriety or cutting back on alcohol is due to the dangers of sudden alcohol withdrawal. Yet, they also don’t provide harm reduction education either.
For some, complete abstinence from drinking alcohol is not possible. Chronic alcohol addiction sometimes leads to permanent damage to the nervous system, which leads to further cravings. In that case, it may be more helpful to teach those people about moderating their daily alcohol doses and never to quit suddenly. However, if people don’t know why this is important, they are less likely to follow this advice.
Unfortunately, any alcohol consumption that exceeds the moderate drinking limit for adults — 1 drink per day for women, two drinks per day for men — can contribute to anxiety. The risk is even higher for binge drinking — more than four drinks in 2 hours for women, and more than five drinks in 2 hours for men.
For those who drink “socially,” it’s worth being honest with yourself and your doctor about whether you go over the moderate drinking limits. Many of us hold steadfast to the idea that we are “just social drinkers,” not knowing that 2–3 drinks daily or even every few days can impact anxiety levels.
Lastly, those who use medication to help with mental health issues are strongly encouraged not to drink alcohol. Many of these medications interact with alcohol in dangerous ways, not to mention that the medication may not work as well.
Knowing this information can not only save your mental health, but it can also save your nervous system or even your life.