Updated 18 March 2014

6 in 10 drinkers have anxiety disorders

Many people drink because they're feeling anxious. In fact it is estimated that about 60% of people in rehabilitation centres have an underlying anxiety disorder.

Many people self-medicate their underlying anxieties with alcohol. It is estimated that about 60% of people in rehabilitation centres have an underlying anxiety disorder.

These range from generalised anxiety disorder and social phobia to panic disorder and post-traumatic stress disorder.

Some patients state that drinking is a solution for their anxiety. For example, a study involving Norwegian medical students, showed that those who report using alcohol "for stress" tend to drink more than their peers do. The fear of being anxious on social occasions is also stated as a reason for drinking regularly.

Some adolescents find alcoholis a rapid and, in the short term, effective way to alleviate fears of not being accepted by their peers. Some people become alcohol-dependent because of their liking for the effects of alcohol, or because alcohol is part of their social or work setting.

But stating that you ‘drink to cope’ predicts that in the next 10 years problematic drinking may develop, or if it had been there already, may increase. Then it can be embarrassing to find they have difficulty controlling their drinking and this can lead to enormous amounts of distress.

Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD), an anxiety disorder following a traumatic event outside the range of usual human experience, is commonly associated with alcohol misuse. To deal with the unpleasant symptoms experienced after a traumatic event many people use alcohol to numb their emotions and help them to forget for a while.

Although with regard to traumatic events in adult life, one study has actually found that being a regular drinker prior to the event reduced the risk of later PTSD. This is in line with other general population research, which suggests that regular drinkers (note: not heavy drinkers) have better mental health than abstainers, partly due to social and personality characteristics.

Another common cause of anxiety and alcohol dependence might be an independent depressive disorder. Anxiety symptoms, including irrational fears, are an important part of depressive illness.

Quiz: do you have a problem with alcohol?

But the link between these two disorders could also be the other way around. Heavy drinking can cause anxiety. Tremors, insomnia, irrational fears, palpitations and excessive sweating are symptoms that are common to both disorders. Anxiety symptoms also occur during alcohol withdrawal, although about 80% of patients recover from all anxiety symptoms after about 1 month of abstinence.

The severity of dependence predicts the degree of anxiety and other psychological distress. If drinking resumes after detoxification, anxiety symptoms, which recovered quickly, return.

When withdrawal symptoms occur in a crowded place, where people may feel they are being observed, or if they feel far from home, they may develop a phobia of returning to that situation. Even after giving up alcohol though, sometimes these attacks can then develop a life of their own, creating a phobic disorder, panic disorder or agoraphobia, a fear of being in public places.

Read more: Depression Centre

Stressful consequences
Alcohol dependence may also cause anxiety because of the stressful consequences of drinking, such as marital tension or break-up, threats to job security, or impending legal proceedings. A sense of imminent disaster may develop which, although seeded by a real adverse event, grows out of proportion. There is restlessness, difficulty concentrating, irritability and/or disturbed sleep.

Help is available
Getting help for both problems is recommended and a combination of psychotherapy and medication seems to be the most effective route. Anxiety disorders secondary to the drinking tend to have a good outcome, but thanks to recent developments in medication research and therapy approaches, so do primary anxiety disorders with alcohol dependence as a result.

- Taken from Understanding and helping patients with anxiety and alcohol dependence – Jonathan Chick, Dept of Psychiatry, Univ. of Edinburgh

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Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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