Why Alcohol is your Frenemy: the Vicious Cycle of Alcohol and Anxiety
As a therapist who specializes in treating anxiety, stress, and trauma, I frequently encounter clients who struggle with their relationship with alcohol. For many years, I struggled too. Recently, this topic has come up more and more in conversations in my work and in my personal world – perhaps because the pandemic increased alcohol intake for a lot of people, or because stress levels are steadily increasing across the board, or maybe because in my personal world, alcohol is hitting differently now than it used to for us “elder millennials” with kids. Regardless, enough friends and clients have been grappling with their alcohol-anxiety seesaw that I was inspired to write this blog.
Alcohol is commonly perceived as a social lubricant and a means to unwind. Our culture promotes this idea everywhere you look by including alcohol at the center of every celebration and big event and marketing alcohol as the key to any successful meal, social gathering, and romantic encounter. We literally have happy hour with discounted drinks to help de-stress after the workday.
But what effect does it really have on our bodies and minds? In my experience, people tend to be fairly educated about the effects of excessive drinking on physical health but not so aware of the general impact of alcohol use on the nervous system and mental health.
The relationship between alcohol and anxiety is often complex and cyclical, creating an ongoing loop that exacerbates both conditions. You might also notice these problems worsening with age, and you’re not imagining it.
But just because a problem is very common doesn’t mean that it is “normal” or that you have to settle for feeling that way. The more you understand what’s going on in your body, the more empowered you are to make the best choices for you.
In this blog, I will delve into the physiological and psychological mechanisms behind this cycle and offer some healthier ways to manage anxiety and enhance social experiences without relying on alcohol.
The Physiological Rollercoaster: How Alcohol Affects Anxiety
Alcohol is a depressant, which for some people sounds counter-intuitive because it makes them feel good when they’re experiencing its effects. Temporarily, alcohol depresses the central nervous system, creating a sense of relaxation and euphoria. However, as alcohol metabolizes and its sedative effects wear off, your body starts to have a rebound effect with heightened anxiety, restlessness, and irritability.
This phenomenon is partly due to the brain’s adaptation to alcohol’s depressant effects. To maintain equilibrium, the brain reduces the production of its natural calming chemicals, such as gamma-aminobutyric acid (GABA), and increases excitatory neurotransmitters like glutamate. When the alcohol leaves the system, this balance is disrupted, leading to withdrawal symptoms that can include increased heart rate, sweating, tremors, and, critically, heightened anxiety. Essentially, your nervous system enters a survival or “fight-or-flight” state due to the chemical imbalance temporarily created by the alcohol; your body then produces cortisol, the “stress hormone.” All that cortisol didn’t feel noticeable to us as long as the alcohol was depressing the CNS, but once the effects wear off, we’re actually left with more cortisol than before we drank.
This physiological response often prompts individuals to drink again to stave off these uncomfortable feelings, perpetuating the cycle. While we tend to be aware of these symptoms in cases of addiction, we overlook that this process happens to a certain extent every time someone consumes alcohol and varies by person depending on their physiology, their tolerance level, their genetic predisposition (for addiction and anxiety/mood dysregulation) and their baseline mood and anxiety levels.
The more intensity and frequency of that cycle, the more ingrained it gets – you might be familiar with the phrase, “neurons that fire together, wire together.” So technically, it isn’t just a cycle… it’s a spiral in which continued use leads to increasing anxiety.
Sometimes the cycle leads to addiction, but often I see clients who are just stuck in a pattern of increasing anxiety because they are continuing to drink in controlled amounts, yet suffering increased effects of nervous system dysregulation in conjunction with poor sleep, weakened immune system, and inflammatory issues that cause gut health problems. Alcohol isn’t necessarily the root of any of these issues, but it can definitely contribute to the progression of them.
It is also worth noting that bodies become more susceptible to the effects of alcohol as they age. Alcohol tolerance gets lower as you get older for a variety of reasons (slower metabolism, less total water volume in our bodies, etc.). Heavy use can also quicken age-related cognitive decline.
For women, there are even more contributing factors physiologically to our bodies having more trouble processing alcohol as we age (loss of lean muscle mass, lower enzyme levels, and hormonal and metabolic changes during menopause).
That is all to say: especially for women, and especially as we age, alcohol will have more impact on our bodies and our nervous systems.
I should also add around 1 in 7 adults take anti-anxiety/anti-depressant medication- it’s a higher number of women than men and higher use among older adults (i.e., populations already more susceptible to the harmful effects of alcohol). A majority of people taking these meds never had to meet with a mental health professional. And in my experience, most people have no idea that drinking alcohol while on anti-anxiety/anti-depressant medications is not only harmful to their bodies- it actually can worsen their anxiety or depression.
Talking about how alcohol (particularly in heavy amounts) affects the body, the brain, the nervous system, gut health, and the effectiveness of medications, especially for women, has become a frequent conversation in my office.
The Psychological After-Effects: Regret, Shame, and Anxiety
The physiological crash after drinking is often compounded by psychological distress. The regret or shame associated with behaviors while intoxicated—such as saying things you wouldn’t usually say, making poor decisions, or even simply feeling out of control—can cause or significantly exacerbate anxiety. These feelings can create a sense of internal conflict and self-criticism, further fueling the desire to drink as a form of escape, avoidance, or coping with discomfort.
It is also more challenging to manage anxious thoughts (worries, fears, self-criticism) when your body is physiologically in a state of heightened anxiety. That’s because when the fight-or-flight system turns on, it impairs executive functioning abilities so that our bodies prioritize survival. Since emotional regulation is a key task of executive functioning, our physiologically induced anxiety results in not being able to regulate our anxious thoughts.
Adding insult to injury, the lack of quality sleep also undermines executive function, and since both alcohol and anxiety can significantly impair the amount and quality of sleep, our ability to manage anxiety is even further reduced.
In essence, alcohol might make you do things that make you feel anxious the next day, and it can definitely make you physiologically more anxious and more tired, all of which makes it harder to manage anxiety… which was exacerbated by, or produced by, the alcohol.
A Compassionate Perspective on Why We Drink
Now that we’ve acknowledged how drinking can make us anxious (and simultaneously less capable of managing our anxiety), I want to offer a really compassionate lens for why that is precisely why people drink so much. I am including this for a couple of different reasons: first, to reduce any shame that is brought up by reviewing how much alcohol impacts our mental health, and second, to offer insight that will also help with making meaningful change moving forward.
In the Internal Family Systems (IFS) model of therapy, “symptoms” are viewed as parts of ourselves that are trying to help us in some way. Anger is a part of us that tries to protect us and set boundaries; fear is there to protect us from danger, and so on.
When dealing with anxiety, an internal “manager” or protective part might try to keep you safe by avoiding triggers (“Let’s have a drink so that I don’t have to feel so nervous when I start talking to people!), while a “firefighter” part might use alcohol to quickly extinguish the flames of intense anxiety or emotional pain (“That conversation was so anxiety-producing, I need another drink!”).
Recognizing that drinking is a protective strategy allows us to approach it with compassion and curiosity. Instead of harsh self-judgment, we can ask ourselves what underlying fears or needs our internal “protectors” are trying to address by drinking. This understanding can be the beginning of real, meaningful change not only in drinking habits but also in learning to meet our deeper emotional needs and heal from (rather than just constantly manage) anxiety.
Strategies for Enjoying Social Functions Without Alcohol
While some people and treatment approaches embrace total sobriety, my advice to clients is to explore the root causes of their anxiety and the function that alcohol serves.
- Mindfulness and Grounding Techniques: Practicing mindfulness can help manage anxiety by keeping us grounded in the present moment. Techniques such as deep breathing, progressive muscle relaxation, and sensory grounding (focusing on physical sensations like the feel of your feet on the ground) can be particularly effective.
- Self-Compassion: Cultivating self-compassion involves treating ourselves with the same kindness and understanding we would offer a friend. Acknowledging that it’s okay to feel anxious and that it’s a common human experience can reduce the intensity of our emotional reactions.
- Social Support: Building a support network of friends and family who understand and respect your decision not to drink can make a significant difference. Engaging in open conversations about your choices can also help normalize sobriety in social settings.
- Alternative Activities: Focus on activities that do not revolve around alcohol. This might include engaging in hobbies, participating in sports, or attending events that emphasize connection and fun without the presence of alcohol.
- Professional Help: Seeking therapy can provide invaluable support in understanding and addressing the root causes of anxiety and developing healthier coping mechanisms. Techniques such as Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and IFS can be particularly helpful.
- Non-Alcoholic Alternatives: At social gatherings, opt for non-alcoholic beverages that still feel festive, such as mocktails, sparkling water with a splash of juice, or soda. This can help you feel included without the negative effects of alcohol.
- Join some type of Group Fitness Class or Training: Aside from the obvious benefits to your physical health and reduction in anxiety, there are added benefits to working out in a group. The social aspect and structured schedule make it more likely you’ll get into an exercise routine, plus forming social connections in a group (and in an alcohol-free setting) reduces stress, and being part of a fun workout class or a group training for a race gives you things to talk about at social gatherings,
By understanding the physiological and psychological impacts of alcohol on anxiety and employing strategies to manage anxiety in healthier ways, we can break out of the cycle of physical and emotional hangovers. Embracing a holistic approach to well-being and understanding drinking as a social activity but also as self-medicating, as well as understanding its effects, both enjoyable and unpleasant, can empower more nuanced choices and change.