Why Alcohol Can Make Anxiety Worse, Not Better.

Key Takeaways

• Alcohol can take the edge off anxiety in the moment. But NIAAA says that over time, heavy drinking and repeated withdrawal can make both anxiety and drinking worse.
• The anxious morning after drinking ("hangxiety") has a real cause. As the buzz wears off, the brain's rebalancing can leave you more restless and anxious than before you drank.
• Alcohol also breaks up your sleep, and needing more to get the same calm is a recognized sign of alcohol use disorder. And NIAAA notes tolerance can push drinking up, which can make sleep problems worse.
• If you've been drinking heavily and often, don't quit cold on your own. Alcohol withdrawal can be dangerous, so talk to a doctor or a medical detox program first.
• When anxiety and drinking feed each other, treating them together tends to work better than taking them one at a time. That's what dual diagnosis care is for.

You poured the drink because your chest was tight and your brain wouldn't stop replaying the same five worries. It worked, for a while. Then came the 4 a.m. wake-up, the jittery morning, and the meeting you had to show up for with a feeling that something bad was about to happen. Awkward Recovery is a Joint Commission Gold Seal-accredited outpatient program in South Austin, Texas, that treats mental health conditions and substance use disorders. When you have both, that's called a dual diagnosis (co-occurring disorders), and treating the two together is a core part of what we do.

So does alcohol make anxiety worse? Over time, it can, even though it feels like it helps. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says alcohol "may appear to relieve anxiety in the short term." It also warns that "over time, heavy drinking and repeated withdrawal can escalate both the anxiety symptoms and maladaptive drinking." This article covers why that happens, how to stop safely, and the signs it might be time for more help. For the bigger picture, see our guide to anxiety treatment in Austin.

Why does a drink feel like it helps anxiety?.

A drink feels like it helps because in the moment, it can make you feel calmer. That short-term relief is the hook.

NIAAA points out that because alcohol is so easy to get, "it is commonly used to cope with anxiety." Think about when you reach for it. Maybe you have a drink before the party so you can talk to people, or two after work so your brain stops running the to-do list. Maybe it's a nightcap because sleep won't come otherwise. That isn't casual drinking. It's a coping strategy that made sense when you started and can quietly stop working.

Self-medicating isn't a character flaw. Maybe your week includes Sixth Street, patio happy hours and the pressure to be "on" at work and with friends. It makes sense that people reach for whatever works fastest.

"Why can't I just stop?" is a less useful question than "What is the drink doing for me?" If the answer is "calming me down," then the work is building other ways to calm down and treating the anxiety underneath. That way the drink stops being your only tool.

What happens when the buzz wears off?.

When the buzz wears off, you can feel more anxious than you did before the first drink. NIAAA explains that while you drink, "the brain quickly adjusts to those positive effects as it tries to maintain balance." Then, "when the buzz wears off, people can feel more restless and anxious than before they drank."

NIAAA notes the popular press sometimes calls this "hangxiety." NIAAA's hangover fact sheet lists anxiety among hangover symptoms and notes that "The symptoms can last 24 hours or longer." You don't need an anxiety disorder for this to happen to you. According to NIAAA, "anxiety-like symptoms can occur after a single heavy drinking episode."

Here's the cruel part. A morning drink can seem like the fix, but NIAAA says it "will not cure a hangover." It "might temporarily minimize some symptoms," but "it could contribute to and prolong" them. NIAAA also says anxiety-like symptoms "can increase between drinking episodes, reaching high levels during alcohol withdrawal." That's the loop, and it can get harder to break the longer it runs.

The bottom line: A drink can make you feel calmer for a while, but your brain adjusts to it, and when the buzz wears off you can end up more anxious than before. Drinking again to fix the dread can prolong it.

How does drinking affect sleep and anxiety?.

Drinking can help you fall asleep faster, but it makes the sleep itself worse. According to NIAAA, "People may fall asleep faster after drinking alcohol, but their sleep is fragmented, and they tend to wake up earlier."

That matters because for people with generalized anxiety disorder (GAD), sleep is often already a sore spot. The National Institute of Mental Health (NIMH) lists trouble falling or staying asleep among the signs of GAD. NIAAA says GAD "typically presents with persistent and generalized worrying, poor sleep, fatigue, and difficulty relaxing."

The "drink to sleep" plan can go like this. You crash fast, then wake up at 4 a.m. wide awake and wired. Then you face the day, with the job, the kids and the morning you have to show up for, on broken sleep and the restless, anxious feeling that can follow when the buzz wears off. By evening, the drink looks like the answer again.

Why do you need more to get the same calm?.

Over time, the same amount of alcohol can do less. NIAAA's guide to understanding alcohol use disorder lists this as a sign of alcohol use disorder (AUD). One of its questions asks whether you've "Had to drink much more than you once did to get the effect you want?" NIAAA's clinician guide notes that "tolerance to alcohol can increase alcohol intake."

Put that next to the rebound and you can see how things snowball. The amount it takes to calm you can go up, and the anxiety between drinks can rise too.

Another question on NIAAA's list hits close to home for anyone reading this. It asks whether you "Continued to drink even though it was making you feel depressed or anxious." If that question made you wince, pay attention to it. It doesn't mean you're broken. NIAAA says any of these symptoms "may be cause for concern," and a yes can be a sign the coping strategy is turning into a problem of its own. Our page on alcohol use disorder recovery goes deeper on what that looks like.

The bottom line: Needing more alcohol to get the same calm, and drinking even though it makes you more anxious, are both signs NIAAA uses to identify alcohol use disorder. They're worth taking seriously early.

Is it an anxiety disorder, or is it the alcohol?.

It can be either one or both, and it's hard to tell while you're still drinking. NIAAA says a key question is "whether the anxiety is alcohol-induced or, instead, a pre-existing or primary anxiety disorder." Clinicians sort that out partly by looking at "the presence or lack of anxiety symptoms during phases of alcohol drinking and extended phases of abstinence."

Put simply, some people had anxiety long before they ever drank, and alcohol became how they managed it. Others developed anxiety mostly from what alcohol was doing to them, and some have a bit of both. An assessment with a licensed clinician is how you find out which applies to you.

If you have both, you're far from alone. NIAAA calls anxiety disorders "the most prevalent psychiatric disorders in the United States." It also reports that "The prevalence of AUD among persons treated for anxiety disorders ranges from 20% to 40%." NIMH adds that "GAD is also commonly associated with alcohol and substance misuse."

It also helps to know what separates an anxiety disorder from a rough week. NIMH explains that "anxiety disorders involve more than occasional worry or fear." For people with these disorders, "anxiety does not go away, is felt in many situations, and can get worse over time," according to NIMH's anxiety disorders overview. If panic attacks are part of what you're dealing with, our page on panic attack treatment covers that side.

Thinking about quitting? Stop safely.

If you've been drinking heavily and often, don't stop cold turkey on your own. Talk to a doctor or a medical detox program first. MedlinePlus warns that "Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition."

Anxiety is often part of withdrawal, too. MedlinePlus lists "Anxiety or nervousness" among the common symptoms. It says withdrawal symptoms "tend to occur within 8 hours after the last drink, but can occur days later." They also "tend to peak by 24 to 72 hours, but may go on for weeks." So if you cut back and your anxiety spikes, that isn't proof you can't live without alcohol. It may be withdrawal, and that's a reason to get medical support, not a reason to keep drinking.

Awkward Recovery doesn't provide detox. If you think you might be in alcohol withdrawal, MedlinePlus advises contacting your provider right away or going to the emergency room. Once the medical piece is handled, an outpatient program like ours can be where the longer work on anxiety and drinking happens. For a closer look at what early sobriety feels like, read the first 60 days sober from alcohol.

How do you break the alcohol and anxiety loop?.

To break the loop, it helps to have skills that calm you down without a rebound the next morning, and treatment that works on the anxiety and the drinking at the same time. NIAAA notes that an integrated treatment plan can include cognitive behavioral therapy (CBT) for both alcohol use disorder and a co-occurring anxiety disorder. NIMH calls CBT "a research-supported type of psychotherapy" that "is commonly used to treat GAD."

In practice, that looks like this:

• Getting specific about triggers. Which situations, thoughts or body sensations are you drinking to avoid? Naming them is uncomfortable, and it's also where the work starts.
• Building skills that do the drink's job. Evidence-based therapies like CBT, DBT and EMDR are part of treatment, and NIMH says CBT is commonly used to treat GAD. Clients also have experiential options like yoga, breathwork, sound healing and fitness.
• Facing what you've been avoiding. We encourage clients to face their fears rather than plan their lives around them. We work on the pace together, based on a clinical assessment of readiness and skills.
• Getting the medication question handled. If medication is part of your care, Awkward Recovery coordinates with your prescriber. We don't prescribe.
• Treating both at once. Our dual diagnosis treatment addresses anxiety and substance use together. NIAAA notes that integrated treatment of AUD and co-occurring psychiatric disorders "tends to lead to better results."

Early on, anxiety can feel louder without the drink. That's uncomfortable, and it isn't the end of the story. NIAAA notes that "Quitting drinking on its own often leads to clinical improvement of co-occurring mental health disorders." Treatment gives you tools so you're not white-knuckling the hard stretch.

The bottom line: Breaking the loop takes more than willpower. It means replacing a short-term coping strategy with evidence-based skills, and NIAAA notes that treating both together tends to work better.

Signs it might be time for more help.

If drinking has become your main way of handling anxiety, you may need more support than you can manage on your own. Some signs:

• You drink to get through anxious moments like social plans, work stress or falling asleep.
• The morning-after anxiety is part of why you drink again.
• You need more than you used to for the same calm.
• You keep drinking even though it's making you more anxious.
• Weekly therapy on its own isn't keeping up.

An intensive outpatient program (IOP) means several sessions a week of skills work, exposure work and group therapy while you keep living your life: work, family, home. Awkward Recovery runs a night IOP.

If anxiety is the main issue and alcohol isn't a big part of your story, that's okay. You don't need a drug or alcohol problem to come here. Clients whose main concern is mental health are in a group with other mental-health-primary clients rather than folded in with addiction clients. If both are in the picture, our page on anxiety and substance use explains how we treat them together.

Frequently Asked Questions.

Why do I feel so anxious the day after drinking?

Feeling anxious the day after drinking can happen to anyone who drinks heavily, and there's a reason for it. While you drink, your brain adjusts to alcohol's calming effect to keep itself in balance. When the alcohol wears off, that adjustment can leave you more restless and anxious than you were before. The National Institute on Alcohol Abuse and Alcoholism lists anxiety as a hangover symptom and notes that hangover symptoms can last 24 hours or longer. Anxiety-like symptoms can show up even after a single heavy drinking episode, whether or not you have an anxiety disorder.

Does alcohol make anxiety worse over time?

It can. Alcohol may seem to ease anxiety in the short term, but the National Institute on Alcohol Abuse and Alcoholism says that over time, heavy drinking and repeated withdrawal can escalate both anxiety symptoms and problem drinking. Anxiety can build between drinking episodes. Some people also find they have to drink more than they once did to get the same effect, which is one of the signs of alcohol use disorder. Together, those changes make drinking to manage anxiety a loop that can get harder to break the longer it runs.

Is it normal to feel more anxious when you stop drinking?

Yes. Anxiety is listed among the common symptoms of alcohol withdrawal. According to MedlinePlus, withdrawal symptoms tend to start within 8 hours of the last drink, but can start days later. They tend to peak by 24 to 72 hours and may go on for weeks. Feeling more anxious early on doesn't mean you can't live without alcohol. But withdrawal can range from mild to life-threatening. If you've been drinking heavily and often, talk to a doctor or a medical detox program before you stop. Contact a provider right away or go to the emergency room if you think you're in withdrawal.

How do I know if my anxiety is a real disorder or just from drinking?

It can be either, or both, and it's hard to tell while you're still drinking. Some people had anxiety before alcohol ever entered the picture. Others develop anxiety mostly because of what alcohol is doing to them. According to the National Institute on Alcohol Abuse and Alcoholism, clinicians sort this out partly by looking at whether anxiety symptoms show up during periods of drinking and during longer periods without alcohol. An assessment with a licensed clinician is how you find out which one you're dealing with.

Does anxiety get better after you quit drinking?

Often, yes. The National Institute on Alcohol Abuse and Alcoholism notes that quitting drinking on its own often leads to clinical improvement in co-occurring mental health disorders. Anxiety can feel louder at first, though, especially during withdrawal, and some people have an anxiety disorder that needs its own treatment. Evidence-based therapy can help with that. The National Institute of Mental Health says cognitive behavioral therapy is commonly used to treat generalized anxiety disorder, and it gives you tools that don't come with a rebound the next morning.

Do I need an alcohol problem to get anxiety treatment at Awkward Recovery?

No. You don't need a drug or alcohol problem to come to Awkward Recovery. The program treats mental health conditions like anxiety as well as substance use disorders. Clients whose main concern is mental health are in a group with other mental-health-primary clients rather than folded in with addiction clients. They use the same evidence-based approaches, including CBT, DBT and EMDR. If anxiety is your main concern and drinking is only part of the picture, or not part of it at all, you can still reach out.

Does Awkward Recovery treat anxiety and alcohol use at the same time?

Yes. Awkward Recovery provides dual diagnosis treatment, which means treating co-occurring conditions like anxiety and alcohol use disorder together instead of one at a time. Care uses evidence-based therapies including CBT, DBT, acceptance and commitment therapy (ACT), motivational interviewing and EMDR, along with process groups. Awkward Recovery coordinates medication with your prescriber but does not prescribe, and it does not provide detox. The intensive outpatient program runs at night. Awkward Recovery is in South Austin and is accredited by The Joint Commission.

If You or Someone You Know Is in Crisis.

• 988 Suicide & Crisis Lifeline: Call or text 988, any time, day or night.
• SAMHSA National Helpline: 1-800-662-4357. It's confidential and open 24/7.
• Crisis Text Line: Text HOME to 741741.

If you're having thoughts of suicide and you have a plan or intend to act on them, call 988 or go to the nearest emergency room now.

Ready to Get Out of the Loop?.

Drinking to manage anxiety doesn't make you weak. It was a coping strategy that worked fast and then stopped working. The anxiety underneath it is treatable, and so is the drinking. And treating them together tends to work better. Awkward Recovery is a Joint Commission Gold Seal-accredited outpatient program at 4109 Todd Ln, Unit 700, Austin, TX 78744, for people who are done pretending the drink is helping. Call us at (512) 616-0809 or reach out online. We're in-network with major insurance plans and verify your benefits for free. No bullshit, just real support.