I Want to Talk About Alcohol and its Relationship to Anxiety
Because we don’t talk about it enough
I may as well put this out there from the start. I believe alcohol is highly correlated to anxiety and I think this relationship is often swept under the carpet. Thankfully, there are some glaring truths we can’t ignore when looking at the anxiety and alcohol consumption data.
I also want to say, I am 3 years sober from alcohol, and if I were drinking right now, I’d never write this post. Why? Denial. Because those who have a problematic relationship with alcohol will deny it. We don’t mean to, it’s just the nature of the beast. When you love something you want to protect it don’t you? More so, when you really “need” something you’ll defend it with your life.
In Catherine Walsh’s story “I Know Why My Father Drank,” she eloquently describes alcohol as a liquid blanket of comfort. I resonated so much with this description and her story of her heavy drinking father. My own father passed away from cirrhosis. He couldn’t live without his liquid blanket even though he knew it was killing him.
But this isn’t a story of mine and my father’s drinking and how and why I got sober, although, it certainly drives my desire to write this.
What I really want to talk about is how alcohol is contributing to anxiety which is the most prevalent mental health issue in the world. I should say too, my father and I both suffered greatly with anxiety.
Here’s a diagram from Our World in Data looking at the worldwide prevalence of anxiety disorders in 2016.
It’s clear that anxiety is higher in the developed world. I suspect there may be limitations to this data. Countries that lack the services that would diagnose and report these facts may show a lower prevalence. Also, stigma is still a significant issue which leads people to suffer in silence and never report their symptoms. Also, since the developed world is talking more about mental health and has more access to diagnostic services, this may also explain our higher incidence of anxiety.
Here’s another diagram from Our World in Data that looks at global alcohol consumption in 2015.
It’s clear that anxiety and alcohol consumption have a similar pattern. The only outlier is Russia, where the prevalence of anxiety is lower than the drinking amount. I’m not discounting the many other contributing factors to anxiety but the relationship here is definitely interesting.
Let’s talk about alcohol withdrawal
A study published in Alcohol Health and Research World in 1998, says that anxiety is the most common feature of alcohol withdrawal. For heavy drinkers, the anxiety can be so severe that the person experiences hallucinations, extreme irritability, and may be at risk of seizures.
The process of withdrawal from alcohol causes excitation and irritability of the nervous system. These symptoms are also present in mild withdrawal but may be so slight that the person doesn’t realize that they’re even in withdrawal.
For people who only have one drink per week, withdrawal may not be an issue. But as the data shows, people are drinking at least 3 drinks a week in countries like US, Canada, and Europe. This is only an average so some may drink more and some less.
Check out this diagram from the 2011 Global Status Report on Alcohol and Health from the World Health Organization.
According to this report, the disability-adjusted life years (DALY) refers to years of life lost due to premature mortality combined with years of life lost due to time lived in less than full health.
A staggering 38.8% of alcohol-attributable DALY’s are from neuropsychiatric disorders.
Alcohol — anxiety. I think we can draw some conclusions here.
I want to tell you, I was not an extreme alcoholic. I would average 3–4 drinks during the week and on the weekend, I would have 5-6 drinks in one night. I had constant issues with anxiety all the time. When I quit, I had mild withdrawal with heightened anxiety (way more than usual), thirst, extreme sleep disturbance and vivid dreams that jolted me awake. I also had mild nausea and headaches.
It took about 2–3 months of sobriety before things settled down. Once it did, I was shocked by the fact that my anxiety had all but disappeared.
I’d venture to say that extremely heavy drinkers probably know what they’re up against, even if they don’t talk about it. But the average person is a moderate social drinker and may not be aware of the connection between their anxiety and those 2–3 drinks after work. And if this is a repeated pattern, they could be subjecting themselves to a dose of anxiety-causing agents that they never fully recover from.
If you google ‘dry January’ you’ll see a wide array of posts and articles documenting people’s journey going alcohol-free for a month. Most people report feeling better, and virtually no one says they feel worse having gone alcohol-free. All of them report having improved sleep, feeling less agitated, less stressed, less anxious and more energetic. Mind you, experts say that the people who agree to go sober are less likely to have a problem to begin with. But it begs the question, if people who don’t have a problem with alcohol report less anxiety, then what about those who do have a problem?
This article is not about putting drinkers down.
I’m not telling you to stop drinking. I know how great that liquid blanket is and I know how shitty life may seem without it. I also know that many people with anxiety self-medicate with alcohol. I know it’s hard to live without self-medication.
But the important thing I want to impart is that if you suffer from anxiety and also drink moderately several times a week, it’s worth looking at this relationship.
And if you take medication for anxiety, here’s something else you should know.
In the past, the advice from researchers and doctors was that antidepressants and other anxiety medication should not be mixed with alcohol. Both alcohol and these medications increase drowsiness and affect liver functioning so taking them together was always ill-advised. Taking several substances that require the liver to metabolize them can stress the liver. Over time, this constant stress is what damages the liver.
More importantly, if the liver has to choose which substance to metabolize, it may interfere with its ability to process either the alcohol or the medication leading to a build-up of one and excess removal of the other. This speaks to a possibility that antidepressants may not work as well if taken with alcohol. Or, alcohol may increase the side effects of the medication. Interestingly, this research doesn’t seem to inform healthcare practice, or it doesn’t make its way into the mainstream discourse about alcohol use anymore.
As a mental health nurse, there was never any real discussion about alcohol intake, medication and anxiety issues. A heavy drinker admitted to inpatient care would be given diazepam to curb withdrawal. Alcohol was seen as a minor issue compared to everything else. And there was undoubtedly limited education about taking medications with alcohol or other substances.
It doesn’t help that there’s conflicting info on the internet. A google search reveals some articles that say it’s okay to drink with medication and others that recommend not drinking. It seems we can’t get a straight answer from science or Google.
Here’s a thought — the pharmaceutical and alcohol industries are multi-billion dollar businesses.
Perhaps we can draw some conclusions about the nature of this confusion.
To drink or not to drink is entirely up to you. But know that if you suffer from anxiety, a contributing cause could be staring back up at you from the bottle.