And how to stop the vicious cycle.

By Julia Malacoff
Jun 23, 2020 @ 11:08 am
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If you’ve ever woken up the morning after a big night out (or just splitting a bottle of wine with a friend on your the couch) with a sense of panic, doom, or general anxiety, you’re not alone. In fact, anxiety after drinking alcohol is relatively common, experts say.

Considering that both alcohol consumption and anxiety are currently on the rise due to the coronavirus pandemic, it’s helpful to understand the relationship between alcohol and anxiety, plus what you can do if you’re experiencing anxiety after drinking.

Drinking alcohol is a common coping strategy.

“Many people drink to relieve symptoms of anxiety and insomnia,” points out John Krystal, M.D., chief of the Department of Psychiatry at Yale Medicine and a leading researcher in alcohol use disorder. Often, people use alcohol to de-stress after a long day that spiked already-existing anxiety. This can set off a vicious cycle, Dr. Krystal says. “Heavy drinking often contributes to problems at home and at work, which increases life stress levels, further motivating heavy drinking.”

Some people also drink alcohol to deal with anxiety in social situations. “Alcohol generally lowers inhibition, so it can feel liberating for people who are self-conscious or anxious,” explains Perpetua Neo, Ph.D., a psychologist who works with high-achievers — successful, type A personalities — who deal with anxiety. But for some, alcohol can paradoxically increase anxiety and self-consciousness by raising your heart rate, causing your skin to flush, and more. This can cause an already-anxious person to become hyper-aware of how they’re feeling, making them feel even more anxious than they would otherwise. That effect ends up carrying over into the hours after drinking, and maybe even the following day.

But people who already have anxiety aren’t the only ones who can experience weird, jittery feelings after drinking. This can happen for a couple of other reasons, according to Ruby Mehta, LCSW, clinical operations lead at Tempest. “Alcohol interferes with the quality of our sleep,” she explains. And when we’re sleep-deprived, “it primes our body to be anxious.”

Plus, Mehta explains, “the physical symptoms associated with hangovers are similar to anxiety: nausea, dehydration, rapid heartbeat.” When you take these factors into consideration, it’s no wonder people often experience anxiety along with their hangover.

Even worse: the next-day crash is significantly more likely if you’re already prone to anxiety, according to Elena Touroni, PsyD, a clinical psychologist and co-founder of My Online Therapy.

Alcohol also affects the chemicals in your brain, which can spike anxiety.

Alcohol is a sedative, which is part of why some people temporarily feel “better” after a few drinks. “Unfortunately, Newton’s Law applies here: ‘For every action, there is an equal and opposite reaction,’” says Brad Lander, Ph.D., addiction medicine specialist at The Ohio State University Wexner Medical Center. If you’ve only had a moderate amount to drink, it’s probably not going to be super noticeable. But if you’d had a larger amount to drink, the bounce-back effect will be more pronounced, Lander notes.

There’s also the fact that alcohol affects your brain chemistry. “The pleasant feeling we get from drinking comes from a rise in serotonin in the brain,” Lander says. But alcohol also affects other neurotransmitters, or chemical messengers with many functions, including sending messages between your brain and body. “Drinking causes gamma-aminobutyric acid (GABA) to go down, which accounts for the disinhibition that happens when we drink.” Think: kissing a stranger or calling your ex, Lander explains. “As the GABA levels go down, glutamate levels go up, and glutamate is associated with anxiety.”

What should you do to stop anxiety after drinking?

To reduce anxiety in the moment, try to be kind to yourself, Touroni suggests. “If you’re someone who already experiences anxiety day-to-day, then you’re likely to have a harsh and punishing inner critic. The last thing you want to do is beat yourself up when you’re feeling vulnerable, so try and notice and call out any shaming inner chatter. And remind yourself it will pass.”

Another way to keep yourself calm is to try a breathing exercise. “This is a safe and effective way to calm the nervous system’s ‘fight or flight’ response, which is what causes the rapid heartbeat and racing thoughts,” Mehta explains. “You can start with a 4-3-5 breath, where you breathe in for 4 seconds, hold the breath for 3 seconds, and then slowly breathe out for 5 seconds. You can repeat this process for a few minutes to quell feelings of anxiety.”

If you’ve been drinking to deal with anxiety and it’s making it worse, Dr. Krystal recommends identifying sources of stress. A big one to consider right now: “We are dealing with the psychological impact of the COVID-19 pandemic,” he says. “Surveys suggest that people are experiencing increased levels of anxiety as a consequence of the COVID-19 pandemic.” Online therapy might be a good option, particularly if you’re still stuck in a stage of lockdown.

In terms of preventing future anxiety after drinking, the most effective option is to avoid alcohol altogether. “It’s not unusual to feel ‘jittery’ after a night of drinking, but if it’s causing problems for you, don’t drink,” Lander says. “If you were allergic to shellfish, you wouldn’t eat shrimp every weekend.” If you continue to drink, the problem could get worse, he says. “As neurotransmitters get further and further out of balance, the recovery time gets longer and longer — meaning the anxiety keeps getting worse.”

If you’re having a hard time quitting or reducing your alcohol intake or want to work on alternative coping mechanisms, getting help is key. “I would suggest speaking with a therapist or mental health professional (if you don’t already), and being honest with them about how you feel,” Mehta says.

Another option: Think of what your future looks like, Neo suggests. “Does drinking bring you closer to that self, or further away? Then look at the company you keep,” she recommends. “If they're all about drinking and little else, perhaps it's time to change your environment.”