Crippling anxiety after a night of drinking, explained

Crippling anxiety after a night of drinking, explained

VicesDecember 26, 2017 By Sean Sullivan

A party approaches and you’ve mentally crossed off each hour of the week until you can leave the world behind for another good time. Now it's here; so you drink. And at some point, the world goes black, the sun rises, and along with the familiar story of regret comes an excruciating headache. And what else? A massive dose of anxiety. Yes, you did "do that" — and now you’re paying for it with a sobering panic dissecting every drunken decision from the previous night. 

You’re not alone. Alcohol and anxiety have been married for a long time. But, why?

First, we need to know what happens when you start knocking back shots like the apocalypse is scheduled for tomorrow. We spoke with George F. Koob, Ph.D., Director of the National Institute on Alcohol Abuse and Alcoholism, to find out.

“Alcohol is acutely an anxiolytic — it decreases anxiety and is relaxing, in most people — but it has a relatively short action,” Koob says. Anyone who’s had a drink already knows this: it takes our troubles away temporarily, which is partially why almost every civilization has honored alcohol as the nectar of the gods — thank you, Bacchus. 

As the blood's alcohol content level (BAC) rises (that’s the measurement that says you’re going to jail if you’re behind the wheel and it's over 0.08 percent), inhibitions melt away. Because alcohol is playing with your brain like policymakers, altering chemicals that regulate how you feel, so that the brain’s reward center is firing off constantly as you consume, saying, “Great job! Here, have another. Now go interrupt that group of strangers and tell them about yourself.” You’re walking on boozy sunshine.

But, as Dr. Koob adds, “The brain generates an opposing response to the relaxing effects, and when the alcohol wears off, one is left with the opposing response, also known as a hangover.” In one sense, a hangover is your brain punishing itself: Why did you poison me? Hence why you feel awful in all the appropriate ways one feels after a night of drinking: dehydration, nausea and a pulsating headache. In another sense, a hangover indicates that your nervous system is clawing back to life, and as it does, so does your Jiminy Cricket conscience.

Those inhibitions that alcohol suppressed are back in the office, causing anxiety to ratchet up as you retrace your steps through last night’s yellow fog. It doesn’t go well. Oh, no. Did I really do that keg stand? Yes, you did, and worse. And with each hazy memory, you accumulate more things to worry about. There’s even a fun portmanteau for that next-morning alcohol regret: Hangxiety (which could also refer to an erectile dysfunction; watch out for whiskey).

"Drunkenness is temporary suicide." - Bertrand Russell

Hangxiety isn’t all bad. In fact, at least one study suggests that some degree of anxiety about last night’s intoxication is appropriate. If you feel bad about all the stupid things you did it may be because you’re normally a well-functioning, moral person. Dr. Koob writes, “Many people take [a hangover] as a warning that they were or have been drinking too much.” So, be thankful for that little spurt of anxiety and recognize that you probably need to stop sampling drinks from around the world in a single night.

But maybe you're someone who feels anxious while drinking — not just when you wake up in the morning. There's science on that too.

According to a study published in the journal Nature Neuroscience, alcohol numbs your natural ability to deal with fear, meaning you have a much harder time escaping from anxious thoughts. You try to suppress that anxiety by drinking so much your heart pounds against your chest like it’s too tall at the basement rave. You misinterpret the palpitation, and what happens? You immediately jump to the worst possible — WebMD certified — answer: Game over man. I’m dying. That’s the anxiety train slamming into a brick wall.

For the most part, both cases of alcohol-related anxiety dissipate once you stop feeling like you’re two drinks behind. According to Dr. Koob, “If you drink enough you can develop an anxiety-like disorder that should remit when you stop drinking.” Phewph. Okay, so once you get some eggs and juice into you, and wait about 24 hours, you should be feeling better and then everything's back to normal; no more worries, right? Not exactly.

“Alcohol can also 'precipitate' (unleash) a latent (primary) anxiety disorder in a vulnerable individual that can persist even beyond abstinence,” Koob says. Uh oh. Alcohol can actually cause people to experience anxiety apart from weekends and weekend recoveries. And who knows how it will manifest itself. 

There are all kinds of anxiety, from the crippling social phobia that makes someone shrivel into their shirt like a turtle, to the inability to speak with even Amazon customer service when a blender arrives dead on arrival. We lump them all together for convenience, though as far as alcohol is concerned, social anxiety tends to top the chart. According to the Anxiety and Depression Association of America (ADAA) there are about 15 million American adults right now with a social anxiety disorder of some sort. And more than one-third don’t seek help for at least a decade.

Instead, sufferers of anxiety pass the clinic and the pharmacy for the liquor store as a form of treatment. A study conducted by Sarah W. Book, M.D. and Carrie L. Randall, Ph.D., found that “About one–fifth of patients with social anxiety disorder also suffer from an alcohol use disorder (AUD) (i.e., alcohol abuse or dependence).”

We’re right back to where we started. You drink, maybe to ward off anxiety so excessively that you start to feel anxious even when sober. So, then you drink to try and mellow out, but wake up feeling horrible so you take another drink, and repeat the process ad infinitum. Not good.

According to the NIAA, an estimated 16 million people have Alcohol Use Disorder (AUD), which is diagnosed according to the DSM-5 psychological fact sheet. And “DSM diagnosed anxiety disorders have a 20-40 percent comorbidity with alcohol use disorder,” according to Dr. Koob. It’s a vicious cycle.

What’s the solution?

The solution is easy, even obvious. If you drink only a bit and feel overwhelmingly anxious then cut back. Simple, right? Learn your limits: don’t move from IPAs to vodka tonics to icy tequilas in a single evening. As soon as you start to feel self-critical and doubtful while sipping on mystery punch, stop! There’s your limit. Drinking isn’t going to help you quell those doubts. 

But if you drink to excess and then feel anxious in excess, there’s only one way to help yourself and nobody ever wants to hear it: stop drinking. Self-medicating with alcohol is like trying to cure syphilis by visiting brothels. It only makes it worse.

“Seeking help from clinicians is key to understand whether anxiety symptoms are secondary to excessive drinking or they reflect a primary anxiety disorder,” says Dr. Koob, and the NIAAA has a treatment guide to help those who want to help themselves.

Remember, it’s okay to experience a bit of anxiety as a part of drinking. But when alcohol induced anxiety becomes a debilitating shadow that follows you every day, when you spend more time worrying than enjoying yourself, it might be a sign that liquor is not for you. Or, that there’s something else going on and you ought to talk to a professional (not the Internet) to hack at the root of the problem.

To pull a line from another substance-abusing product, “If it’s not a pleasure, why bother?” After all, the point of drinking — the reason it’s endured for many thousands of years — is because it takes away the worries of the world.

If drinking alcohol only makes you anxious, why bother?