Dual Diagnosis: Alcoholism & Anxiety

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Facts About a Dual Diagnosis of Alcoholism and Anxiety

Many people struggle with crippling alcohol addiction on a daily basis. This is a disease that can take control of you and dictate your life every single day. Unfortunately, if you have a substance use disorder (SUD) involving alcohol, the chances that you have a dual diagnosis are high. This occurs when you have an addiction and a mental health disorder simultaneously.

One type of dual diagnosis is alcoholism and anxiety. If you were diagnosed with both conditions, you’re not alone; many people who have anxiety turn to substances to blunt the effects of their mental health disorder. These are some facts about dual diagnosis and how to handle it.

What Is Dual Diagnosis?

If you have a dual diagnosis, it means that you suffer from both a substance use disorder (SUD), such as alcoholism, and a mental health disorder. Many people with alcohol use disorder (AUD) also have a mental health condition.

Why Do People Have a Dual Diagnosis?

In many cases, a person with anxiety or another mental health disorder cannot cope with their symptoms. So, they turn to alcohol or other drugs to diminish their discomfort. Unfortunately, these substances make the person feel even worse. The reverse is also true: A person who has a serious AUD may end up developing a mental health disorder. Alcoholism and anxiety are a common mix.

Certain factors, like genetics and environment, can contribute to the development of dual diagnosis of alcoholism and anxiety. If a person has a family history of mental health disorders or SUD or both, it increases the risk that they will follow suit and develop at least one of those conditions. Environmental factors such as stress or trauma can lead to a person developing alcoholism or a mental health disorder. These issues can combine so that the individual requires a dual diagnosis.

Regardless of the initial problem affecting a person, anxiety can lead a person to develop an AUD that can encourage the development of anxiety. In the former situation, the individual may turn to alcohol to self-medicate to better cope with the symptoms of their mental health condition. In the latter situation, anxiety could develop because of the way alcoholism changes the brain.

Signs of Alcohol Use Disorder

According to the Anxiety and Depression Association of America, approximately 20% of individuals with anxiety also have an alcohol use disorder (AUD). Also, according to a study, women are more likely to turn to alcohol when they struggle with anxiety. Although drinking may temporarily mute the symptoms of anxiety, it can also increase the risk of other side effects.

A person may be at risk of alcoholism if they experience the following:

  • Consume alcohol four or more times weekly
  • Drink five alcoholic beverages daily
  • Are unable to stop drinking alcohol
  • Must have an alcoholic beverage immediately upon waking up to become motivated
  • Experience feelings of guilt after drinking
  • Have been told by a loved one, medical professional or coworker that they need to cut down or stop drinking altogether

How Does Alcoholism Impact Anxiety?

People often develop anxiety as a result of excessive worry or a traumatic event they experience or witness. When someone with anxiety has trouble dealing with their symptoms, they might turn to alcohol as a way to calm down. However, while this might be a quick fix in the short term, the opposite effect occurs once the alcohol in their system wears off. This leads to the person consuming more and more alcohol to ease the symptoms and developing an addiction. In turn, this results in a dual diagnosis of alcoholism and anxiety.

There are similar effects in individuals who struggle with alcoholism and subsequently develop anxiety. Alcohol changes various brain chemicals, which can cause anxiety. As a result, if someone has a long-term alcohol use disorder, it can cause some of those changes in the brain to become permanent. In some cases, attempting to quit drinking cold turkey can also cause anxiety, which is a common alcohol withdrawal symptom. This can be dangerous and even life-threatening, underscoring the need for professional help instead of trying to go it alone.

How to Realize You Have a Dual Diagnosis

Unfortunately, in some cases, you might need to reach rock bottom to realize that you have a problem with alcohol and anxiety. Certain signs and symptoms can indicate this dual diagnosis. They include:

  • You rely on alcohol to calm you when you have an anxiety attack or even when you feel overly stressed out about a real or imagined situation.
  • You’ve noticed a link between your alcohol use and your anxiety, have recognized that drinking worsens your anxiety symptoms, or feel that your symptoms worsen after the alcohol has left your system.
  • You have a family history of alcoholism or anxiety or another mental health disorder. This can include any combination of these issues.
  • You experience anxiety symptoms regardless of whether you are sober or have been drinking.
  • You have previously sought treatment for your alcohol abuse or anxiety.

Although it can be jarring to finally realize that you have a dual diagnosis, all hope is not lost. Denial is a common initial reaction, but once you come around to accept your situation, it puts you that much closer to seeking help.

What Is Anxiety?

Anxiety disorder is a mental health condition that affects your daily life and how you perform certain tasks. There are different types of anxiety, but even if a person suffers from generalized anxiety disorder, they can experience a slew of symptoms. The body and mind undergo what’s known as a fight or flight reaction to a real or perceived threat. However, there are also varying levels of anxiety. One person may be anxious due to specific issues such as health. The next might experience symptoms due to multiple factors, to the point where they have trouble functioning normally in society.

How Alcohol and Anxiety Medications Interact

A dual diagnosis involving alcohol addiction and anxiety is dangerous for different reasons. In addition to the way alcohol can exacerbate the symptoms of an anxiety disorder, mixing alcohol and anti-anxiety medications is dangerous. Alcohol is a depressant, so it slows your central nervous system. When taken with anti-anxiety drugs such as benzodiazepines, the consequences can be deadly. Combining alcohol and such medications can cause the respiratory system to slow down to dangerous levels. In the worst-case scenario, a person can stop breathing and die if they don’t have quick medical intervention.

Alcohol mixed with other anxiety drugs such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) can cause severe drowsiness. This makes certain activities like driving dangerous.

How Diagnostic Tests Can Detect Dual Diagnosis

If you believe you may have a dual diagnosis involving alcoholism and anxiety, it’s crucial to seek medical assistance. However, dual diagnosis is actually a combination of problems. The doctor may have to perform certain diagnostic tests to rule out certain conditions because many symptoms of alcoholism and anxiety can mimic each other. It’s also important to honestly answer any and all questions the doctor asks so that they can make a definitive diagnosis and recommend the treatment you need.

What Are the Treatment Options for Dual Diagnosis Involving Alcoholism and Anxiety?

When you seek treatment for a dual diagnosis involving alcoholism and anxiety, your doctor or other healthcare provider will tailor the program based on your specific needs. No two individuals are exactly alike, so what might work for one person may not work for you. Your provider will aim to learn how your alcohol use disorder and anxiety counteract so that they can come up with the best treatment regimen.

One of the first steps in treating alcoholism coupled with anxiety is to enter a detoxification facility to withdraw from alcohol. In most cases, this means inpatient detox where you are monitored by trained professionals on a daily basis. If your withdrawal symptoms are severe, they will be there to assist you in easing those effects. 

Once you complete the detox process, you may enter a therapy program. This might include cognitive behavioral therapy (CBT) to help you understand why you started abusing alcohol and teach you better ways to respond to triggers and your anxiety symptoms. Another treatment is dialectical behavioral therapy (DBT), which can help you minimize self-destructive reactions and behaviors.

Support groups are other therapeutic options. They are helpful for many people with dual diagnosis, including those who have alcoholism and anxiety. Support groups allow you to meet with other people in the same or very similar situations so that you can share your own personal stories about your own experiences. With group support, you and others can find strength and solace in one another and offer helpful advice on how to deal with a variety of issues so that you can move forward on a positive path.

Healthier Ways to Deal with Anxiety

For some, anxiety can be crippling. Even with milder forms of this mental health condition, it can be difficult to cope with symptoms like panic, fear, racing heart, and hyperventilation. However, there are healthier ways to deal with anxiety that don’t involve consuming alcohol. One of the best options is to practice meditation to control your breathing and clear your mind. It can also help lower your heart rate to healthy levels.

Yoga, tai chi and other types of exercise can help ease the symptoms of anxiety while keeping your body toned and limber. Any type of exercise is good for easing anxiety and giving you a sense of purpose and accomplishment. Working out also helps to release dopamine in the brain, making you feel better.

Keeping a journal can also help ease anxiety symptoms. It’s empowering to jot down all your thoughts, feelings and fears.

A weighted blanket is great for easing anxiety and calming you by mimicking the feeling of an embrace over your body. If you suffer from nightmares, a weighted blanket may even help reduce those bad dreams.

If you have a dual diagnosis involving alcoholism and anxiety, reach out to our caring team at AlcoholAwareness.org. Call our free 24/7 alcoholism hotline at (855) 955-0771. We can recommend a support group and other resources in your area.

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