Drinking and anxiety
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The Relationship Between Drinking and Anxiety
Co-Occurrence of Alcohol Use Disorder and Anxiety
A significant number of individuals with alcohol use disorder (AUD) also experience anxiety disorders. Research across psychiatry, psychology, and neuroscience indicates that having either an anxiety or alcohol-related diagnosis increases the risk of developing the other disorder. Behavioral studies show that drinking to cope with negative emotions is a strong predictor of current and future alcohol problems. Neuroscientific research suggests that overlapping neurobiological systems and psychological processes contribute to both anxiety and alcohol misuse.
Drinking to Cope with Social Anxiety
Individuals with high social anxiety often use alcohol to manage their social fears. Studies have shown that socially anxious individuals are more likely to drink to feel comfortable in social situations and avoid these situations if alcohol is unavailable. They report that alcohol provides moderate relief from anxiety, which helps them endure social interactions. This behavior supports the self-medication hypothesis, which posits that alcohol is used to reduce social discomfort in socially anxious individuals.
Variable Relationship Between Anxiety Disorders and Alcohol Problems
The relationship between anxiety disorders and alcohol problems varies among different types of anxiety disorders. For instance, alcohol problems in individuals with agoraphobia and social phobia are more likely to result from attempts to self-medicate anxiety symptoms. In contrast, panic disorder and generalized anxiety disorder may more often follow from pathological alcohol consumption. Simple phobia does not appear to have a meaningful relationship with alcohol problems.
Impact of Drinking to Cope on Treatment Outcomes
Drinking to cope (DTC) with anxiety significantly affects the treatment outcomes for individuals with co-occurring AUD and anxiety disorders. Studies have shown that patients who engage in DTC behavior before treatment benefit more from cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms compared to those who receive only anxiety symptom reduction training. This suggests that addressing the functional link between anxiety and alcohol use is crucial for effective treatment.
Alcohol Consumption as a Risk Factor for Anxiety and Depression
Longitudinal studies have been inconclusive in identifying alcohol as a direct risk factor for anxiety and depression. However, excessive alcohol consumption has not been consistently associated with the onset of these conditions. Interestingly, abstainers are less likely to develop new-onset anxiety and depression, while sub-threshold symptoms of anxiety and depression are weakly linked to the onset of alcohol dependence.
Social Anxiety and Heavy Situational Drinking
Socially anxious individuals are at greater risk for alcohol use disorder, particularly in high-risk situations involving negative emotions or personal/intimate contexts. Drinking motives such as coping and conformity mediate the relationship between social anxiety and heavier alcohol consumption in these contexts. This suggests that interventions targeting these specific drinking motives could be beneficial for socially anxious individuals.
Anxiety Sensitivity and Coping-Related Drinking Motives
Anxiety sensitivity (AS), the tendency to interpret anxiety sensations as dangerous, is linked to the use of alcohol to cope with negative emotions. Research indicates that anxiety symptoms mediate the relationship between AS and the tendency to use alcohol for coping. This highlights the importance of addressing anxiety symptoms in treatment programs for individuals with high AS to reduce their reliance on alcohol for coping.
Conclusion
The relationship between drinking and anxiety is complex and multifaceted. Individuals with anxiety disorders often use alcohol to cope with their symptoms, which can lead to the development of alcohol use disorders. The effectiveness of treatment for co-occurring AUD and anxiety disorders can be significantly influenced by the extent to which individuals engage in drinking to cope. Understanding the specific contexts and motives behind drinking behavior in anxious individuals is crucial for developing targeted interventions and improving treatment outcomes.
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