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Throughout history, anxiety and alcohol have been related. Today some people who seek medical help for anxiety may also be excessive drinkers and at alcoholism clinics, patients often complain of anxiety symptoms. It is estimated that about 60% of people in rehabilitation centres have an underlying anxiety disorder. These range from generalized anxiety disorder and social phobia to panic disorder and post-traumatic stress disorder.

Some patients state that drinking is a solution for their anxiety. For example, a study involving Norwegian medical students, showed that those who report using alcohol ‘for stress’ tend to drink more than their peers do. The fear of being anxious on social occasions is also stated as a reason for drinking regularly. Some adolescents find alcohol is a rapid and, in the short term, effective way to alleviate fears of not being accepted by their peers. Some people become alcohol-dependent because of their liking for the effects of alcohol, or because alcohol is part of their social or work setting. But stating that you ‘drink to cope’ predicts that in the next 10 years problematic drinking may develop, or if it had been there already, may increase. Then it can be embarrassing to find they have difficulty controlling their drinking and this can lead to enormous amounts of distress.

Post-traumatic stress disorder (PTSD), an anxiety disorder following a traumatic event outside the range of usual human experience, is commonly associated with alcohol misuse. To deal with the unpleasant symptoms experienced after a traumatic event many people use alcohol to numb their emotions and help them to forget for a while.

Although with regard to traumatic events in adult life, one study has actually found that being a regular drinker prior to the event reduced the risk of later PTSD. This is in line with other general population research, which suggests that regular drinkers (note: not heavy drinkers) have better mental health than abstainers, partly due to social and personality characteristics.

Another common cause of anxiety and alcohol dependence might be an independent depressive disorder. Anxiety symptoms, including irrational fears, are an important part of depressive illness.

But the link between these two disorders could also be the other way around. Heavy drinking can cause anxiety. Tremors, insomnia, irrational fears, palpitations and excessive sweating are symptoms that are common to both disorders. Anxiety symptoms also occur during alcohol withdrawal, although about 80% of patients recover from all anxiety symptoms after about 1 month of abstinence.

The severity of dependence predicts the degree of anxiety and other psychological distress. If drinking resumes after detoxification, anxiety symptoms, which recovered quickly, return.

When withdrawal symptoms occur in a crowded place, where people may feel they are being observed, or if they feel far from home, they may develop a phobia of returning to that situation. Even after giving up alcohol though, sometimes these attacks can then develop a life of their own, creating a phobic disorder, panic disorder or agoraphobia, a fear of being in public places.

Alcohol dependence may also cause anxiety because of the stressful consequences of drinking, such as marital tension or break-up, threats to job security, or impending legal proceedings. A sense of imminent disaster may develop which, although seeded by a real adverse event, grows out of proportion. There is restlessness, difficulty concentrating, irritability and/or disturbed sleep.

Whichever came first, there is help. If you feel you or someone you know may have these symptoms, contact the Depression and Anxiety Support Group, Monday to Friday, 8am to 7pm, Saturdays, 8am to 5pm or on Sundays 9am to 1pm, on (011) 783-1474/6. Trained counsellors are available to listen and where appropriate, give referrals for further help.

Getting help for both problems is recommended and a combination of psychotherapy and medication seems to be the most effective route. Anxiety disorders secondary to the drinking tend to have a good outcome, but thanks to recent developments in medication research and therapy approaches, so do primary anxiety disorders with alcohol dependence as a result.

*taken from Understanding and helping patients with anxiety and alcohol dependence – Jonathan Chick, Dept of Psychiatry, Univ. of Edinburgh