Hangxiety and the link between alcohol and anxiety

In this article, Mental Health Prevention Lead Lisa Gunn explores why alcohol can have this effect, whether certain drinks are worse than others, and what to do if you think you have a problem with alcohol.

Key takeaways

• People who experience social anxiety have higher incidence rates for alcohol-related problems
• Alcohol affects neurotransmitters in the brain which can induce anxiety
• We can get temporary relief from anxiety when we consume alcohol
• 19% of people say their alcohol intake has hurt their physical health and mental health
• When we sober up, anxiety can intensify and worsen
• ‘Hangxiety’ describes the fear, dread, and panic we can experience the morning after
• Blacking out and overconsumption can intensify all of this
• Chronic alcohol use can have a permanent effect on our anxiety levels

Why does alcohol make my anxiety worse?

Alcohol is a depressant that can initially produce a calming effect. When this wears off, we typically see a rebound effect where anxiety levels spike. This is partly because alcohol disrupts the balance of neurotransmitters and chemical messengers in the brain.

There is also a social aspect to this. When we drink, we become inebriated and ‘care-free’, which can cause us to say and do things we wouldn’t do when we’re sober. If we go into ‘blackout’ (periods of alcohol-induced memory loss) during a period of acute intoxication, we are even more likely to wake up with feelings of anxiety, fear, worry, and dread.

Other ways alcohol can amplify anxiety include:

• Dehydration
• Disrupted sleep
• Not eating properly before, during, and after a night out
• Low blood sugar levels
• Physical fatigue after a night out

Can alcohol ever help reduce anxiety?

When we drink, we may experience short-term relief from anxiety. This is especially true of social anxiety because alcohol can make us feel more relaxed, at ease, and comfortable with ourselves.

This is a short-term solution and is not recommended for a variety of reasons, including:

• It’s a short-term solution to a long-term problem
• You risk developing dependence on alcohol
• It doesn’t address the anxiety itself
• Symptoms can intensify when we sober up
• It can lead to overconsumption

Alcohol and ‘hangxiety’

Some people call the anxiety, worry, dread, or panic after a night of heavy drinking ‘hangxiety’ or ‘the fear’. It’s common in heavy drinkers who routinely ‘blackout’ because of excessive alcohol consumption.

These intense hangovers can be so strong that you might avoid certain people or places because of how you think you behaved, or even find yourself uttering the words “I’m never drinking again”.

While feelings of anxiety and worry are common after a night out, hangxiety is characterised by intense feelings of dread and worry that can be difficult to shake off. Some common physical and mental symptoms of it include:

• Fear
• Worry
• Paranoia
• Increased heart rate
• Embarrassment
• Swearing you’ll never drink again
• Restlessness
• An intense desire to ‘put things right’ or to ‘wind back the clock’
• A heavy sense of dread
• Intense anxiety
• A desire to isolate
• Worrying about what you think you said or did last night

How common is this?

Waking up in the morning with a pounding head and a patchy memory can feel very lonely. If this sounds familiar, it’s important to remember that anxiety after a night out is incredibly common because of how alcohol affects our central nervous system.

One study estimates that around 12% of adult drinkers experience anxiety during a hangover, with a further 15% experiencing depression. Another study reported significantly higher numbers of 18.3% for anxiety and 29.9% for depression.

What’s most important to remember is that if you already experience problems with anxiety or if you naturally worry a lot, you may be more susceptible to certain symptoms, thoughts, feelings, and emotions when you consume alcohol.

Alcohol and social anxiety

People with social anxiety often turn to alcohol as a way of getting through uncomfortable social situations. The initial feeling alcohol gives can bring about a sense of relaxation and ease, making it easier to talk and socialise with others. It can temporarily reduce feelings of self-consciousness, worry, and anxiety, however, this relief is usually fleeting.

As the alcohol starts to wear off, our body returns to a natural state and a rebound effect as we sober up can heighten our anxiety. For socially anxious people, this can mean fixating on what we did and said, how we looked, what other people thought of us, and an overall sense of embarrassment about our behaviour while intoxicated.

Over time, a reliance on alcohol to manage social anxiety can even worsen the problem and lead to a harmful cycle of dependence. Instead of helping with our anxiety, alcohol may start to worsen it, making social situations even more difficult to manage.

Alcohol and panic attacks

For individuals prone to panic attacks, alcohol can be particularly problematic.

Alcohol can make us feel more laid back and relaxed, but the rebound anxiety we feel when we sober up is a common trigger for panic attacks in highly anxious people. While we may feel confident and carefree on a night out, a combination of the following can trigger a panic attack:

• Dehydration
• Fluctuating blood sugar levels
• Self-consciousness
• Social anxiety
• Fatigue
• Memory loss
• Hangxiety the following morning

Alcohol-induced memory lapses or blackouts can further contribute to anxiety and panic and amplify a sense of worry about our actions and behaviours when we’re drunk.

To help manage panic attacks effectively, try to address the underlying anxiety with a professional. Healthier coping strategies like therapy, making sensible and manageable lifestyle adjustments, and using stress management techniques are much more effective in the long run.

Are certain drinks worse than others?

We’ve all heard people say different drinks affect them differently. Whether it’s “wine makes me emotional” or “tequila makes me anxious”, is there any truth in any of this?

The simple answer is that alcohol is a liquid made from fermented sugar (ethanol) and when we mix this with other additives and compounds, we get different flavours and alcoholic beverages. This is what can cause different drinks to react differently in different people.

Wine

Red wine contains histamines and tyramine, which cause headaches and anxiety-like symptoms in some people. These compounds can make red wine more likely to trigger anxiety in susceptible people.

White wine typically has fewer histamines than red wine but can still raise anxiety because of its alcohol content and sugar levels.

Sweet wines tend to have a higher sugar content that can spike or drop our blood sugar levels and induce ‘jittery’ or restless symptoms in people who are more susceptible.

Beer and lager

Beer and lager generally have a lower alcohol content than wine and spirits, which can result in a more gradual increase and decrease in blood alcohol levels. Because of the lower alcohol content, we can typically drink more lager over a longer period. This can help with rebound anxiety, but it still depends on how much we consume.

Spirits

Spirits have a high alcohol content that often exceeds 40%. This can cause our blood alcohol level to spike, which can lead to more pronounced rebound anxiety once the effects wear off.

Because of their high alcohol content, spirits are more likely to cause us to blackout, which can worsen rebound anxiety the following morning.

Cocktails

Cocktails are typically made from a blend of spirits and fruit juices. Cocktails can be a deceptively strong drink, as they often contain multiple shots of alcohol and taste sweet and sugary because of their fruit juice base. This can lead us to drink more than we can handle because the drinks are tasty.

The sugary mixers in a cocktail can also heighten anxiety by causing our blood sugar levels to rise and fall over the course of a night out.

Can you drink while taking anxiety medication?

Drinking alcohol while taking medication for anxiety is generally not recommended. This is because alcohol can reduce the effect of an antidepressant or anti-anxiety medication. Drinking whilst taking certain medications can also induce side effects like drowsiness, dizziness, confusion, and stomach problems.

It can also detract from a healthcare professional's ability to assess whether the medication is working or if it’s right for you. If alcohol is a source of anxiety for you to begin with, a doctor will be unable to say whether the medication is helping if you’re still drinking regularly.

The practice of ‘skipping’ doses when you know you’re going to be drinking should also be avoided. While having a couple of drinks is unlikely to harm you, taking a break from long-term treatment can make drug therapy less effective and ultimately harm your mental health. You also risk setting back your treatment, since many people will stop taking their medication altogether after a short break., leading to amplified symptoms further down the road.

You should always have an open and honest conversation with your healthcare professional so you can receive the best advice for your situation. This will also help you decide what safe limits look like for you depending on which medication you’re on.

Tips for managing anxiety

It can be tempting to try and mask feelings of anxiety, restlessness, or worry with alcohol, but there are safer and more effective ways of managing these feelings.

Talk with a therapist

Working with a therapist to unpack the link between your anxiety and your drinking habits is a great way to understand more about your relationship with alcohol.

Whether you think you have a problem or not, learning more about why you’re feeling this way and your triggers can help improve your overall condition and make you a more confident, happier person.

Our professionals are trained to deal with drink-related mental health problems and can provide expert guidance and advice that’s tailored to you and your unique situation.

If you’re interested in how therapy at Nuffield Health can help you, click here to find out more.

Lifestyle changes and self-care

According to our Healthier Nation Index survey, 14% of people have reduced their alcohol intake over the last 12 months to look after their mental health.

Making lifestyle adjustments that are directly linked to your alcohol consumption can help make adjusting your drinking habits a lot easier. Learning more about the triggers that cause anxiety in our mind and body means we can slowly start to adjust our behaviour and introduce more compassionate and caring practices that work for us.

This includes:

• Spending more time doing hobbies you enjoy
• Getting regular exercise
• Making sure you’re sleeping enough
• Socialising away from alcohol
• Taking breaks from alcohol
• Looking at your diet and staying hydrated
• Avoid triggering people, places, and things
• Journaling and writing your feelings down

Seeking help for your drinking

If you’re struggling to stop drinking and think you might have a problem with alcohol, there is help available. From support groups with like-minded people to one-to-one therapy, talking about your anxiety and how alcohol makes you feel can help you better understand your relationship with it.

If you think you have a problem with alcohol, consider contacting one of the services below for help:

• Seeing your GP means having someone listen and advise the best course of action for your mental and physical health based on your current intake and relationship with alcohol
• Al-Anon offers support and understanding to the friends and family members of problem drinkers and alcoholics
• Alcoholics Anonymous (AA) runs free self-help groups for anyone who thinks they have a problem with alcohol. There is no need for membership and each group is free and self-supporting
• Drinkaware provides advice, information, and tools to help people make better choices about their drinking. Drinkline is a free and confidential helpline they run for anyone worried about their drinking or someone else they know
• Talk to Frank provides free information and advice on all things drug and alcohol-related
• SMART Recovery groups help people understand more about their relationship with alcohol and build motivation to control and change how they interact with alcohol
• Turning Point offers tailored support to people with drug or alcohol problems. This could come in the form of advice, medical treatment, peer support, social activities, or help getting back into work
• We Are With You offers free and confidential advice and support for people with alcohol, drug, or mental health problems. They also have a helpline and a webchat specifically for people over the age of 50.

Alcohol withdrawal and anxiety

Feelings of paranoia, worry, fear, and despair are all common in individuals tapering off alcohol. During a detox, anxiety can manifest physically and mentally, often causing symptoms like 'the shakes,' trembling, distress, and panic as the body and mind go through withdrawal.

If you are physically dependent on alcohol, you should never stop drinking on your own. Going ‘cold turkey’ can cause the onset of delirium tremens (DTs), which can lead to intense confusion, hallucinations, violent seizures, and even death.

The severity of the symptoms a person experiences during withdrawal will typically vary depending on their level of dependence, their mental state entering a detox, and their overall physical condition. During a medically supervised detox, doctors and other support staff will work to minimise the intensity of all the symptoms mentioned above to make the process as safe as possible.

Over the long term, the prospect of never drinking again or having to adjust your relationship with alcohol can also be scary and anxiety-inducing. In alcoholics, these unsettling and anxious thoughts about the future are commonplace and can ultimately result in relapse if left unchecked.

Last updated Wednesday 19 June 2024

First published on Wednesday 19 June 2024