For those with anxiety disorders, the risk of developing a substance abuse problem is 2 to 3 times higher than for the general population. Using alcohol can help to numb some of the debilitating symptoms of anxiety. For those with social anxiety disorder, having a few drinks can help make social situations more bearable. For those with panic attacks, alcohol and marijuana can have an initial calming effect, lessening the feelings of anxiety for a short time.
But self-medicating with alcohol, or other substances, can cause more harm in the long run. The more often you use alcohol to help numb symptoms of anxiety, the more alcohol you need to get the same effect. Many people develop a dependency on alcohol and suffer the effects not only of anxiety but of substance abuse - both physically and emotionally.
When you have a hangover, your body is going through withdrawal.
Besides the upset stomach and headache that often accompany a hangover, other symptoms include:
- Increased anxiety, agitation or panic attacks
- Elevated blood pressure
- Increased heart rate
- Increase in body temperature
The drinks that initially helped you cope with your symptoms have the potential to worsen your anxiety the next morning. Often, a cycle emerges: you drink to decrease your anxiety and as the alcohol leaves your system, your anxiety increases, causing you to drink again.
The Difference Between Social Drinking and Problem Drinking
So how do you know if you drink too much? The National Institute on ALcohol Abuse and Alcoholism defines "at risk" behavior as:
- For women - drinking more than 7 drinks per week or more than 3 drinks per occasion
- For men - drinking more than 14 drinks per week or more than 4 drinks per occasion
An article, Alcohol Use and Anxiety: Diagnostic and Management Issues, appearing in The American Journal of Psychiatry, recommends that assessment for drug and alcohol use be "a routine part of the psychiatric evaluation."  Because denial of the problem is common, the article suggests doctors use standardized screening tests to identify individuals with possible alcohol problems.
Treatment for Dual Diagnosis of Substance Abuse and Anxiety
Both substance abuse and anxiety disorders are medical conditions which, with the proper diagnosis and care, can be treated. Treating only one or the other can lead to continued problems. For example, if the substance abuse is treated without identifying or treating the underlying anxiety disorder, you are still left with unmanaged anxiety symptoms. On the other hand, if the anxiety disorder is treated without consideration to the substance abuse, withdrawal, as we discussed earlier, can continue to increase your symptoms of anxiety.
Both conditions, therefore, should be treated together. Experts suggest a combination of medication and therapy. Medications with low-abuse potential should be used and the use of benzodiazepines, or as-needed antianxiety medications, should be avoided. Therapy can include both talk therapy and cognitive behavioral therapy (CBT), a treatment which has been found to be highly effective and long-lasting for anxiety disorders. CBT works to identify and change thinking and behavior processes.
 "Alcohol Use and Anxiety: Diagnostic and Management Issues," 2001, Kathleen Brady, Bryan Tolliver, Marcia Verduin, American Journal of Psychiatry, 164: 217-221
"Anxiety and Substance Abuse," Date Unknown, Staff Writer, Medscape.com
"Substance Abuse," Date Unknown, Staff Writer, Anxiety and Depression Association of America