Why am I having an anxiety attack after drinking alcohol?
If you feel anxious after drinking alcohol, you may be having an alcohol-induced panic attack.
Approximately 2.7% of adults in the United States suffer from panic disorder. There are twice as many women as men who experience panic.
What are the symptoms of a panic attack after drinking?
Symptoms of a panic attack include sudden and intense anxiety, feelings of being detached from oneself, and feeling like you cannot manage your own thoughts, emotions or behaviors. Despite no apparent danger, the nervous system becomes activated causing increased heart rate, body tremors, hyperventilation, excessive sweating, dizziness, and other uncomfortable sensations.
If you consume alcohol before or during these episodes, the symptoms can become more exacerbated.
What are some reasons why people drink alcohol?
Alcohol interacts with multiple neurotransmitters in the brain, specifically GABA and glutamate. Since alcohol acts as a depressant, it slows down the central nervous system, lowers your inhibition and creates an initial relaxation response. Alcohol may allow you to act more freely in social situations or in new environments that would typically be anxiety provoking.
Alcohol also contributes to serotonin and dopamine release, which activates the reward center of the brain, leading to feelings of euphoria and relaxation. The initial surge of pleasure and calm can reinforce further use of the substance.
How might social anxiety play a role?
Alcohol is considered a social lubricant. It is often used to mitigate discomfort and anxiety in social settings. For people who tend toward social anxiety, they may lean on alcohol to initiate a conversation with a stranger, to decrease social inhibition, to make a public speech, etc.
Although alcohol can make us more initially socially receptive and connected, too much alcohol can have the opposite effect. It can interfere with our ability to articulate our words, to receive social cues and to make meaningful conversations.
In addition, the panic symptoms that might be induced due to the shift in brain chemicals after consumption can contribute to an exacerbation in social anxiety.
How does alcohol contribute to panic attacks?
Too much alcohol can have the opposite effect, depleting GABA levels, and triggering more tension and anxiety. In addition, as the alcohol is metabolized, a person’s blood sugar can drop and dehydration can set in, leading to a rise in panic symptoms.
As alcohol levels wear off and the brain tries to restore its equilibrium, there is a decrease in GABA production (a reduction of relaxation) and a surge in glutamate activity (increased anxiety). The brain interprets these shifts as threatening. As the blood alcohol concentration (BAC) lowers, the fight or flight response is activated, triggering a panic attack.
Alcohol-induced panic attacks can compel people to binge drink to cope with the intense symptoms. However, the more you drink, the more you perpetuate the cycle of alcohol-induced anxiety.
In addition to the chemical shifts that lead to alcohol-induced anxiety, the fear of the intense symptoms set off a further exacerbation of symptoms. People may have chest pain from the anxiety and mistaken it as a heart attack. They may associate the feeling of loss of control as a psychotic episode. They might worry that the dizziness and tunnel vision will lead to them pass out.
This fear of fear combined with the unpredictable nature of the panic attack perpetuate the anxiety response even further. The anticipation about another impending panic attack may be more troubling than the panic itself.
What are some specific examples of how panic attacks manifest in the body?
Shortness of breath:
The sudden release of adrenaline and cortisol in the body can lead to uncomfortable sensations of having difficulty taking in a full breath.
By taking slow, rhythmic abdominal breaths (belly breathing), you can avoid hyperventilating and reduce anxiety symptoms.
Feeling faint or lightheaded:
Panic can cause your body to feel weak and dizzy, making it difficult to walk and stand.
Engaging in light exercise, although seemingly difficult, can actually help the body desensitize to the sensations of panic.
Chest Pain:
Intense tightness in the chest, caused by anxiety, can be quite distressing and worrisome. It can contribute to rapid shallow breathing which, in turn, perpetuates the chest pain.
Abdominal breaths and muscle relaxation techniques are very effective in helping to relieve this symptom.
Nausea:
Panic attacks can cause the digestive tract to shut down, leading to nausea, gagging, and/ or vomiting. Some people develop a sour or unpleasant taste in their mouth. Others may feel sick to their stomach. In most cases, people find it difficult to eat or drink.
Heart Palpitations:
A racing heart from a panic attack can easily be misconstrued as a heart attack, causing further anxiety, chest pain and a heightened stress response. However, unlike a heart attack, a panic attack does not cause blockage to the coronary arteries. Yet the rapid and intense palpitations and chest pain can be extremely unpleasant and can cause a person to seek out medical attention.
Tingling or Numbness
Panic can cause sensations of pins and needles and even numbness in the extremities. Hands and feet can feel cold and clammy. The fight or flight response redirects blood flow toward vital organs necessary if there were a real threat.
What are some strategies to help me overcome and prevent alcohol-induced panic attacks?
Fortunately, there are a number of effective strategies to help people learn how to manage their anxiety and prevent panic attacks from occurring.
If you experience alcohol-related panic attacks, it is beneficial to stop drinking or reduce alcohol consumption to a minimum. Additionally , it is helpful to slow down the rate at which you drink.
By understanding how the sympathetic nervous system can activate false alarms and trigger a panic attack, you can help manage the intensity of symptoms. By reframing the irrational fears that your body and mind are in danger, combined with some deep breathing exercises, and other CBT techniques, you can learn how to manage your anxiety effectively.
If you suffer from alcohol-induced panic attacks or anxiety in general, reach out to Dr. Suzanne Feinstein at Advanced Behavioral Health. Dr. Feinstein is a Columbia University-trained Clinical Psychologist who specializes in evidence-based treatments such as Exposure Therapy and Response Prevention (ERP), cognitive reframing, mindfulness training and other CBT techniques.